Starting Signifor (pasireotide)Your first 90 days with Cushing disease: the steps, the dates and who to call

How you take it

Signifor is a shot under the skin 2 times a day that you give yourself after being taught. Signifor LAR is a shot into the buttock muscle every 4 weeks, given by a trained healthcare professional.

Before your first dose

• Blood tests for blood sugar (a fasting test and an HbA1c) and for your liver, because pasireotide can raise blood sugar and liver test results.
• A heart tracing (ECG) and a blood test for potassium and magnesium. Low levels are fixed before your first dose.
• An ultrasound of your gallbladder, because gallstones are common with this medicine. Your doctor may also check other pituitary hormones.
• A full medicine check, especially heart rhythm and blood pressure medicines, cyclosporine and bromocriptine.
• For Signifor, your doctor shows you how to draw up and give the shot before you do it yourself. For Signifor LAR, a trained healthcare professional gives every shot.
• Your insurance approves the medicine. With commercial insurance, a co-pay program may lower what you pay. Your doctor's office faxes the prescription form to a pharmacy called Anovo.

The first 90 days

1. Before day 1Blood tests, heart tracing and gallbladder ultrasound before your first dose
2. Before day 1Blood tests, heart tracing and gallbladder ultrasound before your first dose
3. About 10 days beforePrescription form to Anovo
4. About a week beforeInsurance approval
5. Day 1Signifor, first shots
6. Day 1Signifor LAR, first shot
7. Every week, then every 7 daysBlood sugar checks every week
8. Every week, then every 7 daysBlood sugar checks every week
9. Weeks 1 to 2First liver blood test after starting Signifor
10. Weeks 2 to 3First liver blood test after starting Signifor LAR
11. 21 days after a shotECG for some people on Signifor LAR
12. Every 4 weeks, then every 28 daysNext Signifor LAR shot, every 4 weeks
13. About day 31, then every 30 daysNext box of Signifor, about once a month
14. Monthly, then every 30 daysMonthly liver tests
15. About 2 monthsSignifor response check
16. Day 90Three months in