What are the dosing guidelines for Ipamorelin (growth hormone secretagogue) for growth hormone stimulation?

Dosing Guidelines for Ipamorelin for Growth Hormone Stimulation

Ipamorelin should be administered at a dose of 0.045-0.05 mg/kg body weight per day by subcutaneous injection in the evening for optimal growth hormone stimulation. 1

Mechanism of Action and Efficacy

• Ipamorelin is a synthetic pentapeptide (Aib-His-D-2-Nal-D-Phe-Lys-NH2) that functions as a growth hormone secretagogue, stimulating the release of growth hormone from the anterior pituitary gland 2
• It acts through a GHRP-like receptor mechanism similar to other growth hormone-releasing peptides, but with higher selectivity for GH release 2
• In animal studies, ipamorelin has demonstrated dose-dependent increases in longitudinal bone growth rate and body weight gain 3
• Unlike other growth hormone secretagogues, ipamorelin shows high specificity for GH release without significantly affecting ACTH or cortisol levels, making it potentially safer for clinical use 2

Dosing Protocol

• Subcutaneous administration is the recommended route for ipamorelin 1
• Evening administration is preferred to mimic the natural circadian pattern of growth hormone release 1
• For children with growth hormone deficiency, the recommended dosage range is 0.045-0.05 mg/kg body weight per day 1
• Injections should be given consistently at the same time each day to maintain stable hormone levels 1

Monitoring and Follow-up

• Clinic visits should be scheduled every 3-6 months (more frequently for young patients) to monitor 1:

  • Stature and height velocity
  • Pubertal development
  • Skeletal maturation via wrist radiography
  • Thyroid hormone levels (TSH and free T3)
  • Serum glucose, calcium, phosphate, bicarbonate, and parathyroid hormone levels

• An adequate growth response is indicated by a height velocity increase of at least 2 cm per year over baseline during the first year of treatment 1

Treatment Duration and Discontinuation

• Treatment should be discontinued in the following circumstances 1:
  • When epiphyseal closure is demonstrated
  • If height velocity drops below 2 cm per year in late-pubertal adolescents
  • When the patient reaches their genetic target height
  • In cases of severe adverse effects
  • If there is evidence of accelerated bone maturation
  • When there is an inadequate response despite optimal dosing and adherence

Special Considerations

• For non-responders (height velocity increase <2 cm/year over baseline), evaluate 1:

  • Patient adherence to therapy
  • Serum IGF-1 levels
  • Weight-adjusted dosage
  • Nutritional and metabolic factors

• Higher doses are not more effective than the recommended range and should not be used in non-responders 1

• Yearly assessment of pubertal stages (Tanner stages) is recommended for children older than 10 years of age to monitor for potential accelerated pubertal development 1

• Yearly assessment of bone age by radiography of the left wrist should be performed to exclude accelerated bone maturation 1

Safety Profile

• Ipamorelin has shown a favorable safety profile in animal studies with minimal side effects 2
• The most commonly reported adverse events with similar growth hormone secretagogues include transient facial flushing and pain at the injection site 4
• Regular monitoring of bone age and pubertal development is essential to detect potential accelerated maturation 1