Sincalide is a synthetic form of the natural hormone cholecystokinin. It's primarily used in medical settings to stimulate the release of digestive enzymes from the pancreas and bile from the gallbladder. This stimulation aids in diagnosing disorders of the gallbladder and pancreas, such as gallstones or pancreatic insufficiency.

Sincalide (Kinevac) is a cholecystokinin drug (an 8-aminoacid C-terminal of cholecystokinin, CCK-8) that is used to diagnose pancreatic and biliary disorders.

Sincalide Uses:

• Barium meal transit time acceleration:
  • to speed up the passage of a barium meal through the small intestine, cutting down on the amount of time and radiation needed to examine the intestinal tract using fluoroscopy and x-rays.
• Pancreatic secretion stimulation:
  • before taking a duodenal aspirate to examine the cytology, content, and activity of the enzymes, to promote pancreatic secretion (particularly in combination with secretin).
• Gallbladder contraction stimulation:
  • to induce gallbladder contraction, as determined by various diagnostic imaging techniques, or to collect a sample of concentrated bile via duodenal aspiration for lipid, salt, phospholipid, and crystal analysis.

Sincalide Dose in Adults

Sincalide Dose in the treatment of Barium meal transit time acceleration:

they usually give it through an IV.

• For the first dose, they typically give 0.04 micrograms per kilogram of the patient's weight. They inject it slowly over 30 to 60 seconds. They start this after the barium meal has passed beyond the first part of the small intestine (called the proximal jejunum).
• If the barium hasn't moved after about 30 minutes, they might give another dose of the same amount (0.04 mcg/kg).
• In some cases, they might choose to give it differently, as an IV infusion. For this, they give a higher dose of 0.12 micrograms per kilogram, but they do it slowly over 30 minutes instead of quickly.

Sincalide Dose for Gallbladder contraction stimulation:

• They might start with an IV injection. The first dose is typically 0.02 micrograms per kilogram of the patient's weight. They inject it slowly over 30 to 60 seconds. If the gallbladder doesn't contract well within 15 minutes, they might give another dose, this time at 0.04 mcg/kg.
• Another option is giving it as an IV infusion. For this, they give a higher dose of 0.12 micrograms per kilogram, but they do it slowly over 50 minutes instead of quickly.
• In some cases, they might give it as an intramuscular (IM) injection. For this, they give 0.1 micrograms per kilogram.

Sincalide Dose in the treatment of Pancreatic secretion stimulation:

• They typically give it through an IV. The dose is usually 0.02 micrograms per kilogram of the patient's weight. They administer it slowly over 30 minutes.
• They start giving sincalide 30 minutes after they begin a different infusion called secretin. This combination helps stimulate pancreatic secretion effectively.

Sincalide Dose in Children

Not studied.

Pregnancy Risk Category: B

• According to the limited information available from studies in humans, and because of its impact on smooth muscle, it's recommended to avoid using sincalide during pregnancy, even close to the due date.
• This is because it might increase the risk of spontaneous abortion (miscarriage) or premature labor (going into labor too early).
• So, doctors generally advise against using sincalide in pregnant women to prevent any potential harm to the pregnancy or the baby.

Sincalide use during breastfeeding:

• The presence of sincalide in breast milk isn't well understood.
• According to the manufacturer, if a mother is considering breastfeeding while undergoing therapy with sincalide, several factors should be weighed.
• These include the potential risk of the infant being exposed to the medication, the benefits breastfeeding provides to the baby, and the benefits of the treatment to the mother.

Sincalide Dose in Kidney Disease:

• The manufacturer's labeling for sincalide doesn't include specific dosage adjustments for patient with kidney disease.

Sincalide Dose in Liver disease:

• The manufacturer's labeling for sincalide doesn't include specific dosage adjustments for individuals with hepatic impairment, meaning there are no recommended changes to the dose of sincalide based on liver function.

