TesamorelinNursing considerations

Side effects by what to assess

Sources: [1][2][3][4][5][6][7][8]

Blood glucose

Why

Glucose intolerance or diabetes

When

Before starting and periodically during treatment

Act on

Consider stopping if glucose intolerance or diabetes develops without a clear fat response

Normal

Fasting 70 to 99 mg/dL.

Sources: [1][2]

Hemoglobin A1c

Why

Development of diabetes, defined in trials as an A1c of 6.5% or higher

When

Periodically during treatment

Normal

Below 5.7% is normal and 6.5% or higher indicates diabetes. Many people with diabetes aim for below 7%.

Sources: [1][2]

IGF-1 (insulin-like growth factor 1)

Why

Growth hormone response and overexposure

When

During therapy

Act on

Consider stopping for persistent elevation above 3 SDS, especially without a clear fat response

Sources: [1]

High-alert status

Tesamorelin is not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1][2]

Boxed warning

None. The Egrifta labels carry no boxed warning.

Sources: [1][2]

Antidote or reversal

No specific antidote, and the label has no overdosage section. Stop the drug and give supportive care.

Sources: [1]

Patient teaching

• Inject at about the same time each day, below the navel, moving the spot each time
• Expect blood tests for IGF-1 and blood sugar during treatment
• Report swelling, joint pain, or numb or tingling hands, which can mean fluid retention
• Report increased thirst or urination, which can signal high blood sugar; people with diabetes may need medication changes
• Stop and seek care right away for rash, hives, flushing, swelling of the face or throat, or trouble breathing
• Stop and call the prescriber if you become pregnant
• Do not breastfeed while using it
• Dispose of needles in a puncture-resistant container and never share syringes

Sources: [1][2][3]

Sound-alike and look-alike names

None listed in the ISMP list of confused drug names.

Sources: [1]

Adult dose

Egrifta SV (2 mg vial)

1.4 mg (0.35 mL of reconstituted solution) subcutaneously once daily into the abdomen.

Egrifta WR (11.6 mg vial)

1.28 mg (0.16 mL of reconstituted solution) subcutaneously once daily; one reconstituted vial provides 7 daily doses.

Sources: [1][2]

Renal adjustment

Not studied. Pharmacokinetics in renal impairment have not been established.

Sources: [1]

Hepatic adjustment

Not studied. Pharmacokinetics in hepatic impairment have not been established.

Sources: [1]

Mechanism

A synthetic analog of growth hormone-releasing factor (GHRH). It binds pituitary GHRH receptors and stimulates pulsatile release of endogenous growth hormone, which raises IGF-1 and IGFBP-3 and is both anabolic and lipolytic. The half-life is about 8 minutes after subcutaneous injection, and absolute bioavailability is under 4%.

Sources: [1][2][3]