From the Guidelines
Sermorelin should be administered at a dose of 0.045–0.05 mg/kg body weight per day by subcutaneous injections in the evening, as recommended for growth hormone treatment in children with chronic kidney disease 1.
Monitoring and Management
The monitoring of patients on sermorelin should include:
- Baseline and periodic blood tests for IGF-1 levels, glucose, and thyroid function
- Clinic visits every 3–6 months or more frequently for young patients and those with advanced chronic kidney disease to monitor stature, height velocity, pubertal development, skeletal maturation on wrist radiography, renal function, thyroid hormone levels, serum glucose, calcium, phosphate, bicarbonate, and parathyroid hormone levels 1
- Assessment of patient adherence to sermorelin therapy, including measurement of serum insulin-like growth factor 1 levels, weight-adjusted dosage, and assessment of nutritional and metabolic factors 1
Risks and Uses
Common uses of sermorelin include:
- Addressing age-related growth hormone decline
- Improving body composition
- Enhancing recovery
- Potentially benefiting sleep quality Risks associated with sermorelin use include:
- Injection site reactions
- Headache
- Flushing
- Dizziness
- Rarely, more serious effects like elevated blood glucose or insulin resistance Sermorelin should be avoided in patients with:
- Active malignancy
- Intracranial lesions
- Uncontrolled diabetes
Treatment Duration and Storage
Treatment duration with sermorelin typically ranges from 3-6 months initially, with reassessment of benefits and side effects 1. Proper storage requires refrigeration, and patients should be educated on sterile injection technique to minimize complications.
Key Considerations
It is essential to note that sermorelin works by stimulating the pituitary's natural production of growth hormone, potentially offering a more physiologic approach with fewer side effects compared to synthetic growth hormone. However, the decision to use sermorelin should be made on a case-by-case basis, considering the individual patient's needs and medical history.
From the FDA Drug Label
ADVERSE REACTIONS Reactions which may occur because of this solution, added drugs or the technique of reconstitution or administration include febrile response, local tenderness, abscess, tissue necrosis or infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection and extravasation If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate countermeasures, and if possible, retrieve and save the remainder of the unused vehicle for examination.
The monitoring of Sermorelin (Growth Hormone-Releasing Hormone, GHRH) should include observation for signs of adverse reactions such as febrile response, local tenderness, abscess, tissue necrosis or infection at the site of injection. The management of adverse reactions includes discontinuing the infusion, evaluating the patient, and instituting appropriate countermeasures. The provided drug labels do not contain information on dosing regimens or uses of Sermorelin. Risks associated with Sermorelin include febrile response, local tenderness, abscess, tissue necrosis or infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection and extravasation 2.
From the Research
Monitoring and Management of Sermorelin
- Sermorelin, a 29 amino acid analogue of human growth hormone-releasing hormone (GHRH), is used to diagnose and treat children with idiopathic growth hormone deficiency 3
- Intravenous and subcutaneous sermorelin stimulate growth hormone secretion from the anterior pituitary, with hormone responses to intravenous sermorelin appearing to be a rapid and relatively specific test for the diagnosis of growth hormone deficiency 3
- The combination of intravenous sermorelin and arginine is a more specific test for growth hormone deficiency, although normal growth hormone responses to intravenous sermorelin cannot exclude growth hormone deficiency due to a hypothalamic deficit 3
Dosing Regimens of Sermorelin
- Once daily subcutaneous sermorelin 30 microg/kg bodyweight given at bedtime is effective in treating some prepubertal children with idiopathic growth hormone deficiency, with significant increases in height velocity sustained during 12 months' treatment 3
- The effect of long-term treatment with once daily subcutaneous sermorelin 30 microg/kg bodyweight on final adult height is yet to be determined 3
- GHRP/SERM therapy, including sermorelin, increases serum insulin-like growth factor-1 (IGF-1) levels with strict compliance to thrice-daily dosing 4
Risks and Uses of Sermorelin
- Sermorelin is well tolerated, with transient facial flushing and pain at injection site being the most commonly reported adverse events 3
- Sermorelin is used to diagnose and treat growth hormone deficiency, and may also be used to increase serum IGF-1 levels in hypogonadal men 3, 4
- Acromegaly, a condition characterized by increased release of growth hormone, can be treated with medical therapy, including somatostatin receptor ligands, dopamine agonists, and the growth hormone receptor antagonist pegvisomant 5, 6
- IGF-1 and growth hormone concentrations are associated with major adverse outcomes from acromegaly, including all-cause mortality, type 2 diabetes, major adverse cardiovascular events, and cancer 7