Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intravenous:
SecreFlo: 16 mcg (1 ea)
Solution Reconstituted, Intravenous [preservative free]:
ChiRhoStim: 16 mcg (1 ea)
Pharmacology
Mechanism of Action
Human secretin is a synthetic peptide hormone produced by cells in the duodenum in response to acidification; it stimulates pancreatic ductal cells to secrete pancreas fluid in large volumes that contain bicarbonate; may also work through vagal-vagal neural pathways since stimulation of the efferent vagus nerve stimulates bicarbonate.
Pharmacokinetics/Pharmacodynamics
Distribution
Vd: 2.7 L
Excretion
Clearance: 580.9 ± 51.3 mL/minute
Half-Life Elimination
45 minutes
Use: Labeled Indications
Diagnosis of gastrinoma: Stimulation of gastrin secretion to aid in the diagnosis of gastrinoma.
Diagnosis of pancreatic dysfunction: Stimulation of pancreatic secretions, including bicarbonate, to aid in the diagnosis of pancreatic exocrine dysfunction.
Endoscopic retrograde cholangiopancreatography: Stimulation of pancreatic secretions to facilitate in the identification of the ampulla of Vater and accessory papilla during endoscopic retrograde cholangiopancreatography.
Contraindications
There are no contraindications listed in the manufacturer's labeling.
Dosage and Administration
Dosing: Adult
Diagnosis of gastrinoma: IV: 0.4 mcg/kg as a single dose
Diagnosis of pancreatic dysfunction/Endoscopic retrograde cholangiopancreatography: IV: 0.2 mcg/kg as a single dose
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Diagnostic agent for pancreatic function: Limited data available: Infants, Children, and Adolescents: IV: 0.2 mcg/kg as single dose over 1 minute (Horvath 2016)
Diagnostic agent for gastrinoma (Zollinger-Ellison): Limited data available: Adolescents ≥15 years: IV: 0.4 mcg/kg as single dose over 1 minute (Berna 2006). Dosing based on experience with the porcine product; a conversion of 1 unit = 0.2 mcg of human synthetic product has been suggested by the manufacturer.
Facilitation of endoscopic retrograde cholangiopancreatography/magnetic resonance cholangiopancreatography visualization: Limited data available: Infants, Children, and Adolescents: IV: 0.2 mcg/kg as a single dose over 1 minute; maximum dose: 16 mcg/dose (Delaney 2008; Trout 2013)
Reconstitution
Add 8 mL NS to the 16 mcg vial to yield concentration of 2 mcg/mL; add 10 mL NS to the 40 mcg vial to yield a concentration of 4 mcg/mL; shake vigorously to ensure dissolution and use immediately. Discard any unused product.
Administration
IV: Administer by IV injection slowly over 1 minute.
Dietary Considerations
Patients should fast 12 to 15 hours prior to beginning the test.
Storage
Prior to reconstitution, store at -20°C (-4°F). Protect from light.
Drug Interactions
Anticholinergic Agents: May diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Consider therapy modification
Histamine H2 Receptor Antagonists: May diminish the diagnostic effect of Secretin. Specifically, use of H2-Antagonists may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of histamine H2-antagonists (H2RAs) and secretin. Discontinue H2RAs at least 2 days prior to secretin administration. Consider therapy modification
Proton Pump Inhibitors: May diminish the diagnostic effect of Secretin. Specifically, use of PPIs may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of proton pump inhibitors (PPIs) and secretin, and discontinue PPIs several weeks prior to secretin administration, with the duration of separation determined by the specific PPI. See full monograph for details. Consider therapy modification
Adverse Reactions
1% to 10%: Gastrointestinal: Nausea (2%)
<1%, postmarketing, and/or case reports: Abdominal distress, flushing, vomiting
Warnings/Precautions
Disease-related concerns:
- Hepatic impairment: Use with caution in patients with hepatic impairment (including ethanol-induced disease); may be hyperresponsive to secretin stimulation and mask the presence of coexisting pancreatic disease. Consider additional testing and clinical assessments to aid in diagnosis.
- Inflammatory bowel disease: Patients who have inflammatory bowel disease may be hyporesponsive to secretin stimulation falsely suggesting pancreatic disease; consider additional testing and clinical assessments for aid in diagnosis.
Concurrent drug therapy issues:
- Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
Other warnings/precautions:
- Vagotomy: Patients who have undergone vagotomy may be hyporesponsive to secretin stimulation falsely suggesting pancreatic disease; consider additional testing and clinical assessments for aid in diagnosis.
Monitoring Parameters
Peak bicarbonate concentration of duodenal fluid aspirate (chronic pancreatitis); serum gastrin (gastrinoma). Refer to protocols for collection of pancreatic secretion and/or serum gastrin.
Pregnancy
Pregnancy Considerations
Animal reproduction studies have not been conducted.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience abdominal pain, flushing, vomiting, or nausea (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
