Dosing and uses of Kinevac (sincalide)
Adult dosage forms and strengths
lyophilized powder for reconstitution
- 5mcg/vial
Gallbladder Contraction
Indicated to stimulate gallbladder contraction, as may be assessed by various methods of diagnostic imaging, or to obtain by duodenal aspiration a sample of concentrated bile for analysis of cholesterol, bile salts, phospholipids, and crystals
0.02 mcg/kg IV injected over 30-60 seconds; if satisfactory contraction of the gallbladder does not occur in 15 minutes, a second dose may be administered
When used in cholecystography, roentgenograms are usually taken at 5-minute intervals after the injection
For visualization of the cystic duct, it may be necessary to take roentgenograms at 1-minute intervals during the first 5 minutes after the injection
Alternant administration to reduce intestinal side effects
- 0.12 mcg/kg in 100 mL NaCl as an IV infusion at rate of 2 mL/minute, OR
- 0.1 mcg/kg IM
Pancreatic Secretion
Indicated to stimulate pancreatic secretion (especially in conjunction with secretin) prior to obtaining a duodenal aspirate for analysis of enzyme activity, composition, and cytology
Secretin dose: 0.25 units/kg IV infusion over 60 minutes, THEn
Sincalide dose: 30 minutes after the initiation of the secretin infusion, a separate IV infusion of sincalide of 0.02 mcg/kg is administered over a 30-minute interval; further dilute calculated dose with sodium chloride for injection to total 30 mL; infuse IV at rate of 1 mL/minute
Barium Transit
Indicated to accelerate the transit of a barium meal through the small bowel, thereby decreasing the time and extent of radiation associated with fluoroscopy and x-ray examination of the intestinal tract
Administer sincalide after the barium meal is beyond the proximal jejunum 0.04 mcg/kg IV injected over 30-60 seconds; if satisfactory transit of the barium meal has not occurred in 30 minutes, a second dose may be administered.
Alternant administration to reduce intestinal side effects: 0.12 mcg/kg diluted in 100 mL NaCl infused IV over 30 minutes
Pediatric dosage forms and strengths
Safety and efficacy not established
Kinevac (sincalide) adverse (side) effects
>10%
Abdominal discomfort or pain (20%)
Nausea (20%)
1-10%
Dizziness (2%)
<1%
Vomiting
Flushing
Sweating
Rash
Hypotension
Hypertension
Shortness of breath
Urge to defecate
Headache
Diarrhea
Sneezing
Numbness
Warnings
Contraindications
Hypersensitivity
Intestinal obstruction
Cautions
Stimulating gallbladder contraction in patients with small gallbladder stones could result in stones lodging in the cystic duct or the common bile duct
Stimulates smooth muscle contraction; risk of uterine stimulation (see Pregnancy and lactation)
Pregnancy and lactation
Pregnancy category: B; limited potential for teratogenic effect on fetus, however, because of sincalide’s action to stimulate smooth muscle, pregnant patients should be advised that spontaneous abortion or premature induction of labor may occur
Lactation: Unknown if distributed in human breast milk
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Kinevac (sincalide)
Mechanism of action
Cholecystopancreatic-gastrointestinal hormone peptide; produces a substantial reduction in gallbladder size by causing this organ to contract; evacuation of bile that results is similar to that which occurs physiologically in response to endogenous cholecystokinin
Like cholecystokinin, sincalide stimulates pancreatic secretion; concurrent administration with secretin increases both the volume of pancreatic secretion and the out-put of bicarbonate and protein (enzymes) by the pancreas
This combined effect of secretin and sincalide permits the assessment of specific pancreatic function through measurement and analysis of the duodenal aspirate; parameters usually determined are: volume of the secretion; bicarbonate concentration; and amylase content (which parallels the content of trypsin and total protein)
Both cholecystokinin and sincalide stimulate intestinal motility, and may cause pyloric contraction which retards gastric emptying
Absorption
Time to maximal effect: 5-15 minutes
Administration
IV Preparation
Reconstitute lyophilized powder by adding 5 mL of sterile water for injection per 5 mcg viaL
IV Administration
Varies for specific indication, see Adult Dosing
Storage
Unreconstituted vial: Store at controlled room temperature (25° C [77° F]); excursions permitted to 15-30° C (59-86° F)
Reconstituted vial: May store at room temperature; use within 8 hr of reconstitution
