![Nutropin [somatropin (rDNA origin) for injection]: Growing Opportunity](/images/logo-nutropin-growing.png){kind=logo}
Measuring the Dose
Whenever a new vial of Nutropin AQ is used, always mark the date on the vial. Nutropin AQ may not be used for more than 28 days after the first use.
Before each use, ensure the Nutropin AQ solution is clear. Occasionally, after refrigeration, one may notice that small colorless particles of protein are present in the Nutropin AQ solution. This is not unusual for solutions containing proteins, and it does not indicate any decrease in potency of this product. Allow the vial to come to room temperature and gently swirl. If the solution is cloudy or hazy, do not inject it. The patient should be instructed to call the specialty pharmacy (SP) or Nutropin Hotline if this occurs.
Instruct the patient/caregiver to wash hands thoroughly. Check the date on the Nutropin AQ vial to make sure it is not outdated.
Wipe the rubber stopper located on top of the vial with an alcohol swab.
Remove the plastic needle guard and set it aside. Draw air into the syringe by pulling back on the plunger. The amount of air should be equal to the Nutropin AQ dose.
Slowly insert the needle straight through the center of the rubber stopper of the vial containing the Nutropin AQ solution.
Gently push the plunger to discharge the air into the vial.
Turn the vial upside down with the syringe needle still in it and slowly pull back on the plunger in a continuous motion until the correct amount of solution is in the syringe.
Remove the needle from the Nutropin AQ vial and give the injection immediately. If you need to set the syringe down while you prepare the injection site, replace the needle guard temporarily until you are ready to inject.
Giving the Medication
Needles and syringes must be used only once to ensure sterility of both the needle and the syringe. The following is a review of the steps involved in giving the medication:
Clean the injection site with an alcohol-saturated cotton ball or alcohol swab.
Double-check that the correct amount of Nutropin AQ solution is in the syringe. If you had replaced the needle guard while you prepared the injection site, remove it now. Instruct the patient/caregiver how to hold the syringe.
The skin should be gently grasped between thumb and index finger before and during the injection. The needle should be inserted into the skin at a 45° to 90° angle depending on the patient and size of the needle, with a quick, firm motion.
Slowly (within a few seconds) inject the solution by gently pushing the plunger until the syringe is empty.
Withdraw the needle quickly, pulling it straight out, and apply pressure over the injection site with a dry gauze pad or cotton ball.
Dispose of the needles in an appropriate container. Keep out of reach of small children.
Please see additional information about proper needle disposal and how to travel with GH medication.
Rotating the injection site
Injection site discomfort has been reported. Rotate the injection site to avoid tissue atrophy that may result from subcutaneous administration of GH at the same site over a long period of time. Even if the patient develops a preference for one site, he or she should still rotate the injection site. The drawings below show suggested injection sites on the body.
INDICATIONS
Pediatric Patients
Nutropin AQ® [somatropin (rDNA origin) injection] and Nutropin [somatropin (rDNA origin) for injection] are indicated for the long-term treatment of growth failure due to a lack of adequate endogenous GH secretion.
Nutropin AQ and Nutropin are also indicated for the treatment of growth failure associated with chronic renal insufficiency up to the time of renal transplantation. Nutropin AQ and Nutropin therapy should be used in conjunction with optimal management of chronic renal insufficiency.
Nutropin AQ and Nutropin are also indicated for the long-term treatment of short stature associated with Turner syndrome.
Nutropin AQ and Nutropin are also indicated for the long-term treatment of idiopathic short stature, also called non-growth hormone deficient short stature, defined by height SDS ≤-2.25, and associated with growth rates unlikely to permit attainment of adult height in the normal range, in pediatric patients whose epiphyses are not closed and for whom diagnostic evaluation excludes other causes associated with short stature that should be observed or treated by other means.
Adult Patients
Nutropin AQ and Nutropin are indicated for replacement of endogenous GH in adults with GH deficiency who meet either of the following two criteria:
- Adult-Onset: Patients who have GH deficiency, either alone or associated with multiple hormone deficiencies (hypopituitarism), as a result of pituitary disease, hypothalamic disease, surgery, radiation therapy, or trauma; or
- Childhood-Onset: Patients who were GH deficient during childhood as a result of congenital, genetic, acquired, or idiopathic causes.
