Octreotide

Indications
 Subcutaneous
Secretory neoplasms
Adult: Initially, 50 mcg 1-2 times daily, increased gradually to up to 600 mcg daily in 2-4 divided doses according to response. Continued treatment is not recommended if there is no benefit within a wk of starting treatment for carcinoid tumour. Initial dose may be given via IV admin of a rapid response is required.
Renal impairment: Dosage may need to be reduced in severe renal impairment requiring dialysis.
Subcutaneous
Acromegaly
Adult: Initially 50 mcg tid, increased as necessary to usual dose 100-200 mcg tid. Max: 500 mcg tid.
Renal impairment: Dosage may need to be reduced in severe renal impairment requiring dialysis.
Subcutaneous
Prophylaxis of complications following pancreatic surgery
Adult: 100 mcg tid of a rapid-acting preparation given for 7 consecutive days, starting at least 1 hr before operation.
Renal impairment: Dosage may need to be reduced in severe renal impairment requiring dialysis.
Intravenous
Variceal haemorrhage in patients with cirrhosis
Adult: As continuous IV infusion: 25 mcg/hr for 48 hr (up to 5 days in patients at high risk of re-bleeding).
Child: ≥1 mth: 1 mcg/kg/hr (up to 50 mcg/hr); given as continuous IV infusion. Higher doses may be needed initially, reduce dose gradually over 24 hr until bleeding has stopped.
Renal impairment: Dosage may need to be reduced in severe renal impairment requiring dialysis.
Subcutaneous
HIV-associated diarrhoea
Adult: Initial dose 100 mcg tid. If symptoms are not controlled after 1 wk, increase dose to 250 mcg tid, if still not effective after 1 wk stop therapy.
Renal impairment: Dosage may need to be reduced in severe renal impairment requiring dialysis.
Intramuscular
Acromegaly
Adult: Following initial control with SC therapy: As a depot preparation, initially 20 mg every 4 wk. Adjust if required after 3 mth to 10-30 mg every 4 wk. Max: 40 mg every 4 wk.
Renal impairment: Dosage may need to be reduced in severe renal impairment requiring dialysis.

Incompatibility: Incompatible with most TPN solutions due to formation of a glycosyl octreotide conjugate, which may decrease efficacy.
Warnings / Precautions
 Renal disease; risk of gall bladder disease; DM; hypothyroidism. Pregnancy, lactation, children, elderly. Monitor levels of vitamin B12 during long term therapy.
Adverse Reactions
 Local pain, stinging, tingling at site of inj; anorexia, nausea, vomiting, abdominal pain, bloating, flatulence, loose stools, steatorrhoea; biliary tract abnormalities. Hypoglycaemia and hyperglycaemia, hypothyroidism, cardiac conduction abnormalitles, pancreatitis.
Drug Interactions
 Dosage adjustment of concurrent therapy may be necessary with calcium channel blockers, oral hypoglycaemics, β-blockers, diuretics. May increase concentration of bromocriptine.
Potentially Fatal: Requirements of insulin may be reduced requiring careful blood-glucose monitoring. Reduction in ciclosporin bioavailability and efficacy.
See Below for More octreotide Drug Interactions
Food Interactions
 Schedule injections between meals to decrease adverse GI effects.
Mechanism of Actions
 Octreotide is a synthetic analogue of somatostatin which acts by suppressing basal and stimulated secretion of growth hormone (GH). It also suppresses LH response to gonadotrophin-releasing hormone and reduces the secretion of gastrin, vasoactive intestinal peptide (VIP), insulin, glucagon, secretin, motilin and pancreatic polypeptide.
Absorption: Rapidly absorbed (SC); peak plasma concentrations after 25-30 min.
Distribution: 65% plasma protein bound.
Excretion: Via urine (as unchanged); 1.5 hr (elimination half-life), prolonged in elderly.
Storage Conditions
 Intramuscular: Store at 2-8°C. Stable at room temperature for up to 14 days. Intravenous: Store at 2-8°C. Stable at room temperature for up to 14 days. Subcutaneous: Store at 2-8°C. Stable at room temperature for up to 14 days.
ATC Classification
 H01CB02 - octreotide ; Belongs to the class of antigrowth hormone. Used in hypothalamic hormone preparations.
Storage
 Intramuscular: Store at 2-8°C. Stable at room temperature for up to 14 days. Intravenous: Store at 2-8°C. Stable at room temperature for up to 14 days. Subcutaneous: Store at 2-8°C. Stable at room temperature for up to 14 days.
Available As
  • Octreotide 100 mcg
  • Octreotide 20 mg
  • Octreotide 50 mcg

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