Tesamorelin

INTRODUCTION

Indications

Reduction of excess abdominal fat (lipodystrophy) seen in HIV-infected patients.

Action

Acts as an analogue of human growth hormone–releasing factor (GRF, GHRH), resulting in endogenous production of growth hormone (GH), which has anabolic and lipolytic properties. Therapeutic Effects: Reduction of abdominal adipose tissue in HIV-infected patients.

Adverse Reactions/Side Effects

CV: peripheral edema. Endo: glucose intolerance. Local: erythema, hemorrhage, irritation, pain, pruritus. MS: arthralgia, carpal tunnel syndrome, extremity pain, myalgia. Misc: hypersensitivity reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Periodically assess body weight, abdominal girth, and other anthropometric measures (body mass index, body composition). Document whether this drug is successful in helping decrease abdominal fat.

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess any muscle, joint, or extremity pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Watch for symptoms of carpal tunnel syndrome, including pain, numbness, tingling, and weakness in the median nerve distribution to the hand. Assess these symptoms using EMG and nerve conduction, and reexamine these values periodically to document drug-induced changes in median nerve function.

• Be alert for signs of glucose intolerance and subsequent hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

• Monitor subcutaneous injection site for pain, redness, itching, and hemorrhage. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Implement resistive exercises and other therapeutic exercises as needed to maintain muscle strength and function and prevent muscle wasting associated with HIV infection and AIDS.

• Design and implement aerobic exercise and endurance training programs to help prevent heart disease associated with drug-related hyperlipidemia and other problems with lipid and glucose metabolism.

• Do not apply physical agents (heat, cold, electrotherapeutic modalities) or massage over the injection site; these interventions can alter drug absorption from subcutaneous tissues.

Patient/Client-Related Instruction

• Check that patient and family/caregivers understand administration techniques and use appropriate safety precautions (maintain sterility, do not share needles, and so forth).

Pharmacokinetics

Absorption: <4% absorbed following subcutaneous administration.

Distribution: Unknown.

Metabolism ...