Drug interactions- summary-

Betablockers + Lanreotide -
coadmin of drugs such as beta-blockers may have additional effect on the reduction of heart rate
associated with lanreotide . Dosage adjustments may be necessary

Lantrotide + bromocriptine-
coadmin  may increase availability of bromocriptine.

Lanreotide + cyclosporine-
coadmin of cyclosporine with lanreotide  may decrease relative availability of cyclosporine
and may necessiate dose adjustment of cyclosporine to maintain theapeutic levels

Lanreotide + CYP3A4 metabolism eg quinidine, terfenadine-
lanreotide may decrease metabolic clearance of drugs known to be metabolised by CYP-450
enzymes eg quinidine, terfenadine. Use with caution and consider dose reduction of coadministered
 medications

Acromegaly

Acromegaly-
When growth hormones- secreting tumors develop after puberty , acromegaly results. The disorder
occurs equally in men and women. Approximately  10 to 15 perecent of all large pitutiary  tumors
secrete growth hormone and cause acromegaly.

Because of the slow progression of the disease the changes in physical features, which often
begin between second and fourth decade are frrqeuntly not recongnized for 10 to 20 years

Cardiovascular- 13%      bradycardia  12% 

GI - 56%                        abdominal pain  15%  diarrhea 45%   flatulence 7%

Hematologic - 8%       anemia 8%

Hepatic- 19%              choleithiasis  13% 

Local 14%                 

Metabolic /nutrional - 20%      weight decrease 8%

Special precautions-

Cholelithiasis  and gall bladder sludge-  lanreotide may reduce gall bladder motility and
lead to gallstone formation. Therfore patients treated with lanreotide should be monitored
regularly.

Hyperglycemia and hypoglycemia- monitor blood levels when lanreotide treatment is initiated
and when the dose is altered and adjust anti-diabetic treatment accordingly.

Thyroid function abnormalities- thyroid function tests are recommended when clicinally indicated

Cardiovascular anbormalities - take care when initiating treatment in patients with bradycardia

Renal function impairment-  patients with moderate to severe renal function impairment,
begin treatment with lanreotide 60mg

Hepatic function impairment- for patients with moderate to severe hepatic function impairment
begin treatment with lanreotide 60mg

Pregnancy- use lanreotide in pregnancy only if required

Lactation- decide whether to disconitinue nursing or the drug depending on the importance
of the drug to the mother

Children- safety and efficacy  in children have not been established

Elderly -no overal differences noticed between elderly patients and younger patients.
However greater sensitivity in elderly patients cannot be ruled

 Indication-
Acromegaly

Dosage-
Begin ttreatment with lanreotide 90mg via the deep subcutaneous route at 4-week intervals
for 3 months

1. Advice patients to inform their health care provider or the pharmacist if they develop
    unusual symptoms or if any unknown symptoms persists

2. Advice patients that respone to lanreotide be monitored by periodic measurements of
   GH and IGH -1 levels with a goal of decreasing these levels to normal range

Pregnancy-
Use lanreotide in pregnancy only if required

Lactation-
Decide whether to disconitinue nursing or the drug depending on the importance
of the drug to the mother

Children-
Safety and efficacy  in children have not been established

Elderly -
No overal differences noticed between elderly patients and younger patients.
However greater sensitivity in elderly patients cannot be ruled