LANREOTIDE ACETATE

LANREOTIDE ACETATE
(lan-re'o-tide)
Somatuline Depot
Classifications: hormone; somatostatin analog;
Therapeutic:acromegaly agent; hormone replacement
Prototype: Octreotide
Pregnancy Category: C

Availability

60 mg, 90 mg, 120 mg single-dose prefilled syringe

Action

An analog of natural somatostatin produced by the hypothalamus. Somatostatin inhibits the secretion of growth hormone (GH) that in turn inhibits secretion of insulin-like growth factor-1 (IGF-1).

Therapeutic Effect

Inhibition of IGF-1 suppresses proliferation of chondrocytes and stops bone growth.

Uses

Long-term treatment of acromegaly in those who have not responded to surgery and/or radiotherapy, or for whom surgery and/or radiotherapy is not an option.

Unlabeled Uses

Treatment of symptoms, specifically diarrhea and cutaneous flushing, with carcinoid neuroendocrine tumors

Contraindications

Hypersensitivity to lanreotide; pregnancy (category C); lactation. Safety and efficacy in children have not been established.

Cautious Use

Cholelithiasis, gallbladder disease; diabetes mellitus; moderate to severe renal impairment; moderate to severe hepatic impairment; older adults.

Route & Dosage

Acromegaly
Adult: SC 90 mg q4wk x 3 mo; then 60–120 mg q4wk depending on response

Hepatic/Renal Impairment
Initial dose: 60 mg with moderate and severe impairment

Administration

Subcutaneous

Remove from refrigeration 30 min before injection to allow to come to room temperature, but keep in sealed pouch.
Inject deeply into SC tissue in the upper, outer quadrant of the buttock. Do not fold skin. Insert needle rapidly and to its full length at a right angle to skin. Alternate right and life sides.
Store refrigerated and protect from light in original package.

Adverse Effects (≥1%)

Body as a Whole: Injection site pain. CNS: Headache. CV: Bradycardia. GI: Abdominal pain, cholelithiasis, constipation, diarrhea, flatulence, loose stools, nausea, vomiting. Hematologic: Anemia. Metabolic: Decreased weight. Musculoskeletal: Arthralgia. Skin: Pruritus.

Interactions

Drug: beta blockers have an additive effect on the reduction of heart rate. Lanreotide may increase the bioavailability of bromocriptine. Coadministration may decrease the bioavailability of cyclosporine. Lanreotide may increase the plasma level of drugs metabolized by CYP-450 enzymes.

Pharmacokinetics

Absorption: 69–79% depending on dose. Peak: Within 24 h. Metabolism: Extensive, only 5% excreted unchanged. Elimination: Stool (95%) and urine (5%). Half-Life: 23–30 d.

Nursing Implications

Assessment & Drug Effects

Monitor cardiovascular status as bradycardia and hypertension are potential adverse effects.
Lab tests: Baseline and periodic GH, IGF-1, blood glucose; baseline LFTs and renal function tests; periodic thyroid function tests, HCT & Hgb.
Periodic gallbladder motility tests are recommended.
Monitor diabetics for loss of glycemic control.

Patient & Family Education

Ensure that proper technique for SC drug administration is utilized.
Diabetics should monitor blood glucose values often as this drug may elevate or lower blood glucose.
Report to physician severe pain in the upper, right area of the stomach/abdomen, along with nausea and vomiting. These symptoms could indicate the presence of gallstones.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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