Somatropin (Nutropin, Norditropin) is a recombinant human growth hormone

• Use in Growth failure (pediatric patients):

  • It is employed to treat growth failure brought on by insufficient endogenous growth hormone production.

  • It is also utilized in patients with Turner syndrome, Noonan syndrome, and Prader-Willi syndrome who have low stature.

  • It can be used to treat chronic kidney disease-related growth failure until a renal transplant is performed.

  • It is widely used in the treatment of pediatric patients whose epiphyses are not closed and for whom other causes associated with short stature have been excluded.

  • Treatment of growth failure or short stature associated with short stature homeobox gene (SHOX) deficiency

  • It is also used in the treatment of growth failure in children born small for gestational age who fail to achieve catch-up growth by 2 years of age or by 2 to 4 years of age.

  • It is used in the treatment of idiopathic short stature (nongrowth hormone-deficient short stature),

• Use in Growth hormone deficiency (adults):

  • It is used for the replacement of endogenous growth hormone in adults with growth hormone deficiency who meet either of the following points:

  • Adult-onset:

    • Patients with adult growth hormone deficiency due to pituitary disease, hypothalamic disease, radiation therapy, surgery, or trauma

              or

• Childhood-onset:

  • Patients who were deficient in growth hormone during childhood as a result of congenital, genetic, acquired, or idiopathic causes.

• HIV-associated wasting, cachexia:

  • HIV patients with wasting or cachexia can also be treated with growth hormones.

• Short bowel syndrome:

  • It is also used in the treatment of short-bowel syndrome patients getting specialized nutritional support.

• Off-Label Usage of somatropin In Adults:

  • It has used in HIV-associated adipose redistribution syndrome (HARS).

Somatropin Dose in Adults

Dose in the treatment of Growth hormone deficiency:

• The dose is adjusted to reduce adverse events in older or overweight patients.
• Dosage should be decreased during therapy if required by the occurrence of side effects or excessive IGF-I levels.

• Weight-based dosing:

  • Obese patients experience more adverse effects when treated with a weight-based regimen;
  • use is not recommended.

• Norditropin:

  • Initially, 0.004 mg/kg/day subQ is given.
  • The dose can be increased up to a maximum of 0.016 mg/kg/day.

• Nutropin, Nutropin AQ:

  • ≤0.006 mg/kg/day subQ is given.
  • The dose can be increased up to a maximum of 0.025 mg/kg/day in patients ≤35 years, or up to a maximum of 0.0125 mg/kg/day in patients >35 years

• Humatrope:

  • ≤0.006 mg/kg/day is usually given
  • The dose may be increased up to a maximum of 0.0125 mg/kg/day

• Genotropin, Omnitrope:

  • SubQ: Weekly dosage:

    • 0.04 mg/kg or less divided into 6 or 7 equal doses and administered 6 or 7 days per week.
    • The dose may be increased at 4- to 8-week intervals to a maximum of 0.08 mg/kg/week

  • Saizen: SubQ:

    • 0.005 mg/kg/day or less;
    • After four weeks, the dose may be increased to ≤0.01 mg/kg/day.

  • Zomacton: SubQ:

    • 0.006 mg/kg/day;
    • The dose may be increased up to a maximum of 0.0125 mg/kg/day

• Non-weight-based dosing:

  • Manufacturer labeling:
    • Initial dose is~0.2 mg/day sub Q
    • (range: 0.15 to 0.3 mg/day)
    • Can increase every 1 to 2 months by 0.1 to 0.2 mg/day based on response & serum IGF-I levels.
• Off Label alternative recommendations:
  • Initially, the dose in people aged less than 30 years is 0.4 to 0.5 mg/day
  • Higher doses may be required if transitioning from pediatric treatment.
  • In people, aged between 30 and 60 years dose is  0.2 to 0.3 mg/day
  • Lower initial doses (0.1 to 0.2 mg/day) are needed in patients with diabetes or glucose intolerance.
  • Quantity is adjusted by 0.1 to 0.2 mg/day in 1- to 2-month intervals.

• Adjustment of Dose with estrogen supplementation:

  • Larger doses of somatropin are given to women taking oral estrogen replacement products
  • Dosing not affected by topical products

Label Dosage in the treatment of HIV-associated adipose redistribution syndrome:

• Serostim:

  • Induction:

    • 4 mg sub Q once daily at bedtime for 12 weeks is given

  • Maintenance:

    • 2 mg or 4 mg subQ on alternate days at bedtime for 12 to 24 weeks.

Dosage in the treatment of HIV-associated wasting, cachexia:

• Serostim:

  • Initially, 0.1 mg/kg sub Q once daily is given at bedtime
  • The maximum dose is  6 mg/day
  • Patients in danger of side effects (eg, glucose intolerance) are started at 0.1 mg/kg every other day.
  • The dose is adjusted to manage side effects.

• Daily dose based on body weight:

  • <35 kg:
    • 0.1 mg/kg
  • 35 to 45 kg:
    • 4 mg
  • 45 to 55 kg:
    • 5 mg
  • >55 kg:
    • 6 mg

Dosage in the treatment of Short-bowel syndrome:

• Zorbtive:
  • 0.1 mg/kg sub Q is given once daily for 28 days
  • The maximum dose is 8 mg/day
• Fluid retention (moderate) or arthralgias:
  • Treat symptomatically or reduce dose by 50%​​​​​​​
• Severe toxicity:
  • Discontinue therapy for 5 days
  • Restart at half dose.
  • If severe toxicity occurs again or does not end within 5 days after discontinuation then permanently discontinue treatment.

Somatropin Dose in Children 

Dose in the treatment of AIDS-related wasting or cachexia:

• Serostim:
  • Children ≥6 years and Adolescents:
    •  0.04-0.07 mg/kg/day S/C for 28 days

Somatropin (Nutropin, Norditropin) dose in the treatment of chronic renal disease:

• Nutropin, Nutropin AQ:

  • 0.35 mg/kg S/C is given weekly and divided into daily injections
  • It is continued until the time of renal transplantation

• Dosage recommendations in patients who require dialysis for chronic renal insufficiency:

  • Hemodialysis:
    • Administer dose at night before bedtime or at least 3-4 hours after hemodialysis to prevent hematoma formation from heparin
  • CCPD:
    • Give the dose in the morning following dialysis
  • CAPD:
    • Administer the dose at the time of the overnight exchange in the evening.

Dose in the treatment of Growth hormone inadequacy:

• Children and Adolescents:
  • Therapy should be stopped when the following has been achieved:
    • Reached satisfactory adult height
    • When epiphyses have fused
    • When the patient ceases to respond.

• Growth of 5 cm/year or more is expected

• If the growth rate does not increase by 2.5 cm in a 6-month period then double the dose for the next 6 month

• If there is still no satisfactory response stop therapy.

• Genotropin, Omnitrope:

  • 0.16-0.24 mg per kg S/C weekly divided into daily doses

• Norditropin:

  • 0.024-0.034 mg per kg per dose S/C 6-7 times per week

• Humatrope:

  • 0.18-0.3 mg per kg S/C weekly divided into equal doses of 6-7 days/week​​​​​​​
• Nutropin, Nutropin AQ:
  • 0.3 mg per kg weekly S/C divided into daily doses;
  • Dosage may be increased in pubertal patients to 0.7 mg/kg weekly divided into daily doses

• Saizen:

  • 0.06 mg per kg per dose administered 3 days per week or
  • 0.18 mg/kg weekly I/M or S/C divided into equal daily doses or
  • 0.03 mg per kg per dose administered 6 days per week

• Tev-Tropin:

  • 0.3 mg per kg S/C divided 3 times per week

Somatropin (Nutropin, Norditropin) dose in the treatment of Idiopathic short stature: ​​​​​​​

• Humatrope:
  • 0.37 mg per kg S/C weekly divided into daily doses​​​​​​​
• Genotropin, Omnitrope:
  • 0.47 mg per kg S/C weekly divided into equal doses of 6-7 days per week​​​​​​​
• Nutropin, Nutropin AQ:
  • Up to 0.3 mg per kg per week administered in 7 equal doses divided into daily doses

Somatropin (Nutropin, Norditropin) dose in the treatment of Noonan syndrome:

• Norditropin:
  • Up to 0.066 mg per kg per day

Somatropin (Nutropin, Norditropin) dose in the treatment of Prader-Willi syndrome:

• Genotropin, Omnitrope:
  •  0.24 mg per kg per week divided daily into six or seven doses per week

Somatropin (Nutropin, Norditropin) dose in the treatment of SGA at birth who fail to catch up by 2-4 years of age:

• Children:
  • Genotropin, Omnitrope:
    • 0.48 mg per kg S/C weekly divided daily into 6-7 doses per week
  • Humatrope:
    • 0.47 mg per kg S/C weekly divided into equal doses 6-7 days per week
  • Norditropin:
    • Up to 0.469 mg/kg S/C weekly divided into equal doses 7 days/week
  • ​​​​​​​Alternate dosing (small for gestational age):
    • In older/early pubertal children or children with very short stature,  initiate therapy at higher doses
    • 0.46 mg/kg weekly divided into equal doses 7 days/week
    • Then reduce the dose to 0.231 mg/kg weekly if substantial catch-up growth observed
    • In younger children (<4 years) with less severe short stature start therapy with lower doses (0.231 mg/kg weekly) and then titrate the dose upward as needed.

Somatropin (Nutropin, Norditropin) dose in the treatment of SHOX deficiency: ​​​​​​​

• Humatrope:
  • 0.35 mg per kg S/C weekly divided into equal doses of 6-7 days per week

Somatropin (Nutropin, Norditropin) dose in the treatment of Turner syndrome: ​​​​​​​

• Genotropin; Omnitrope:
  • 0.33 mg per kg weekly  is given divided into 6-7 doses/week​​​​​​​
• Humatrope:
  •  0.375 mg per kg weekly given divided into equal doses 6-7 days/week​​​​​​​
• Nutropin, Nutropin AQ:
  • Up to 0.375 mg per kg weekly given divided into equal doses 3-7 times/week

Somatropin (Nutropin, Norditropin) pregnancy Risk Factor B/C (depending upon manufacturer)

• However, adverse events have not been observed in animal reproduction studies.
• A normal pregnancy will see a decrease in maternal endogenous growth hormone production as placental growth hormone production increases.
• There are not enough data on somatropin use during pregnancy. Therefore, recommendations regarding the use in pregnant women can't be made.

Somatropin use during breastfeeding:

• It is unknown if somatropin can be found in breast milk.
• The establishment of lactogenesis can affect endogenous growth hormones. Recombinant growth hormone has been evaluated for its effectiveness as a galactagogue.
• Breastfed infants have not experienced adverse events after maternal use (limited data).
• According to the manufacturer breastfeeding during therapy is a decision that should be made after considering the risks to infants and the benefits to mothers.

Somatropin (Nutropin, Norditropin) dosage in kidney disease:

• There are no dosage adjustments given in the manufacturer's labeling;
• patients with chronic renal failure and end-stage renal disease have decreased clearance.

Somatropin (Nutropin, Norditropin) dosage in Liver disease:

• There are no dosage adjustments given in the manufacturer's labeling;
• patients with chronic renal failure and end-stage renal disease have decreased clearance.

Common Side Effects of Somatropin (Nutropin, Norditropin) include:

• Immunologic:

  • Antibody Development

• Cardiovascular:

  • Edema
  • Lower Extremity Edema
  • Peripheral Edema
  • Facial Edema

• Endocrine & Metabolic:

  • Elevated Glycosylated Hemoglobin
  • Eosinophilia
  • Hypothyroidism

• Central Nervous System:

  • Hypoesthesia
  • Headache
  • Pain
  • Paresthesia

• Gastrointestinal:

  • Nausea
  • Vomiting
  • Flatulence
  • Abdominal Pain

• Local:

  • Pain At the Injection Site
  • Injection Site Reaction

• Infection:

  • Infection

• Otic:

  • Otitis Media

• Neuromuscular & Skeletal:

  • Arthralgia
  • Arthropathy
  • Limb Pain
  • Swelling Of Extremities
  • Myalgia
  • Scoliosis
  • Ostealgia

• Respiratory:

  • Upper Respiratory Tract Infection

Less Common Side Effects of Somatropin (Nutropin, Norditropin) include:

• Cardiovascular:

  • Chest Pain
  • Hypertension

• Dermatologic:

  • Diaphoresis
  • Nevus

• Central Nervous System:

  • Fatigue
  • Nipple Pain
  • Carpal Tunnel Syndrome
  • Sleep Apnea
  • Depression
  • Insomnia

• Hematologic & Oncologic:

  • Hematoma

• Endocrine & Metabolic:

  • Impaired Glucose Tolerance
  • Dependent Edema
  • Diabetes Mellitus
  • Hypertriglyceridemia
  • Hyperglycemia
  • Hyperlipidemia
  • Gynecomastia
  • Fluid Retention

• Genitourinary:

  • Breast Hypertrophy
  • Mastalgia
  • Urinary Tract Infection
  • Breast Neoplasm
  • Breast Swelling
  • Breast Tenderness

• Infection:

  • Influenza

• Neuromuscular & Skeletal:

  • Stiffness
  • Joint Stiffness
  • Joint Swelling
  • Tonsillitis
  • Abnormal Bone Growth
  • Leg Pain
  • Hip Pain

• Otic:

  • Otitis

• Ophthalmic:

  • Periorbital Edema

• Respiratory:

  • Sinusitis
  • Dyspnea
  • Bronchitis
  • Flu-Like Symptoms

Rare side effects of Somatropin (Nutropin, Norditropin):

• Dermatologic:

  • Exacerbation Of Psoriasis
  • Rash At the Injection Site
  • Alopecia
•  

• Central Nervous System:

  • Aggressive Behavior
  • Seizure

• Endocrine & Metabolic:

  • Disturbance In Fluid Balance
  • Glycosuria
  • Hypoglycemia

• Genitourinary:

  • Hematuria

• Gastrointestinal:

  • Gastroenteritis

• Hematologic & Oncologic:

  • Meningioma

• Respiratory:

  • Pharyngitis

• Local:

  • Bleeding At the Injection Site
  • Burning Sensation At Injection Site
  • Erythema At Injection Site
  • Fibrosis At Injection Site
  • Inflammation At the Injection Site
  • Injection Site Nodule
  • Injection Site Numbness
  • Local Skin Hyperpigmentation
  • Swelling At the Injection Site

• Neuromuscular & Skeletal:

  • Lipoatrophy
  • Musculoskeletal Disease
  • Weakness

Contraindications to Somatropin (Nutropin, Norditropin) include:

• Pediatric patients with Prader–Willi syndrome is either severely obese or suffer from severe respiratory impairment.
• Acute critical illness caused by complications following open heart surgery or abdominal surgery
• Multiple accidental traumas or acute respiratory failure
• active malignancy;
• Patients with Prader-Willi syndrome who have had a history of sleep apnea (Genotropin and Humatropin, Norditropins, Norditropins, Nutropin, NutropinAQ, Omnitrope, and Zomacton).
• Hypersensitivity to somatropin and any component of the formulation
• Growth promotion for pediatric patients with closed epiphyses
• Active proliferative and severe nonproliferative diabetic retinopathy
• Pregnancy and lactation
• Renal transplant
• Active intracranial tumor;
• Critically ill patients
• diabetes mellitus

Warnings and precautions

• Glucose tolerance:

  • Somatropin may decrease insulin sensitivity.
  • It is possible to detect previously undiagnosed impaired glucose tolerance or overt diabetes mellitus;
  • Type 2 diabetes can be new-onset or exacerbated.
  • Some patients have experienced diabetic ketoacidosis or diabetic coma.
  • Some patients may be able to tolerate glucose better after discontinuing somatropin.
  • It is possible to adjust antidiabetic medication.

• Fluid retention:

  • Fluid retention can happen in adults.
  • Patients may present with edema, arthralgia, myalgia, and nerve compression syndromes [including carpal tunnel syndrome]/paresthesias are generally transient and dose-dependent.
  • Stop taking somatropin if symptoms of carpal tunnel syndrome do not resolve.

• Hypersensitivity

  • There have been serious systemic hypersensitivity reactions including anaphylactic reactions or angioedema.

• Intracranial hypertension

  • It has been reported that intracranial hypertension may cause headaches, nausea, papilledema, and visual changes. Symptoms usually appear within 8 weeks of treatment. After discontinuation or reduction, signs and symptoms of intracranial Hypertension will often resolve quickly.
  • It is recommended to have a funduscopic exam before starting therapy, and again periodically afterward.
  • Patients with papilledema should stop treatment immediately. If IH-associated symptoms and signs have resolved, it may be possible to resume treatment at a lower dose.
  • Patients with Turner syndrome, chronic renal impairment, Prader-Willi Syndrome, and Prader syndrome may be at higher risk of developing intracranial hypertension.

• Lipoatrophy

  • When lipoatrophy is sustained for a long time, it can be seen at injection sites.
  • Use proper injection technique. Rotate injection sites.

• Neoplasm

  • Patients with active malignancy have a higher risk of developing malignancy.
  • Any preexisting malignancy must be treated and inactive before starting therapy. If there is evidence of progression or recurrence, stop the therapy.
  • For recurrence of or progression of the underlying condition, monitor patients with preexisting tumors and growth hormone deficiencies due to intracranial lesions.
  • Children with cancer treated with somatropin have a higher risk of developing the second neoplasm.
  • Patients with HIV and children with short stature (genetic cause), have a higher baseline risk of developing malignancies. Before initiating therapy, consider the risks and benefits and monitor these patients closely.
  • All patients should be monitored for malignant skin lesions.
  • Before you start treatment, make sure to rule out a pituitary tumors or other brain tumors. Growth hormone deficiency could be a sign that these tumors are present.

• Pancreatitis

  • It is rare to see pancreatitis; however, the incidence of Turner syndrome in children (especially girls with it) may be higher than that seen in adults.
  • If you experience abdominal pain, consider a diagnosis of pancreatitis.

• Slipped capital femoral epiphyses

  • Slippery capital femoral epiphyses can occur more often in patients with endocrine conditions (including Turner syndrome and growth hormone deficiency) or in patients who are undergoing rapid growth.
  • Any child who has a limp, or is complaining of pain in the hips or knees, should be evaluated.

• Acute critical illness

  • Acute critical illness, such as complications from open heart surgery or abdominal surgery, multiple accidents trauma, or increased mortality, is not a reason to initiate somatropin.
  • Patients with an acute critical illness may need to stop therapy.

• Childhood-onset adult growth hormone deficiency:

  • Before initiating somatropin treatment for growth hormone deficiency, patients who have been treated with somatropin during childhood should be examined.

• Chronic kidney disease

  • For signs of progression, it is important to monitor children suffering from growth problems secondary to chronic kidney disease.
  • Children with advanced renal osteodystrophy may have a slipped capital femoral epiphysis or avascular necrosis at the femoral heads.
  • Before initiating somatropin for CKD patients, obtain hip radiographs.
  • Patients might experience pain in their hips or knees or may be unable to walk.

• Hypoadrenalism

  • After initiating somatropin, some people may experience subclinical hypoadrenalism.
  • Those at high risk of pituitary hormonal deficiency and those with reduced serum cortisol levels are at greater risk.
  • patients with previously diagnosed hypoadrenalism might require increased dosages of glucocorticoids due to the effects of somatropin.
  • Excessive glucocorticoid therapy also inhibits the growth-promoting effects of somatropin in children;
  • monitor and adjust glucocorticoids carefully.

• Hypothyroidism:

  • Pituitary hormone deficiency is a risk factor for patients who are at high risk or have pituitary hormone deficiencies.
  • Patients with Turner syndrome are more likely to develop autoimmune thyroid disease and primary hyperthyroidism.
  • Untreated/undiagnosed hypothyroidism can decrease response to therapy, particularly the growth response in children.
  • Monitor thyroid functions periodically and initiates thyroid replacement therapy with levothyroxine as needed.

• Noonan syndrome:

  • Noonan syndrome is not recommended for children suffering from severe cardiac disease.

• Prader-Willi syndrome:

  • After the administration of growth hormones, fatalities were reported in children with Prader-Willi Syndrome.
  • Patients who had any of the following risk factors were at increased risk for death:
    • including severe obesity,
    • Respiratory impairment
    • History of upper airway obstruction
    • Sleep apnea, unidentified respiratory infection
  • Male patients are at higher risk
  • Before starting therapy, monitor for symptoms such as sleep apnea or upper airway obstruction. Also, check regularly for respiratory infections.
  • Patients with signs of upper-airway obstruction such as snoring or new-onset sleep disorder should be treated immediately.
  • Patients with Prader-Willi Syndrome should be able to control their weight.
  • Prader-Willi patients must not also be diagnosed with growth hormone deficiency. Therefore, it is not recommended that Prader-Willi patients are treated for long-term growth problems in children who have Prader-Willi syndrome.

• Scoliosis:

  • Children who grow rapidly can develop scoliosis.
  • Monitor for signs of worsening scoliosis.

• Turner syndrome:

  • Patients with Turner syndrome are at greater risk of developing otitis media or other ear/hearing disorders.
  • They also have an increased chance of primary hypothyroidism and autoimmune thyroid disease.
  • These conditions should be monitored for patients suffering from Turner syndrome.

Recombinant human growth hormone (somatropin): Drug Interaction

Monitoring Parameters:

Treatment of growth hormone deficiency in children):

• clinical evidence of slipped capital femoral epiphyses, such as a limp or hip or knee pain;
• thyroid function tests;
• Growth response;
• adrenal and thyroid function in patients with growth hormone deficiency due to multiple pituitary hormone deficiencies;funduscopic exam before treatment;
• progression of scoliosis in patients with a previous history of scoliosis;
• glucose in patients with risk factors for glucose intolerance;
• progression of pre-existing nevi.
• a physical exam at every visit;
• progression or recurrence of tumor in patients treated for growth deficiency due to a tumor or tumor development in at-risk patients;
• monitor serum IGF-I;
• funduscopic exam if symptoms of intracranial hypertension occur

Chronic kidney disease:

• Progression of renal osteodystrophy.

Idiopathic short stature:

• weight,
• pubertal development
• Height,
• adverse events every 3 to 6 months

Turner syndrome:

• Ear disorders including otitis media; cardiovascular disorders (eg, stroke, aortic aneurysm/dissection, hypertension).

Prader-Willi syndrome:

• sleep apnea,
• respiratory infections
• Signs of upper airway obstruction (includes the onset of or increased snoring),
• effective weight control.

Noonan syndrome:

• Before using, verify short stature syndrome.

Treatment of growth hormone deficiency (adults):

• During dosage titration, track clinical response, serum IGF-I, and adverse effects every 1 to 2 months.
• Serum IGF-I, BMI, fasting glucose, hemoglobin A1c, waist to hip ratio, thyroid function (free T4), adrenal function, lipid profile, blood pressure, clinical response, and side effects should all be checked twice a year after starting a maintenance dosage.
• If the initial bone scan is abnormal, BMD should be performed prior to treatment, and a DXA scan should be repeated every 1.5 to 3 years.

Short bowel syndrome:

• The diet should be optimized before therapy and nutritional status monitored during treatment;
• colonoscopy before therapy (in patients with residual colon) especially if risk factors for colon cancer are present.
• Additionally, monitor for progression of preexisting nevi;
• glucose in patients with risk factors for glucose intolerance;
• thyroid function before and 4 weeks after treatment initiation in patients with suspected or diagnosed hypopituitarism;
• funduscopic examination at the initiation of therapy

How to administer Somatropin (Nutropin, Norditropin)?

• Do not shake.
• Administer SubQ;
• Do not inject IV.
• Rotate the site of administration (back of upper arm, abdomen, buttock, or thigh) to avoid tissue atrophy.

Mechanism of action of Somatropin (Nutropin, Norditropin):

• Somatropin, a purified polypeptide hormonal hormone with recombinant DNA origin, is available.
• Somatropin contains the same sequence of amino acids as human growth hormone.
• It aids in the growth of skeletal and linear bone and organs, by increasing chondrocyte differentiation and proliferation, lipolysis and protein synthesis, as well as hepatic glucose production.
• It increases red blood cell volume by stimulating erythropoietin.
• Insulin-like and diabetogenic effects increase the transmucosal transports of nutrients, electrolytes and water across the gut.

Distribution: V : Nutropin AQ: 50 mL/kg; Norditropin: 43.9 ± 14.9 L

Metabolism: Hepatic and renal metabolism

Bioavailability:

• SubQ: Nutropin AQ; Saizen; Serostim; Zorbtive: 70% - 90%

Half-life elimination: Genotropin: SubQ: in 3 hours Humatrope: SubQ: in 3.8 hours Norditropin: SubQ: almost 7 to 10 hours Nutropin, Nutropin AQ: SubQ: in 2.1 ± 0.43 hours Omnitrope: SubQ: in 2.5 to 2.8 hours Saizen: SubQ: almost 2 hours Serostim: SubQ: in 4.28 ± 2.15 hours Zomacton: SubQ: almost 2.7 hours Zorbtive: SubQ: in 4 ± 2 hours

Excretion: via Urine

International Brands of Somatropin:

• Genotropin
• Genotropin MiniQuick
• Humatrope
• Norditropin FlexPro
• Norditropin NordiFlex Pen
• Nutropin AQ NuSpin 10
• Nutropin AQ NuSpin 20
• Nutropin AQ NuSpin 5
• Nutropin AQ Pen
• Omnitrope
• Saizen
• Saizen Click.Easy
• Saizenprep
• Serostim
• Tev-Tropin
• Zomacton
• Zorbtive
• Genotropin GoQuick
• Genotropin MiniQuick
• Humatrope
• Norditropin NordiFlex Pen
• Norditropin SimpleXx
• Nutropin AQ NuSpin 10
• Nutropin AQ NuSpin 20
• Nutropin AQ NuSpin 5
• Nutropin AQ Pen
• Omnitrope
• Saizen
• Serostim
• Caretropin
• Declage
• Eutropin
• Genheal
• Genotonorm
• Genotonorm Miniquick
• Genotropin
• Growject BC
• Growtropin II
• Growtropin-Aq
• Growtropin-II
• HHT
• Humatrope
• Nordilet
• Norditropin Nordilet
• Norditropin Simplex
• Norditropin Simplexx
• Novell-
• Eutropin
• Nutropin AQ
• Nutropinaq
• Omnitrope
• Saizen
• Scitropin
• Scitropin A
• Scitropina
• Valtropin
• Xerendig
• Zoamcton
• Zomacton

Somatropin brands in Pakistan: