Growth failure in children

Cardiovascular -     cardiac murmur

CNS-       convulsions, dizziness, headache

GI -          vomiting

Hematologic /lymphatic -   thymus hypertrophy

Metabolic/nutrional -       hypoglycemia

Musculoskeletal  -   arthalgia,   pain in extremity

Respiratory -   snoring, tonsilar hypertrophy

Special senses-   abnormal typanometry, ear pain,   ear tube insertion, fluid in middle ear,
                               hypoacusis, otitis media, serious otitis media

Miscellaneous-     bruising, lipohypertrophy

Do not use mecaserin for growth promotion in patients with closed epiphyses

Contraindicated in the presence of active or suspected neoplasma, discontinue therapy
if evidence of neoplasia develops

Intravevenous IV administration of mesacarin is contraindicated

Mecaserin should not be used by patients who are allergic to mecaserin (IGF-1 ) or any of
the active ingredients in mecaserin
  

Special precautions-
Benzyl alcohol - benzyl alcohol, used as preservative has been associated with neurologic
toxicity

Experienced health care providers- treatment with mecaserin should be directed by health
care providers who are experienced in the diagnosis and management of patients with growth
disorders.

Hypoglycemic shock- administer mecaserin shortly before or after a meal or snack, because
it has insulin-like hypoglycemic effects. Pay special attention to small children because their
oral intake may not be consistent. Do not administer mecaserin when meal or snack is omitted

High -risk activites- patients should avoid engaging in high risk activites eg driving within
2 to 3 hours after dosing

Lymphoid tissue hypertrophy- lymphoid tissue hypertrophy associted complications such
as snoring, sleep apnea, and chronic middle ear problems have been reported.
patients should have periodic examinations to rule out such potential complications and
receive appropiate treatment if  necessary

Intracranial hypertension- IH with papiledema , visual changes, headache, nausea, and or
vomiting have been reported. Signs and symptoms resolved after interuption of dosing.
Fundoscopic examination is recommended at the initiation and periodically during the course
of therapy

Pregnancy- There is insufficient medical information to determine whether there is significant
risks to the fetus. Administer with caution and only if required

Lactation- excerciise caution when mecaserin is administered to breast feeding woman

Children-    mecaserin has not been studied in children younger than 2 years of age or in adults

Monitoring- consider preprandial glucose monitoring at treatment initiation and until a well
tolerated  dose isestablished

Indication-
Growth failure in children

Dosage-
Recommended starting dose is 0.04 to 0.08mg/kg ( 40 to 80mcg ) twice daily by subcutaneous
injection
The dose may be increased by 0.04mg/kg per dose to the maximum of dose of 0.12mg/kg
twice daily.
Doses greater than 0.12mg/kg given twice daily have not been evaluated in children with primary
IGFD and because of potential hypoglycemic effects, should not be used

1. Instruct patients and or parents on the safe administration of mecasein.

2.Give mecaserin shortly before or after( 20 minutes on either side of) a meal or snack

3. Mecaserin should not administered when the meal or snack is omitted doses

4. Never increase the dose of mecaserin to make up 1 or 2 more omitted doses.

5. Initiate mecaserin theapy at low dose and increase the dose only if no hypoglycemia
    occurs on treatment after atleast 7 days of dosing.

6. If severe hypoglycemia or persistent hyopglycemia occurson treatmet despite adequate
    food intake, consider mecaserin dose reduction

7. Educate patients and care givers on how to recognize the sgns and symptoms of
    hypoglycemia

8. Throughly instruct patients and or parents in the importance of needle disposal

9. Use puncture resistent container for the disposal of used needls. Do not reuse
    needles or syringes

Pregnancy-
There is insufficient medical information to determine whether there is significant
risks to the fetus. Administer with caution and only if required

Lactation-
Excerciise caution when mecaserin is administered to breast feeding woman

Children-   
Mecaserin has not been studied in children younger than 2 years of age or in adults