6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens 411

BNF 57 6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens 411

syringe = £4.64; 0.4-mg (1.2-unit) syringe = £9.27; 0.6-

Growth hormone receptor antagonists

mg (1.8-unit) syringe = £13.91; 0.8-mg (2.4-unit) syringe = £18.55; 1-mg (3-unit) syringe = £23.18; 1.2-

Pegvisomant is a genetically modified analogue of mg (3.6-unit) syringe = £27.82; 1.4-mg (4.2-unit)

human growth hormone and is a highly selective growth syringe = £32.46; 1.6-mg (4.8-unit) syringe = £37.09;

hormone receptor antagonist. Pegvisomant is licensed 1.8-mg (5.4-unit) syringe = £41.73; 2-mg (6-unit)

for the treatment of acromegaly in patients with inade- syringe = £46.37. For subcutaneous injection

quate response to surgery, radiation, or both, and to treatment with somatostatin analogues. Pegvisomant Humatrope c (Lilly) A should be initiated only by physicians experienced in

Injection , powder for reconstitution, somatropin the treatment of acromegaly. (rbe), net price 6-mg (18-unit) cartridge = £137.25; 12-

mg (36-unit) cartridge = £274.50; 24-mg (72-unit) cartridge = £549.00; all supplied with diluent. For

PEGVISOMANT

subcutaneous or intramuscular injection; cartridges for subcutaneous injection

Indications see notes above Cautions liver disease (monitor liver enzymes every

Norditropin c (Novo Nordisk) A 4–6 weeks for 6 months or if symptoms of hepatitis SimpleXx injection , somatropin (epr) 3.3 mg

develop); diabetes mellitus (adjustment of antidiabetic (10 units)/mL, net price 1.5-mL (5-mg, 15-unit) car-

therapy may be necessary); possible increase in tridge = £115.90; 6.7 mg (20 units)/mL, 1.5-mL (10-

female fertility

mg, 30-unit) cartridge = £231.80; 10 mg (30 units)/ Contra-indications pregnancy and breast-feeding mL, 1.5-mL (15-mg, 45-unit) cartridge = £347.70. For use with appropriate NordiPen c

Side-effects diarrhoea, constipation, nausea, vomi-

free of charge from clinics). For subcutaneous ting, abdominal distension, dyspepsia, flatulence, elevated liver enzymes; hypertension; headache,

D device (available

injection asthenia, dizziness, drowsiness, tremor, sleep distur- NutropinAq c (Ipsen) bances; influenza-like syndrome, weight gain, hyper- A Injection , somatropin (rbe), net price 10 mg (30 units)

glycaemia, hypoglycaemia; arthralgia, myalgia; injec- 2-ml cartridge = £230.00. For use with NutropinAq c tion-site reactions, sweating, pruritus, rash; fatigue;

Pen

D device (available free of charge from clinics). hypercholesterolaemia; less commonly thrombocyto- For subcutaneous injection

penia, leucopenia, leucocytosis, bleeding tendency Dose

Omnitrope c (Sandoz) TA . By subcutaneous injection , initially 80 mg, then Injection , powder for reconstitution, somatropin

10 mg daily, increased in steps of 5 mg daily (rbe), net price 5-mg (15-unit) vial (with diluent) =

according to response; max. 30 mg daily; CHILD not

£91.33. For use with Omnitrope Pen L c D device

recommended

Endocrine

(available free of charge from clinics). For subcuta-

neous injection Somavert c (Pfizer) TA

Excipients include benzyl alcohol (avoid in neonates, see Excipients,

Injection net price 10-mg vial = £50.00; 15-mg vial = £75.00;

, powder for reconstitution, pegvisomant,

p. 2)

Injection , somatropin (rbe) 3.3 mg (10 units)/mL, net 20-mg vial = £100.00 (all with solvent) price 1.5 mL (5-mg, 15-unit) cartridge = £91.33;

syst

6.7 mg (20 units)/mL, 1.5 mL (10-mg, 30-unit) car- c em

tridge = £182.66. For use with Omnitrope Pen 5 D and Omnitrope Pen 10 c D devices respectively. For

Thyrotrophin

subcutaneous injection Excipients include benzyl alcohol (in 5-mg cartridge) (avoid in neonates,

Thyrotropin alfa is a recombinant form of thyrotrophin

(thyroid stimulating hormone). It is licensed for use with Note Biosimilar medicine, see p. 1

see Excipients, p. 2)

or without radioiodine imaging, together with serum thyroglobulin testing, for the detection of thyroid rem- Saizen c (Serono) A nants and thyroid cancer in post-thyroidectomy

Injection , powder for reconstitution, somatropin patients. It is also licensed to increase radio-iodine (rmc), net price 1.33-mg (4-unit) vial (with diluent) =

uptake for the ablation of thyroid remnant tissue in £29.28; 3.33-mg (10-unit) vial (with diluent) = £73.20.

suitable post-thyroidectomy patients. For subcutaneous or intramuscular injection

Click.easy c , powder for reconstitution, somatropin (rmc), net price 8-mg (24-unit) vial (in Click.easy c device with diluent) = £185.44. For use with

THYROTROPIN ALFA

One.click c D autoinjector device or Cool.Click c D (Recombinant human thyroid stimulating needle-free device (both available free of charge from

hormone, rhTSH) clinics). For subcutaneous injection

Indications see notes above and product literature Cautions presence of thyroglobulin autoantibodies

Zomacton c (Ferring) A may give false negative results Injection , powder for reconstitution, somatropin

(rbe), net price 4-mg (12-unit) vial (with diluent) = hypersensitivity to bovine or £81.32. For use with ZomaJet c c 2 D needle-free human thyrotrophin; pregnancy; breast-feeding device or with Auto-Jector

Contra-indications

Side-effects D (both available free of nausea, vomiting; headache, dizziness, charge from clinics) or with needles and syringes. For

fatigue; less commonly asthenia, paraesthesia, back subcutaneous injection

pain, influenza-like symptoms, rash, urticaria; rarely

Excipients include benzyl alcohol (avoid in neonates, see Excipients

diarrhoea; very rarely palpitation, flushing, dyspnoea,

p. 2)

pain at site of metastases, tremor, arthralgia, myalgia,

6.5.2 Posterior pituitary hormones and antagonists BNF 57 hyperhidrosis, and injection-site reactions including

pain, pruritus, and rash

6.5.2 Posterior pituitary

Dose

hormones and

. By intramuscular injection into the gluteal muscle, 900 micrograms every 24 hours for 2 doses, consult

antagonists

product literature Thyrogen c (Genzyme) A

Injection , powder for reconstitution, thyrotropin alfa 900 micrograms/vial, net price = £232.50

Posterior pituitary hormones

Diabetes insipidus Vasopressin (antidiuretic horm-