Lanreotide

INTRODUCTION

Indications

Long-term management of acromegaly which cannot be treated by or has not responded to surgery and/or radiation therapy.

Action

Acts as an analogue of somatostatin, inhibiting growth hormone (GH) and insulin-like growth factor-1 (IGF-1) in patients with acromegaly. Therapeutic Effects: Decreased levels of GH and IGF-1 in acromegalic patients resulting in decreased manifestations of acromegaly.

Adverse Reactions/Side Effects

CV: bradycardia, hypertension. GI: abdominal pain, diarrhea, gallstones. Endo: hyperglycemia, hypoglycemia. Hemat: anemia. Local: injection-site reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report slow heart rate (bradycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Patients with diabetes mellitus should check blood glucose levels frequently.

• Monitor signs of anemia, including unusual fatigue, pallor, shortness of breath with exertion, and bruising. Notify physician immediately if these signs occur.

• Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Because of the risk of arrhythmias and anemia, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, respiratory rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Instruct patient to report other troublesome GI side effects such as diarrhea, or abdominal pain that might indicate gallstones (e.g., sudden intense pain in the abdomen or right side, jaundice, chills, fever).

Pharmacokinetics

Absorption: Following SC administration, lanreotide precipitates in body tissues acting as a depot formulation from which drug is slowly released (75% bioavailability).

Distribution: Unknown.

Metabolism and Excretion: Minimal renal/fecal excretion, some biliary excretion.

Half-life: 23–30 days.

Contraindications/Precautions

Contraindicated in: OB: Lactation.

Use Cautiously in: Diabetic patients; Underlying heart disease, especially bradycardia; OB: Use only if maternal benefit outweighs risk to fetus; Pedi: Safe use in children has not been established.

Interactions

Drug-Drug: ↑ risk of bradycardia with other ...