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Glucocorticoids: In patients receiving concomitant NGENLA and glucocorticoid treatments, glucocorticoid dosing should be carefully monitored to avoid both hypoadrenalism and an inhibitory effect on growth.
The microsomal enzyme 11β-hydroxysteroid dehydrogenase type 1(11βHSD-1) is required for conversion of cortisone to its active metabolite, cortisol, in hepatic and adipose tissue.
Treatment with daily growth hormone products inhibits 11βHSD-1, reducing serum cortisol concentrations, which may unmask previously undiagnosed central (secondary) hypoadrenalism or render low glucocorticoid replacement doses ineffective (see Precautions).
Patients treated with cortisone acetate and prednisone may be affected more than others because conversion of these drugs to their biologically active metabolites is dependent on the activity of 11βHSD-1.
Insulin and/or oral/injectable hypoglycemic agents: In patients with diabetes mellitus requiring drug therapy, the dose of insulin and/or oral/injectable agent may require adjustment when NGENLA therapy is initiated (see Precautions).
Cytochrome P450 metabolized products: Drug-drug interaction studies have not been performed with somatrogon. Somatrogon has been shown to induce CYP3A4 mRNA expression in vitro. The clinical significance of this is unknown. Studies with other human growth hormone (hGH) receptor agonists performed in growth hormone deficient children and adults, and healthy elderly men, suggest that administration may increase the clearance of compounds known to be metabolized by cytochrome P450 isoenzymes, especially CYP3A. The clearance of compounds metabolized by CYP3A4 (e.g., sex steroids, corticosteroids, anticonvulsants and ciclosporin) may be increased and could result in lower exposure of these compounds.
