This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Pasireotide intramuscular

Updated 2 Feb 2023 | Somatostatin analogues


Powder for suspension for intramuscular injection containing pasireotide.

Drugs List

  • pasireotide 10mg powder + solvent for suspension for injection
  • pasireotide 20mg powder + solvent for suspension for injection
  • pasireotide 30mg powder + solvent for suspension for injection
  • pasireotide 40mg powder + solvent for suspension for injection
  • pasireotide 60mg powder + solvent for suspension for injection
  • SIGNIFOR 10mg powder + solvent for suspension for injection
  • SIGNIFOR 20mg powder + solvent for suspension for injection
  • SIGNIFOR 30mg powder + solvent for suspension for injection
  • SIGNIFOR 40mg powder + solvent for suspension for injection
  • SIGNIFOR 60mg powder + solvent for suspension for injection
  • Therapeutic Indications


    Acromegaly: other treatments unsuitable/ineffective
    Cushing's syndrome - treatment

    Treatment of patients with acromegaly for whom surgery is not an option or has not been curative and who are inadequately controlled on treatment with another somatostatin analogue.

    Treatment of patients with Cushing's disease for whom surgery is not an option or for whom surgery has failed.



    Recommended initial dose 40mg every 4 weeks.
    The dose can be increased to a maximum of 60mg for patients whose growth hormone (GH) and/or insulin-like growth factor-1 (IGF-1) levels are not fully controlled after 3 months of treatment with pasireotide at 40mg.

    Cushing's disease
    Recommended initial dose 10mg every 4 weeks.
    Evaluate patient for clinical benefit after the first month of treatment and periodically thereafter. Dose can be titrated every 2 to 4 months, and may be increased to a maximum of 40mg every 4 weeks.

    Patients with Hepatic Impairment

    Moderate hepatic impairment

    The recommended initial dose is 20mg every 4 weeks.

    The dose may be increased to a maximum of 40mg every 4 weeks.

    Cushing's disease
    The recommended initial dose is 10mg every 4 weeks.

    The dose may be increased to a maximum of 20mg every 4 weeks.

    Additional Dosage Information

    Switching formulations
    If switching from subcutaneous to intramuscular in the treatment of Cushing's disease, use an initial dose of 10mg by deep intramuscular injection every 4 weeks. Monitor patient for tolerability and adjust dose as necessary.

    Missed dose
    Administer missed injection as soon as possible, the next dose is to be administered 4 weeks after in order to resume normal dosing schedule of one dose every four weeks.


    Pasireotide is to be administered by deep intramuscular injection into the gluteal muscle.


    Children under 18 years
    Long QT syndrome
    Severe hepatic impairment
    Torsade de pointes

    Precautions and Warnings

    Family history of long QT syndrome
    Cardiac disorder
    Diabetes mellitus
    Electrolyte imbalance
    End stage renal disease
    History of torsade de pointes
    Moderate hepatic impairment
    New York Heart Association class III failure
    New York Heart Association class IV failure
    Non paced second/third degree AV block
    Recent myocardial infarction
    Severe renal impairment
    Unstable angina
    Ventricular fibrillation
    Ventricular tachycardia

    Correct electrolyte disorders before treatment
    Patients with diabetes may experience fluctuations in blood glucose
    Advise ability to drive/operate machinery may be affected by side effects
    Not all available strengths are licensed for all indications
    Vary injection site during prolonged therapy
    Monitor blood glucose and HbA1c before treatment
    Monitor gallbladder ultrasonically before treatment then every 6-12 months
    Monitor hepatic function before treatment and regularly during treatment
    Perform ECG before treatment
    Advise diabetics to increase self-monitoring of glucose at start of therapy
    Monitor adrenocortical function
    Monitor blood glucose 4 weeks after treatment complete
    Monitor blood glucose weekly for 4 to 6 weeks after any dose increase
    Monitor blood glucose weekly for the first 3 months and then as indicated
    Monitor closely patient with a history of congestive cardiac failure
    Monitor ECG after 3 weeks of treatment and then as clinically indicated
    Monitor HbA1c 3 months after end of treatment
    Monitor hepatic function after first 2-3 weeks, then monthly for 3 months
    Monitor patients with cardiac disorders
    Monitor pituitary function as clinically indicated
    Monitor serum electrolytes
    Advise patient to report signs of hypocortisolism
    If hypocortisolism occurs, reduce dose and/or institute steroid therapy
    Predisposition QT prolongation: Counsel patient on symptoms of arrhythmias
    Discontinue if AST or ALT level > 3x ULN and bilirubin > 2x ULN
    Discontinue if AST or ALT level exceeds 5x ULN and persists
    Discontinue if jaundice or other evidence of hepatic impairment occurs
    Do not restart following significant hepatic dysfunction
    Reduce dose or discontinue if persistent uncontrolled hyperglycaemia occurs
    Female: Ensure adequate contraception during treatment

    Pregnancy and Lactation


    Pasireotide is contraindicated in pregnancy.

    Animal studies have shown reproductive toxicity, although the risk to humans is not known.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Pasireotide is contraindicated in breastfeeding.

    Animal studies have shown that pasireotide is secreted in the milk of rats when administered subcutaneously. It is not known whether pasireotide is secreted in human breast milk.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abdominal distension
    Abdominal pain
    Acute adrenal insufficiency
    Alanine aminotransferase increased
    Aspartate aminotransferase increased
    Creatine phosphokinase increased
    Decreased appetite
    Decreased glucose tolerance
    Decreased serum sodium
    Diabetes mellitus
    Elevated amylase levels
    Elevated serum lipase
    Gamma glutamyl transferase (GGT) increased
    Increase in serum glucose
    Increased glycated haemoglobin (HbA1c) levels
    Injection site reactions
    Prolongation of QT interval
    Prothrombin time increased
    Sinus bradycardia


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: July 2018.

    Reference Sources

    Summary of Product Characteristics: Signifor powder and solvent for injection. Novartis Pharmaceuticals UK Ltd. Revised April 2018.

    NICE Evidence Services Available at: Last accessed: 25 July 2018

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.