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.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
(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.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
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)
No
IV: Administer by IV injection slowly over 1 minute.
Parenteral: Administer by direct IV injection slowly over 1 minute
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.
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
There are no contraindications listed in the manufacturer's labeling.
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.
None known.
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
Animal reproduction studies have not been conducted.
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.
Patients should fast 12 to 15 hours prior to beginning the test.
Peak bicarbonate concentration of duodenal fluid aspirate (chronic pancreatitis); serum gastrin (gastrinoma). Refer to protocols for collection of pancreatic secretion and/or serum gastrin.
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.
Distribution: Vd: 2.7 L
Half-life elimination: 45 minutes
Clearance: 580.9 ± 51.3 mL/minute
Solution (reconstituted) (ChiRhoStim Intravenous)
16 mcg (per each): $630.00
Solution (reconstituted) (SecreFlo Intravenous)
16 mcg (per each): $510.00
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