Treatment of children with growth failure due to growth hormone deficiency (GHD), idiopathic short stature (ISS), Turner syndrome (TS), and chronic kidney disease (CKD) up to the time of renal transplantation. Treatment of adults with childhood-onset or adult-onset GHD.
Individualize. Rotate inj site. Weight-based regimen: initially not more than 0.006mg/kg SC daily, may increase to max 0.025mg/kg daily in adults ≤35yrs or 0.0125mg/kg daily in adults >35yrs. Non weight-based regimen: initially 0.2mg/day SC (range: 0.15–0.3mg/day); may increase gradually every 1–2 months by increments of approximately 0.1–0.2mg/day. Elderly or obese: may need lower dose.
Individualize. Rotate inj site. Give in daily divided doses by SC inj. GHD: up to 0.3mg/kg/week. Pubertal patients: up to 0.7mg/kg/week. ISS: up to 0.3mg/kg/week. CKD: up to 0.35mg/kg/week. Dialysis: see literature. TS: up to 0.375mg/kg/week divided into equal doses 3–7 times per week.
Growth hormone (GH).
Acute critical illness. Acute respiratory failure. Children with closed epiphysis. Active malignancy. Active proliferative or severe non-proliferative diabetic retinopathy. Prader-Willi syndrome (severely obese or w. respiratory impairment): see literature.
Monitor gait, thyroid function, glucose tolerance, and for malignant transformation of skin lesions or for intracranial hypertension (do baseline and periodic funduscopic exams). Discontinue if signs of neoplasia, upper airway obstruction or sleep apnea occur. Not for use in patients with functioning renal allografts. History of intracranial lesions: monitor for lesion progression or recurrence. Hypopituitarism. Preexisting scoliosis. Obtain baseline hip X-ray and monitor for renal osteodystrophy in renal failure. Monitor for otitis media, other ear disorders, and cardiovascular disorders in Turner syndrome. May elevate serum phosphate, alkaline phosphatase, parathyroid hormone. Elderly. Newborns. Pregnancy (Cat.C). Nursing mothers.
May be antagonized by glucocorticoids; adjust doses. May affect CYP450 substrates (eg, corticosteroids, sex steroids, anticonvulsants, cyclosporine); monitor. Concomitant oral estrogens: may require larger somatropin doses. Insulin and/or oral/IV hypoglycemic agents may require adjustment before starting therapy.
Local reactions, progression of scoliosis, intracranial hypertension, slipped capital epiphysis, edema, arthralgia, carpal tunnel syndrome, gynecomastia, antibody formation; rare: pancreatitis (monitor).
Nutropin vial—1 (w. diluent)
Nutropin AQ (2mL) vial—1
Nutropin AQ (2mL) pen—1
Nutropin AQ (2mL) NuSpin—1