Formulary
Pegvisomant: Indications, Dosing, Side Effects and Interactions
Pegvisomant is a genetically modified analogue of human growth hormone and is a highly selective growth hormone receptor antagonist.
MedNext Academy | 3 min read
Pegvisomant: Indications, Dosing, Side Effects and Interactions
Pegvisomant is a genetically modified analogue of human growth hormone and is a highly selective growth hormone receptor antagonist.
Drug action
Pegvisomant is a genetically modified analogue of human growth hormone and is a highly selective growth hormone receptor antagonist.
Indications and dose
**Treatment of acromegaly in patients with inadequate response to surgery, radiation, or both, and to treatment with somatostatin analogues (initiated by a specialist)**
- **Adult** (By Subcutaneous Injection): Initially 80 mg for 1 dose, followed by 10 mg daily, then increased in steps of 5 mg daily, adjusted according to response; maximum 30 mg per day.
Cautions
Abnormal liver function tests and/or signs or symptoms of liver injury (further investigations may be required before treatment initiation-consult product literature); diabetes mellitus (adjustment of antidiabetic therapy may be necessary)
Side effects
Common or very common Arthralgia; arthritis; asthenia; constipation; diarrhoea; dizziness; drowsiness; dyslipidaemia; dyspnoea; eye pain; fever; gastrointestinal discomfort; gastrointestinal disorders; haemorrhage; headaches; hyperglycaemia; hypertension; hypoglycaemia; influenza like illness; lipohypertrophy; myalgia; nausea; numbness; oedema; skin reactions; sleep disorders; sweat changes; tremor; vomiting; weight increased Uncommon Apathy; confusion; dry mouth; eye strain; feeling abnormal; healing impaired; hunger; leucocytosis; leucopenia; libido increased; memory loss; Meniere's disease; oral disorders; panic attack; polyuria; proteinuria; renal impairment; taste altered; thrombocytopenia Frequency not known Anger; angioedema; hepatic function abnormal; laryngospasm Side-effects, further information Injection-site reactions Rotate injection sites to avoid lipohypertrophy. Abnormal hepatic function Manufacturer advises interrupt treatment if liver function tests at least 5 times the upper limit of normal or transaminase levels at least 3 times the upper limit of normal and blood bilirubin increased-consult product literature. Discontinue if liver injury is confirmed.
Interactions
**Severe interactions:**
- Pegvisomant has significant structural similarity to growth hormone which causes it to cross-react in commercially available growth hormone assays.
**Other interactions (2):**
- Patients receiving insulin or oral hypoglycaemic medicinal products may require dose reduction of these active substances due to the effect of pegvisomant on insulin sensitivity (see section 4.4).
- Pegvisomant treatment should therefore not be monitored or adjusted based on serum growth hormone concentrations reported from these assays.
Pregnancy
Avoid.
Breast feeding
Avoid.
Hepatic impairment
Manufacturer advises caution (no information available); temporary or permanent withdrawal may be needed-consult product literature.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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