In general, confirmation of the diagnosis of adult GH deficiency in both groups usually requires an appropriate GH stimulation test. However, confirmatory GH stimulation testing may not be required in patients with congenital/genetic GH deficiency or multiple pituitary hormone deficiencies due to organic disease.
IMPORTANT SAFETY INFORMATION
Contraindications
GROWTH HORMONE (GH) SHOULD NOT BE USED IN PATIENTS WITH:
- Closed epiphyses for pediatric growth promotion
- Active proliferative or severe non-proliferative diabetic retinopathy
- Active malignancy
- Acute critical illness due to complications following open heart surgery, abdominal surgery, or multiple accidental trauma, or those with acute respiratory failure
- Prader-Willi syndrome who are severely obese or have severe respiratory impairment. Nutropin AQ and Nutropin are not indicated in patients with Prader-Willi syndrome who do not also have a diagnosis of GH deficiency
- Known sensitivity to benzyl alcohol when using Nutropin reconstituted with Bacteriostatic Water for Injection, USP (benzyl alcohol preserved). For use in newborns, see WARNINGS in full Prescribing Information
Additional Safety Information
- Nutropin AQ and Nutropin should be prescribed by physicians experienced in the diagnosis and management of patients with pediatric or adult GH deficiency, Turner syndrome (TS), or chronic renal insufficiency (CRI).
- Patients should be monitored for signs of glucose intolerance. Patients taking antihyperglycemic agents may require dose adjustment when GH therapy is instituted.
- Patients with preexisting tumors or growth hormone deficiency secondary to an intracranial lesion should be examined routinely for progression or recurrence of the underlying disease process.
- Intracranial hypertension (IH) with papilledema, visual changes, headache, nausea, and/or vomiting has been reported in a small number of patients treated with GH products.
- In patients with hypopituitarism (multiple hormone deficiencies), standard hormonal replacement therapy should be monitored closely when GH therapy is administered.
- Periodic thyroid function tests and thyroid replacement therapy should be initiated or appropriately adjusted when indicated.
- Injection site discomfort has been reported.
- Rotate injection site to avoid tissue atrophy that may result from subcutaneous administration of GH at the same site over a long period of time.
- As with any protein, local or systemic allergic reactions may occur.
Pediatric Patients
- Slipped capital femoral epiphysis may occur more frequently in patients with endocrine disorders or in patients undergoing rapid growth.
- Children with growth failure secondary to CRI should be examined periodically for evidence of progression of renal osteodystrophy.
- Progression of scoliosis can occur in patients who experience rapid growth. Patients with a history of scoliosis who are treated with GH should be monitored for progression of scoliosis.
Adult Patients
- GH therapy may cause fluid retention.
- Carpal tunnel syndrome, arthralgia, and other joint disorders have been reported in GH-treated patients.
Drug Interactions
- Patients on GH therapy, with previously undiagnosed central (secondary) hypoadrenalism, may require glucocorticoid replacement therapy. Patients already on glucocorticoid replacement therapy for previously diagnosed hypoadrenalism may require an increase in their maintenance or stress doses.
- Glucocorticoid replacement therapy should be carefully adjusted in children with concomitant GH and glucocorticoid deficiency to avoid both hypoadrenalism and an inhibitory effect on growth.
- Careful monitoring is advisable when GH is given in any combination with agents metabolized by CP450 liver enzymes.
- In women on oral estrogen replacement, a larger dose of somatropin may be required to achieve the defined treatment goal.
Please see full Prescribing Information for additional Important Safety Information.
The content available from this website is for informational purposes only. Individual results may vary. You may report side effects to the FDA at 1-800-FDA-1088 or to Genentech Drug Safety/Adverse Events at 1-888-835-2555.
Nutropin and Nutropin AQ are registered trademarks; and NuSpin, growingopportunity, and Nutropin GPS are trademarks of Genentech Inc.
