Sermorelin Anesthesia and Perioperative Interaction: What Patients and Clinicians Need to Know

Is there a known interaction between sermorelin and anesthesia?

The sermorelin studies in children and in healthy men did not involve anesthesia, so they do not show whether an interaction with anesthetic drugs exists in either direction.

Sermorelin is a 29-amino-acid analogue of human growth hormone-releasing hormone (GHRH), the shortest synthetic peptide with the full biological activity of GHRH [4]. It acts on the pituitary's GHRH receptor to make the body release its own growth hormone. It is not growth hormone itself [4].

The one timing detail that is documented comes from 30 healthy men aged 19 to 43: after an intravenous dose, the peptide was rapidly eliminated, but growth hormone levels stayed elevated for about 3 hours [3].

Is there a sermorelin label with pre-surgery instructions?

No. There is no current FDA-approved sermorelin prescribing label, and therefore no label-based pre-surgery hold time [1][2]. The only FDA-approved sermorelin was Geref, and its approved uses were a diagnostic test of the pituitary's ability to secrete growth hormone and treatment of idiopathic growth hormone deficiency in children with growth failure. It was never approved for adults, anti-aging, weight loss or athletic performance [1]. The manufacturer discontinued it in 2008 and FDA withdrew both applications effective June 18, 2009 [1]. In March 2013, FDA determined that Geref had not been withdrawn for reasons of safety or effectiveness [1].

Sermorelin sold in the US today is compounded, and compounded drugs are not FDA-approved: FDA does not review their safety, effectiveness or quality before they are marketed [2].

Does sermorelin affect blood sugar during surgery?

The studies did not measure sermorelin's effect on blood glucose during surgery.

What has been measured is a different setting. In a 1-year, multicenter, open-label study of 110 previously untreated prepubertal children with growth hormone deficiency, sermorelin 30 micrograms/kg subcutaneously at bedtime did not change fasting glucose, did not raise IGF-I excessively, and was well tolerated; 86 children were evaluable for growth [5]. No surgery was involved.

In a physiology study, 10 healthy men with a mean age of 68 took GHRH(1-29) 0.5 mg or 1 mg subcutaneously twice daily for 14 days; at the 1 mg dose, 24-hour growth hormone and IGF-I rose to levels not significantly different from those of 9 young men [6]. Neither regimen is an approved dose, because no sermorelin product is approved [1].

What details might the anesthesia team ask about?

Because sermorelin is a compounded injectable, there is no FDA-reviewed label for the team to look up [2]. Details the team may ask about are the product name, the dose, and the date and time of the last injection. It also helps that sermorelin is a GHRH analogue rather than growth hormone [4].