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About Metopirone®

What is Metopirone®?

Each soft capsule of Metopirone® contains 250 mg of metyrapone.1

Indication:1

Metopirone® is a diagnostic drug for testing hypothalamic-pituitary ACTH function. The metyrapone diagnostic test should be restricted to referral hospital centers.

Overnight single‑dose
Metopirone® test (OMT)

Multiple‑dose
6-day treatment plan Metopirone® test

Where


Outpatient*

Hospitalization required

Adult dosage

30 mg/kg at midnight (maximum 3 g) with yogurt or milk


750 mg orally, every 4 hours for 6 doses (total dose of 4.5 g) with milk or snack

Pediatric dosage

30 mg/kg at midnight (maximum 3 g) with yogurt or milk


Take 15 mg/kg orally (minimum 250 mg) every 4 hours for 6 doses with milk or snack

Labs


1 blood sample: Plasma 11-DOC and/or ACTH levels


Samples: 24-hrs urinary 17-OHCS and/or 17-KGS levels. Urine testing done Day 1, 2, and 6. Measure ATCH levels on Day 2.

When to measure


Early in the following morning
(7:30 - 8:00 am)


Day 1 and 2 (before Metopirone® administration) and Day 6 (after Metopirone® administration)

Figure prepared by HRA Pharma based on Metopirone US Prescribing Information.

* Patients with suspected adrenocortical insufficiency should be hospitalized overnight as a precautionary measure.

Abbreviations:
ACTH: Adrenocorticotropic hormone; 11-DOC: 11-deoxycortisol; 17–OHCS: 17-hydroxycorticosteroids; 17–KGS: 17 ketogenic steroids.

Method of administration:1

The capsules should be taken with a snack, yogurt or milk.

Mode of action:1,2

Metopirone® is an inhibitor of endogenous adrenal corticosteroid synthesis.
It reduces cortisol and corticosterone production by inhibiting the 11 β – hydroxylation reaction in the adrenal cortex.

As a consequence: compensatory rise in ACTH and increase in:

  • 11-deoxycortisol (S compound) and ACTH levels in plasma (OMT)
  • 17-OHCS and 17-KGS levels in urine (STD)

Figure prepared by HRA Pharma based on Metopirone US Prescribing Information.

REFERENCES

1. Metopirone®US Prescribing Information, February 2020
2. Avgerinos PC, Yanovski JA, Oldfield EH, Nieman LK, Cutler GB Jr. The metyrapone and dexamethasone suppression tests for the differential diagnosis of the adrenocorticotropin-dependent Cushing syndrome: a comparison. Ann Intern Med. 1994;121(5):318-327. doi:10.7326/0003-4819-121-5-199409010-00002

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