Increlex

mecasermin

Increlex

Indications

Action

Pharmacokinetics

Time/action profile (blood levels)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• seizures (life-threatening)
• dizziness
• headache
• intracranial hypertension

Respiratory

• tonsillar hypertrophy (most frequent)
• snoring

Gastrointestinal

• vomiting

Endocrinologic

• hypoglycemia (life-threatening)

Local

• bruising
• lipohypertrophy

Musculoskeletal

• arthralgia
• extremity pain

Miscellaneous

• anaphylaxis (life-threatening)
• hypersensitivity reactions (life-threatening)
• thymus hypertrophy

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Monitor bone age annually and growth rate determinations, height, and weight every 3–6 mo during therapy.
• Assess tonsils for hypertrophy periodically during therapy. Signs may include (snoring, difficulty breathing or swallowing, sleep apnea, fluid in the middle ear).
• To assess for intracranial hypertension, fundoscopic examinations are recommended prior to and periodically during therapy. May cause headache with nausea and vomiting.
• Monitor patient for allergic reactions (rash, hives, angioedema, pruritus, urticaria, difficulty breathing). May require interruption of therapy.
• Monitor patients for thickening of soft tissues of the face periodically during therapy.
• Lab Test Considerations: Monitor preprandial glucose levels during therapy.
  • May cause mild ↑ in serum AST, ALT, and LDH.

Potential Nursing Diagnoses

Implementation

• Administer within 20 min of a meal or snack; may have insulin-like hypoglycemic effects. Do not administer if meal or snack is omitted. If a dose is omitted, do not increase dose to make up for missed doses.
  • Therapy should be initiated at a low dose and not increased until no hypoglycemic episodes have occurred for at least 7 day. If sever hypoglycemia occurs despite adequate food intake, consider dose reduction.
  • If using syringes measuring dose in units, convert doses in mg/kg to units using formula: Weight (kg) x Dose (mg/kg) x 1 mL/10 mg x 100 units/1 mL = units/injection.
• Subcutaneous: Administer twice daily in upper arm, thigh, abdomen, or buttocks. Rotate sites with each injection. Solution is clear; do not administer solution that is cloudy or contains a precipitate. Solution is stable for 30 days after opening vial if refrigerated. Keep vial away from direct heat and bright light. Discard unused solution.

Patient/Family Teaching

• Instruct patients and/or their parents how to administer mecasermin, injection technique, and equipment disposal. Advise patient and/or parents to read Patient Information package insert before starting therapy and with each prescription refill in case of changes.
• Advise patient and parents not to give mecasermin to any other person; may be harmful.
• Discuss the importance of a well-balanced diet including protein and fat such as meat and cheese. Advise parents to monitor for signs of hypoglycemia (dizziness, tiredness, restlessness, hunger, irritability, trouble concentrating, sweating, nausea, fast or irregular heartbeat). Severe hypoglycemia may result in unconsciousness, seizures, and death. A source of sugar such as orange juice, glucose gel, candy, or milk should be available at all times.
• Caution patients to avoid driving and other activities requiring alertness until response to medication is known.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
• Advise parent to notify health care professional if signs of tonsillar hypertrophy, increased intracranial pressure, or allergic reaction occur.

Evaluation/Desired Outcomes

• Increase in statural growth.