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Increased mortality in patients with acute critical illness due to complications following open heart surgery, abdominal surgery or multiple accidental trauma, or those with acute respiratory failure has been reported after treatment with pharmacologic doses of somatropin. The safety of continuing SKYTROFA treatment in patients receiving replacement doses for approved indications who concurrently develop these illnesses has not been established

Serious systemic hypersensitivity reactions including anaphylaxis and angioedema have been reported with post-marketing use of somatropin products. Inform patients and caregivers that such reactions are possible and that prompt medical attention should be sought if an allergic reaction occurs. Do not use SKYTROFA in patients with known hypersensitivity to SKYTROFA or any of its excipients

Patients with active malignancy have an increased risk of progression with somatropin treatment. Any preexisting malignancy should be inactive and treatment complete before instituting therapy with SKYTROFA. In childhood cancer survivors treated with radiation to the brain/head for their first neoplasm who developed subsequent GHD treated with somatropin, an increased risk for a second neoplasm has been reported. Monitor patients with a history of GHD secondary to an intracranial neoplasm routinely for progression/recurrence of the tumor. Monitor patients carefully for development of neoplasms and/or increased growth/potential malignant changes of preexisting nevi

Treatment with somatropin may decrease insulin sensitivity, and new onset type 2 diabetes mellitus has been reported. Previously undiagnosed impaired glucose tolerance and overt diabetes mellitus may be unmasked. Patients with type 1 and 2 diabetes mellitus or impaired glucose tolerance should be monitored closely, and antihyperglycemic drugs may require adjustment

Intracranial hypertension (IH) with papilledema, visual changes, headache, nausea, and/or vomiting has been reported in a small number of patients treated with somatropin. Symptoms resolved rapidly after cessation of therapy/reduction of the dose. Perform fundoscopic examination routinely before initiating treatment with SKYTROFA to exclude preexisting papilledema, and periodically thereafter. If papilledema is observed, stop the treatment. If somatropin-induced IH is diagnosed, restart treatment at a lower dose after IH-associated signs and symptoms have resolved

Fluid retention during somatropin therapy may occur. Clinical manifestations of fluid retention (eg, edema, arthralgia, myalgia, nerve compression syndromes including carpal tunnel syndrome/paresthesia) are usually transient and dose dependent

Patients receiving somatropin therapy may be at risk for reduced serum cortisol levels and/or unmasking of central hypoadrenalism. Patients treated with glucocorticoid replacement for previously diagnosed hypoadrenalism may require an increase in their maintenance/stress doses following initiation of SKYTROFA therapy. Monitor patients with known hypoadrenalism for reduced serum cortisol levels and/or need for glucocorticoid dose increases

Undiagnosed or untreated hypothyroidism may prevent response to SKYTROFA. Central hypothyroidism may first become evident or worsen with treatment. Perform periodic thyroid function tests and initiate/properly adjust thyroid hormone replacement therapy when indicated

Slipped capital femoral epiphysis may occur more frequently in patients undergoing rapid growth. Evaluate pediatric patients with the onset of a limp or complaints of persistent hip or knee pain

Monitor patients for progression of preexisting scoliosis

Cases of pancreatitis have been reported in pediatric patients receiving somatropin. Consider pancreatitis in patients with persistent severe abdominal pain

Lipoatrophy may result when somatropin is administered at the same site over a long period of time. Rotate injection sites to reduce this risk

There have been reports of fatalities after initiating therapy with somatropin in pediatric patients with Prader-Willi syndrome who had one or more of the following risk factors: severe obesity, history of upper airway obstruction or sleep apnea, or unidentified respiratory infection. Male patients with one or more of these factors may be at greater risk than females. SKYTROFA is not indicated for the treatment of pediatric patients who have growth failure due to genetically confirmed Prader-Willi syndrome

Serum levels of inorganic phosphorus, alkaline phosphatase, and parathyroid hormone may increase after somatropin treatment. Monitor abnormal laboratory tests as appropriate

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