Chirhostim (secretin acetate (human))
Intravenous Vial (EA)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Secretin is a hormone secreted principally by the duodenal mucosa that is used to aid in the diagnosis of pancreatic exocrine dysfunction or gastrinoma or to facilitate the identification of the ampulla of Vater and accessory papilla during endoscopic retrograde cholangiopancreatography (ERCP).
Secretin is a naturally occurring hormone secreted principally by the duodenal mucosa in response to the presence of acidic content in the small intestine (resulting from gastric emptying). Commercially available secretin acetate is prepared synthetically and has an amino acid sequence identical to that of naturally occurring porcine secretin, consisting of 27 amino acid residues.
Exogenous secretin probably elicits all the pharmacologic responses usually produced by endogenous secretin. In individuals with normal pancreatic function, secretin increases the volume and bicarbonate content of secreted pancreatic juice by stimulating exocrine pancreatic function. In addition, secretin stimulates gastrin release in patients with gastrinoma; the hormone has no effect on or produces small changes in serum gastrin concentrations in healthy individuals or in patients with peptic ulcer disease.
The potency of pure secretin is approximately 5000 clinical units (CU)/mg of peptide and is expressed in terms of mcg/mg. The purity of secretin acetate or naturally occurring porcine secretin is 99.6 or 60%, respectively; therefore, the potency of secretin acetate or naturally occurring porcine secretin has been reported to be approximately 5000 or 3000 CU/mg, respectively. As a pure peptide product, dosage of synthetic porcine secretin (secretin acetate) is expressed by weight (in mcg) in terms of the base; each 0.2 mcg of synthetic porcine secretin is approximately equivalent to 1 CU of biologic activity.
Following IV administration of 0.4 mcg/kg in healthy individuals, serum secretin concentrations generally decline rapidly (i.e., within 60-90 minutes) to baseline levels. The elimination half-life of secretin is approximately 2.7 minutes.
Secretin acetate lyophilized powder for injection should be stored at -20degreesC.
Secretin is used to stimulate pancreatic secretions to aid in the diagnosis of pancreatic exocrine dysfunction or to facilitate the identification of the ampulla of Vater and accessory papilla during endoscopic retrograde cholangiopancreatography (ERCP). Secretin also is used to stimulate gastrin release to aide in the diagnosis of gastrinoma.
Generic name: secretin acetate (human)
Therapeutic class: Diagnostic Agents
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
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Indications
The following indications are listed for Chirhostim:
- Secretin Stimulation Testing
Also known as: Oxykrinin Stimulation Testing.
Dosing
No dosing information is available for this tab.
No dosing information is available for this tab.
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
Secretin/Anticholinergics
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Anticholinergic drugs may result in an incorrect secretin stimulation test result.(1)
CLINICAL EFFECTS: Concurrent use of anticholinergic drugs may impact the accuracy of the secretin stimulation test.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The US manufacturer of human secretin states concurrent use of anticholinergic drugs at the time of stimulation testing may cause the patient to be hyporesponsive to the testing and suggest false positive results for pancreatic disease. The manufacturer recommends discontinuing anticholinergic drugs at least 5 half-lives prior to stimulation testing. Consider additional testing and clinical assessment for diagnosis.(1)
DISCUSSION: Concurrent use of anticholinergic drugs may impact the accuracy of the secretin stimulation test.(1)
Secretin/H2 Antagonists; Proton Pump Inhibitors
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: H2 antagonists and proton pump inhibitors (PPIs) may result in an incorrect secretin stimulation test result.(1)
CLINICAL EFFECTS: Concurrent use of H2 antagonists and proton pump inhibitors (PPIs) may impact the accuracy of the secretin stimulation test.(1)
PREDISPOSING FACTORS: Patients with alcoholic or other liver disease may be hyperresponsive to stimulation with a secretin stimulation test, masking the presence of coexisting pancreatic disease. Consider additional testing and clinical assessment for diagnosis.(1)
PATIENT MANAGEMENT: The US manufacturer of human secretin states concurrent use of H2 antagonists and proton pump inhibitors (PPIs) at the time of stimulation testing may cause the patient to be hyperresponsive to secretin stimulation and suggest false gastrinoma results. The manufacturer recommends discontinuing H2 antagonists at least 2 days prior to testing. The US manufacturer of vonoprazan recommends stopping vonoprazan at least 4 weeks prior to testing.(2-3) Consult prescribing information for PPIs before administering prior to a secretin stimulation test.(1)
DISCUSSION: Concurrent use of H2 antagonists and proton pump inhibitors (PPIs) may impact the accuracy of the secretin stimulation test.(1)
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
Known hypersensitivity to secretin or any ingredient (e.g., mannitol) in the formulation.
Secretin should not be used in patients with acute pancreatitis until the acute episode has subsided.
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
- Alcohol use disorder
- Alcoholic fatty liver
- Asthma
- Disease of liver
Adverse reactions
Adverse effects occurring in 1% or more of patients receiving secretin include nausea, abdominal discomfort, bleeding (secondary to sphincterectomy), decreased blood pressure, flushing, diaphoresis, endoscopic perforation of pancreatic duct, upper GI bleeding (secondary to endoscopic abrasion), abdominal cramps, mild bradycardia, burning in stomach, headache, lightheadedness, transient respiratory distress, bloating, diarrhea, fever, transient low oxygen saturation, urticaria (secondary to contrast material), vomiting, fatigue, hot sensation, hunger pangs, leukocytoplastic vasculitis, numbness/tingling in extremities, pallor, abdominal rash, thready pulse, and possible seizure.
Less Frequent
- Fever
Rare or Very Rare
- Hypersensitivity drug reaction
More Frequent
- Abdominal pain with cramps
- Nausea
Less Frequent
- Diarrhea
- Dyspepsia
- Flushing
- Vomiting
Precautions
No enhanced messaging available.
Safety and efficacy of secretin acetate have not been established in children younger than 16 years of age.
Category C. (See Users Guide.)
It is not known whether porcine secretin is distributed into human milk. Because many drugs are distributed into human milk, caution is advised if secretin is administered in nursing women.
No substantial differences in safety and efficacy were observed between geriatric and younger patients in clinical studies; however, the possibility that some older patients may exhibit increased sensitivity to secretin cannot be ruled out.
ICD codes
| Code | Type | Description |
|---|---|---|
| Secretin stimulation testing | ||
| 4A0B8GZ | ICD10PCS | Measurement of gastrointestinal secretion, via natural or artificial opening endoscopic |
ICD code information from First Databank (FDB).
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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