Common Side Effects of Sincalide (Kinevac):

• Gastrointestinal:
  • Abdominal Distress
  • Abdominal Pain
  • Nausea

Contraindication to Sincalide Include:

• In addition to hypersensitivity to sincalide or any component of the formulation and intestinal obstruction, the Canadian labeling for sincalide includes additional contraindications not found in the US labeling.
• These contraindications encompass situations where a fatty meal would be considered risky, including conditions such as acute abdomen, acute pancreatitis, acute cholecystitis, appendicitis, bleeding, penetrating, or perforating peptic ulcer, common bile duct obstruction, cystic duct obstruction, gallbladder empyema or infection, hollow viscous perforation, peritonitis, pyloric stenosis, and small gallbladder stones.
• These additional contraindications outline scenarios where the use of sincalide may not be advisable due to potential risks associated with these conditions.

Warnings and precautions

Gastrointestinal:

• Sincalide administration, particularly through IV injection, can sometimes lead to temporary gastrointestinal (GI) side effects like nausea, vomiting, abdominal discomfort or cramping, dizziness, and flushing.
• However, when given as an IV infusion, these risks of experiencing GI side effects may be reduced.
• Administering sincalide through IV infusion rather than injection can help lessen the likelihood of developing these adverse GI effects.

Hypersensitivity

• Hypersensitivity reactions, including severe ones like anaphylaxis, have been reported during or shortly after sincalide administration, typically within one hour.
• It's essential to closely monitor patients both during and after the infusion for any signs of hypersensitivity.
• If any hypersensitivity reaction occurs, therapy should be stopped immediately, and appropriate treatment for the reaction should be initiated promptly.
• Taking swift action is crucial to manage these potentially serious allergic responses effectively.

Obstruction

• There's a slight risk of small gallstones being pushed into the cystic duct or common bile duct and causing a blockage with the use of sincalide.
• However, this risk is generally minimal.
• It's essential for healthcare providers to be aware of this potential complication, especially in patients who already have gallstones or other conditions affecting bile flow.
• Monitoring for any signs or symptoms of obstruction during or after sincalide administration can help manage this risk effectively.

Sincalide: Drug Interaction

Monitoring parameters:

Hypersensitivity Reaction

• What it is: Some people might have a serious allergic reaction to sincalide, especially during or within an hour after getting it.
• Signs to Watch For: Keep an eye out for signs like sudden swelling, trouble breathing, or a skin rash during or after the infusion.
• What to Do: If any of these signs show up, stop the therapy right away and start treating the allergic reaction immediately. It's crucial to act fast to keep the person safe.

How to administer Sincalide?

IV Administration

• General: Giving sincalide through an infusion instead of a quick injection can help manage some adverse events or make it easier for the digestive system to tolerate.

Contraction of Gallbladder

• IV Push: Inject over 30 to 60 seconds.
• IV Infusion: Mix in 100 mL of normal saline (NS) and infuse at a rate of 2 mL per minute.

Pancreatic Function

• Administration: Give over 30 minutes, starting 30 minutes after beginning a secretin infusion.

Accelerate Barium Transit Through Small Bowel

• IV Push: Inject over 30 to 60 seconds.
• IV Infusion: Mix in 100 mL of NS and infuse over 30 minutes. Administer after the barium meal moves beyond the proximal jejunum.

Mechanism of action of Sincalide (kinevac):

• Sincalide does a few things in the body: it makes the gallbladder squeeze, slows down the emptying of the stomach by making the muscle at the bottom of the stomach (called the pylorus) tighten up, and speeds up how fast things move through the intestines.
• It also makes the pancreas release more digestive juices.
• Overall, it helps with digestion by making muscles in the digestive system contract.

Start of action:

• When it comes to making the gallbladder squeeze, sincalide gets to work pretty quickly. It usually starts causing the gallbladder to contract within about 5 to 15 minutes after it's given.

International Brands of Sincalide:

• Kinevac

Sincalide Brand Names in Pakistan:

No Brands Available in Pakistan.