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Secretin: Drug information

Secretin: Drug information
(For additional information see "Secretin: Patient drug information" and see "Secretin: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • ChiRhoStim;
  • SecreFlo
Pharmacologic Category
  • Diagnostic Agent
Dosing: Adult

Diagnosis of gastrinoma: IV: 0.4 mcg/kg as a single dose

Diagnosis of pancreatic dysfunction/Endoscopic retrograde cholangiopancreatography: IV: 0.2 mcg/kg as a single dose

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Pediatric

(For additional information see "Secretin: Pediatric drug information")

Diagnostic agent for pancreatic function: Limited data available: Infants, Children, and Adolescents: IV: 0.2 mcg/kg as single dose over 1 minute (Horvath 2016)

Diagnostic agent for gastrinoma (Zollinger-Ellison): Limited data available: Adolescents ≥15 years: IV: 0.4 mcg/kg as single dose over 1 minute (Berna 2006). Dosing based on experience with the porcine product; a conversion of 1 unit = 0.2 mcg of human synthetic product has been suggested by the manufacturer.

Facilitation of endoscopic retrograde cholangiopancreatography/magnetic resonance cholangiopancreatography visualization: Limited data available: Infants, Children, and Adolescents: IV: 0.2 mcg/kg as a single dose over 1 minute; maximum dose: 16 mcg/dose (Delaney 2008; Trout 2013)

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intravenous:

SecreFlo: 16 mcg (1 ea)

Solution Reconstituted, Intravenous [preservative free]:

ChiRhoStim: 16 mcg (1 ea)

Generic Equivalent Available: US

No

Administration: Adult

IV: Administer by IV injection slowly over 1 minute.

Administration: Pediatric

Parenteral: Administer by direct IV injection slowly over 1 minute

Use: Labeled Indications

Diagnosis of gastrinoma: Stimulation of gastrin secretion to aid in the diagnosis of gastrinoma.

Diagnosis of pancreatic dysfunction: Stimulation of pancreatic secretions, including bicarbonate, to aid in the diagnosis of pancreatic exocrine dysfunction.

Endoscopic retrograde cholangiopancreatography: Stimulation of pancreatic secretions to facilitate in the identification of the ampulla of Vater and accessory papilla during endoscopic retrograde cholangiopancreatography.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%: Gastrointestinal: Nausea (2%)

<1%, postmarketing, and/or case reports: Abdominal distress, flushing, vomiting

Contraindications

There are no contraindications listed in the manufacturer's labeling.

Warnings/Precautions

Disease-related concerns:

• Hepatic impairment: Use with caution in patients with hepatic impairment (including ethanol-induced disease); may be hyperresponsive to secretin stimulation and mask the presence of coexisting pancreatic disease. Consider additional testing and clinical assessments to aid in diagnosis.

• Inflammatory bowel disease: Patients who have inflammatory bowel disease may be hyporesponsive to secretin stimulation falsely suggesting pancreatic disease; consider additional testing and clinical assessments for aid in diagnosis.

Other warnings/precautions:

• Vagotomy: Patients who have undergone vagotomy may be hyporesponsive to secretin stimulation falsely suggesting pancreatic disease; consider additional testing and clinical assessments for aid in diagnosis.

Metabolism/Transport Effects

None known.

Drug Interactions

Anticholinergic Agents: May diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider therapy modification

Histamine H2 Receptor Antagonists: May diminish the diagnostic effect of Secretin. Specifically, use of H2-Antagonists may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of histamine H2-antagonists (H2RAs) and secretin. Discontinue H2RAs at least 2 days prior to secretin administration. Risk D: Consider therapy modification

Inhibitors of the Proton Pump (PPIs and PCABs): May diminish the diagnostic effect of Secretin. Specifically, use of PPIs may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of PPIs or PCABs and secretin, and discontinue PPIs several weeks prior to secretin administration, with the duration of separation determined by the specific PPI. See full monograph for details. Risk D: Consider therapy modification

Pregnancy Considerations

Animal reproduction studies have not been conducted.

Breastfeeding Considerations

It is not known if secretin is present in breast milk. According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should take into account the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Dietary Considerations

Patients should fast 12 to 15 hours prior to beginning the test.

Monitoring Parameters

Peak bicarbonate concentration of duodenal fluid aspirate (chronic pancreatitis); serum gastrin (gastrinoma). Refer to protocols for collection of pancreatic secretion and/or serum gastrin.

Mechanism of Action

Human secretin is a synthetic peptide hormone produced by cells in the duodenum in response to acidification; it stimulates pancreatic ductal cells to secrete pancreas fluid in large volumes that contain bicarbonate; may also work through vagal-vagal neural pathways since stimulation of the efferent vagus nerve stimulates bicarbonate.

Pharmacokinetics

Distribution: Vd: 2.7 L

Half-life elimination: 45 minutes

Clearance: 580.9 ± 51.3 mL/minute

Pricing: US

Solution (reconstituted) (ChiRhoStim Intravenous)

16 mcg (per each): $630.00

Solution (reconstituted) (SecreFlo Intravenous)

16 mcg (per each): $510.00

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • SecreFlo (IN);
  • Secrelux (GR);
  • Secrepan (JP);
  • Secretin Ferring (FI);
  • Sekretolin (CZ)


For country abbreviations used in Lexicomp (show table)

REFERENCES

  1. Berna MJ, Hoffmann KM, Long SH, Serrano J, Gibril F, Jensen RT. Serum gastrin in Zollinger-Ellison syndrome: II. Prospective study of gastrin provocative testing in 293 patients from the National Institutes of Health and comparison with 537 cases from the literature. evaluation of diagnostic criteria, proposal of new criteria, and correlations with clinical and tumoral features. Medicine (Baltimore). 2006;85(6):331-364. [PubMed 17108779]
  2. ChiRhoStim (secretin human injection, powder, lyophilized) [prescribing information]. Burtonsville, MD: ChiRhoClin; July 2017.
  3. Delaney L, Applegate KE, Karmazyn B, Akisik MF, Jennings SG. MR cholangiopancreatography in children: feasibility, safety, and initial experience. Pediatr Radiol. 2008;38(1):64-75. [PubMed 17999059]
  4. Horvath K, Loveridge-Lenza B, Brenn BR, Del Rosario JF, Molle-Rios Z, He Z. Safety of secretin administration in children. Pancreas. 2016;45(9):1336-1340. [PubMed 27400258]
  5. Metz DC, Buchanan M, Purich E, et al, “A Randomized Controlled Crossover Study Comparing Synthetic Porcine and Human Secretins With Biologically Derived Porcine Secretin to Diagnose Zollinger-Ellison Syndrome,”Aliment Pharmacol Ther, 2001, 15(5):669-76. [PubMed 11328261]
  6. Trout AT, Podberesky DJ, Serai SD, Ren Y, Altaye M, Towbin AJ. Does secretin add value in pediatric magnetic resonance cholangiopancreatography? Pediatr Radiol. 2013;43(4):479-486. [PubMed 23184093]
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