BNF for Children (BNFC) 2018-2019

hyperhidrosis.hypersensitivity (may be more severe in

patients susceptible to allergies, especially asthma).

hypertension.idiopathic intracranial hypertension

exacerbated.increased risk of infection.leucocytosis.

malaise.menstruation irregular.muscle weakness.

myopathy.nausea.osteonecrosis.osteoporosis.

pancreatitis.papilloedema.pituitary unresponsiveness.

posterior subcapsular cataract.protein catabolism.

psychiatric disorder.seizure.skin reactions.tendon

rupture.thromboembolism.vasculitis necrotising.

ventricular hypertrophy.vertigo.vomiting.weight

increased

lALLERGY AND CROSS-SENSITIVITYContra-indicated in

patients with history of hypersensitivity to

tetracosactide/corticotrophins or excipients.

lPREGNANCYAvoid (but may be used diagnostically if

essential).

lBREAST FEEDINGAvoid (but may be used diagnostically if

essential).

lHEPATIC IMPAIRMENTAn enhanced effect of

tetracosactide therapy may occur in patients with cirrhosis

of the liver. Use with caution in hepatic impairment.

MonitoringMonitor hepatic function closely during

treatment.

lRENAL IMPAIRMENTUse with caution in patients with

renal impairment.

lEFFECT ON LABORATORY TESTSMay suppress skin test

reactions.

Post administration total plasma cortisol levels during

30 -minute test for diagnosis of adrenocotical insufficiency

might be misleading due to altered cortisol binding

globulin levels in some special clinical situations

including, patients on oral contraceptives, post-operative

patients, critical illness, severe liver disease and nephrotic

syndrome.

lDIRECTIONS FOR ADMINISTRATIONForintramuscularor

intravenous injection, may be diluted in sodium chloride

0. 9 %to 250 nanograms/mL.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Solution for injection

▶Synacthen(Mallinckrodt Specialty Pharmaceuticals Ireland Ltd)

Tetracosactide acetate 250 microgram per 1 mlSynacthen

250 micrograms/ 1 ml solution for injection ampoules|

1 ampouleP£ 38. 00

Suspension for injection

EXCIPIENTS:May contain Benzyl alcohol

▶Synacthen Depot(Mallinckrodt Specialty Pharmaceuticals Ireland

Ltd)

Tetracosactide acetate 1 mg per 1 mlSynacthen Depot 1 mg/ 1 ml

suspension for injection ampoules| 1 ampouleP£ 346. 28

6.2 Assessment of pituitary

function

DIAGNOSTIC AGENTS

Corticorelin

(Corticotrophin-releasing hormone; CRH)

lINDICATIONS AND DOSE

Test of anterior pituitary function

▶BY INTRAVENOUS INJECTION

▶Child: 1 microgram/kg (max. per dose 100 micrograms)

for 1 dose, to be administered over 30 seconds

lUNLICENSED USENot licensed.

lSIDE-EFFECTSAltered smell sensation.flushing.

hypotension.taste altered

lPREGNANCYAvoid.

lBREAST FEEDINGAvoid.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Powder for solution for injection

▶Acthrel (Imported (United States))

Corticorelin ovine triflutate 100 microgramActhrel powder for

solution for injection vials| 1 vialPs

Gonadorelin

(Gonadotrophin-releasing hormone; GnRH; LH–

RH)

lINDICATIONS AND DOSE

Assessment of anterior pituitary function|Assessment of

delayed puberty

▶BY INTRAVENOUS INJECTION, OR BY SUBCUTANEOUS INJECTION

▶Child 1–17 years: 2. 5 micrograms/kg (max. per dose

100 micrograms) for 1 dose

lCAUTIONSPituitary adenoma

lSIDE-EFFECTS

▶UncommonPain.skin reactions.swelling

▶Rare or very rareAbdominal discomfort.bronchospasm.

dizziness.eye erythema.flushing.headache.nausea.

tachycardia

▶Frequency not knownMenorrhagia.sepsis

lPREGNANCYAvoid.

lBREAST FEEDINGAvoid.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Powder and solvent for solution for injection

EXCIPIENTS:May contain Benzyl alcohol

▶Gonadorelin (Non-proprietary)

Gonadorelin (as Gonadorelin hydrochloride)

100 microgramGonadorelin 100 microgram powder and solvent for

solution for injection vials| 1 vialP£ 75. 00 (Hospital only)

6.3 Gonadotrophin replacement

therapy

GONADOTROPHINS

Chorionic gonadotrophin

(Human chorionic gonadotrophin; HCG)

lDRUG ACTIONA preparation of a glycoprotein fraction

secreted by the placenta and obtained from the urine of

pregnant women having the action of the pituitary

luteinising hormone.

lINDICATIONS AND DOSE

Delayed puberty in the male to stimulate endogenous

testosterone production

▶BY INTRAMUSCULAR INJECTION, OR BY SUBCUTANEOUS

INJECTION

▶Child:(consult product literature)

Test of testicular function, short stimulation test

▶BY INTRAMUSCULAR INJECTION

▶Child: 1500 – 2000 units once daily for 3 days

474 Hypothalamic and anterior pituitary hormone related disorders BNFC 2018 – 2019

Endocrine system

6