Secretin (ChiRhoStim) - Uses, Dose, MOA, Brands, Side effects

Secretin (ChiRhoStim) is a peptide hormone that is produced by the duodenum. It increases the pancreatic secretion of fluid that is very rich in bicarbonate. When administered intravenously, it is used to assess pancreatic function.

Secretin Uses:

Diagnosis of gastrinoma:
- It stimulates the secretion of gastrin and is used to diagnose gastrinomas.
Diagnosis of pancreatic dysfunction:
- It is used to assess pancreatic exocrine deficiency by stimulating pancreatic secretions of fluid and bicarbonate.
Endoscopic retrograde cholangiopancreatography:
- It is used during endoscopic retrograde cholangiopancreatography to aid in the identification of the ampulla of Vater and accessory papilla by stimulating pancreatic secretions.

Secretin Injection (ChiRhoStim) Dose in Adults

Secretin Injection (ChiRhoStim) Dose in the Diagnosis of gastrinoma:

IV: 0.4 mcg/kg as a single dose

Secretin Injection (ChiRhoStim) Dose in the Diagnosis of pancreatic dysfunction/ Endoscopic retrograde cholangiopancreatography:

IV: 0.2 mcg/kg as a single dose

Secretin Injection (ChiRhoStim) Dose in Childrens

Secretin Injection (ChiRhoStim) Dose as a Diagnostic agent for pancreatic function:

Infants, Children, and Adolescents:
- IV: 0.2 mcg/kg intravenously as a single dose over one minute.

Secretin Injection (ChiRhoStim) Dose in the Diagnostic agent for gastrinoma (Zollinger-Ellison):

Adolescents ≥15 years:
- IV: 0.4 mcg/kg intravenously as a single dose over one minute.
- A conversion of 1 unit = 0.2 mcg of the human synthetic product has been suggested by the manufacturer based on experience with the porcine product.

Secretin Injection (ChiRhoStim) Dose in the Facilitation of endoscopic retrograde cholangiopancreatography/ magnetic resonance cholangiopancreatography visualization:

Infants, Children, and Adolescents:
- IV: 0.2 mcg/kg intravenously as a single dose over one minute;
- The maximum dose is 16 mcg/dose.

Pregnancy Risk Category: C

It has not yet been tested in animal reproduction studies or on humans.

Use during breastfeeding:

It is unknown if the drug will be excreted into breast milk.
Before initiating treatment, the manufacturer suggests that you weigh the risks and benefits for both mother and baby.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Side Effects of Secretin Injection (ChiRhoStim):

Gastrointestinal:
- Nausea
- vomiting
- flushing
- dyspepsia

Contraindications to Secretin Injection (ChiRhoStim):

The manufacturer's labeling does not contain any contraindications.

Warnings and precautions

Hepatic impairment
- Patients suffering from liver disease, including alcoholic liver disease, should be cautious when using it. Patients with liver disease, including alcoholic liver disease, may experience a higher than normal response to secretin stimulation. This could lead to masking of coexisting pancreatic diseases.
- These patients may require additional testing or a clinical evaluation.
Inflammatory bowel disease
- Patients with inflammatory bowel diseases may have a lower response to therapy than they would like after secretin stimulation.
- This could falsely indicate that there is pancreatic disease.
- These patients may require additional testing and clinical assessment.

Secretin: Drug Interaction

Risk Factor D (Consider therapy modification)
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.
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.
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.

Monitoring parameters:

In patients with chronic pancreatitis, peak bicarbonate concentration may be monitored in the duodenal fluid aspirated. Monitor gastrin levels in patients with gastrinoma.

How to administer Secretin?

It is administered as a slow intravenous injection over one minute.

Mechanism of action of Secretin:

It is a hormone produced by the cells of the duodenum in response to vagal stimulation and stomach acid. It stimulates the production of pancreatic fluid rich in bicarbonate.

Half-life elimination: