Mecasermin belongs to the class of medications called insulin-like growth factor (IGF-1). It is used to treat growth failure for children and adolescents whose bodies do not produce enough IGF-1.

IGF is a hormone produced in the body that works in a number of ways to ensure children grow appropriately. It works along with growth hormone to help promote bone and organ growth.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The dose of mecasermin is based on body weight and will be calculated by your child's doctor. The usual starting dose is 0.04 to 0.08 mg per kg of body weight, injected subcutaneously (under the skin), twice a day. After 1 week, your child's doctor may gradually increase the dose to a maximum dose of 0.12 mg per kg of body weight, injected twice a day. This increase will depend on how well your child tolerates the medication.

Mecasermin should be injected shortly before or just after a meal. Do not inject this medication if your child cannot eat within 20 minutes of the injection. Check the vial carefully before preparing a dose. The medication should be clear and colourless. If it is discoloured or has particles in it, discard the vial and start a new one.

Your doctor will show you how to inject this medication safely. It should be injected into the upper arm, abdomen, buttocks, or thigh. It is important to change the site of injection with each dose, to prevent lumps or fat deposits from forming underneath the skin.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor.

If you miss a dose, administer it as soon as possible and continue with your regular schedule. If it is almost time for the next dose, skip the missed dose and continue with your regular dosing schedule. Do not administer a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication in the refrigerator, in the original carton to protect it from light. Do not allow this medication to freeze. Discard any medication remaining in the vial 30 days after first using it. Keep this and all medication out of the reach of children.

Each 1 mL of clear, colourless, sterile solution, contains 10 mg of mecasermin for injection. Nonmedicinal ingredients: benzyl alcohol, sodium chloride, polysorbate 20, glacial acetic acid, sodium acetate trihydrate, and water for injection.

Do not take this medication if you:

• are allergic to mecasermin or any ingredients of the medication
• have or may have uncontrolled tissue growth or a tumour
• have had cancer in the past
• have a medical condition that may increase the risk of cancer or tumour growth
• have finished growing (the bone growth plates have closed)

Do not give this medication to children less than 2 years of age.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• headache
• pain, redness, bruising, or swelling at the injection site
• skin thickening at the injection site

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• appearance or growth of new lumps on the skin or body
• ear pain
• signs of bone problems (e.g., limping, hip or knee pain)
• symptoms of enlarged tonsils (e.g., snoring, breathing interruptions during sleep, decreased hearing)

Stop taking the medication and seek immediate medical attentionif any of the following occur:

• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of severe low blood sugar (e.g., dizziness, difficulty concentrating, sweating, nausea, fast or irregular heartbeat)
• symptoms of increased pressure in the brain (e.g., headache, nausea, vomiting)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Driving and operating machinery: Mecasermin can cause blood glucose levels to fall, causing dizziness, drowsiness, or difficulty concentrating, affecting your ability to drive and perform other potentially hazardous activities. Avoid participating in any high-risk activities for 2 to 3 hours after using mecasermin, especially while starting treatment with this medication.

Low blood glucose (hypoglycemia): Mecasermin has effects similar to insulin, in that it causes blood sugar to be used by the body for energy and growth. As a result, low levels of glucose in the blood can occur. To help reduce the likelihood of this happening, mecasermin should not be given without a meal or snack.

Symptoms of mild to moderate hypoglycemia may occur suddenly and can include cold sweat, nervousness or shakiness, fast heartbeat, headache, hunger, confusion, lightheadedness, weakness, and numbness or tingling of the tongue, lips, or fingers. Mild to moderate hypoglycemia may be treated by eating foods or drinks that contain sugar.

If your child has diabetes, it may be necessary to reduce medications used to treat the diabetes, in order to prevent episodes of dangerously low blood glucose. Blood sugar may need to be checked more frequently.

Scoliosis: For children who have scoliosis, rapid growth may cause scoliosis to worsen. Your doctor will monitor for progression of scoliosis.

Tumour growths: Tumours are caused by uncontrolled growth of specific types of cells. They may be non-cancerous (benign) or cancerous (malignant). Children and adolescents treated with mecasermin may develop tumours. If you experience or notice that your child is experiencing unusual swellings or growths, contact your doctor as soon as possible.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

If you could become pregnant, you should have a pregnancy test before starting to use this medication.

Breast-feeding: It is not known if mecasermin passes into breast milk. If you are breast-feeding and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children less than 2 years of age.

There may be an interaction between mecasermin and any of the following:

• acetylsalicylic acid (ASA)
• androgens (e.g., testosterone)
• chloroquine
• diabetes medications (e.g., acarbose, dapagliflozin, exenatide, glyburide, insulin, metformin, rosiglitazone, sitagliptin)
• disopyramide
• hydrochloroquine
• lanreotide
• mifepristone
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• octreotide
• pasireotide
• pegvisomant
• pentamidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• sulfonamide antibiotics ("sulfas"; e.g., sulfisoxazole, sulfamethoxazole)
• sunitinib
• tramadol

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.