Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

octreotide (Rx)Brand and Other Names:Sandostatin, Sandostatin LAR

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 0.05mg/mL
  • 0.1mg/mL
  • 0.2mg/mL
  • 0.5mg/mL
  • 1mg/mL

depot injection

  • 10mg/kit
  • 20mg/kit
  • 30mg/kit
more...

Acromegaly

Solution: 50 mcg SC q8hr initially; titrate up to 500 mcg SC q8hr if necessary; after successful treatment with solution for 2 weeks, initiate treatment with suspension (depot injection)

Suspension (depot injection): 20 mg IM (gluteal) every 4 weeks for 3 months; titrate up or down to 10-30 mg IM every 4 weeks, depending on response; not to exceed 40 mg, as follows

Symptoms controlled: If GH < 1 ng/mL and IGF-1 normal, decrease dose to 10 mg IM every 4 weeks; if GH < 2.5 ng/mL and IGF-1 normal, maintain dose at 20 mg IM every 4 weeks

Symptoms uncontrolled: If GH > 2.5 ng/mL or IGF-I elevated, increase dose to 30 mg IM every 4 weeks; if symptoms persist, increase to 40 mg IM

Dosing Considerations

  • Monitor IGF-1 levels every 2 weeks to guide titration; goal: GH levels <5 ng/mL or IGF-1 levels <1.9 units/mL (men) and <2.2 units/mL (women)
  • Monitor IGF-1 or GH levels every 6 months
  • Withdraw drug yearly for 4 weeks (solution) or 8 weeks (suspension) from patients who have undergone irradiation to assess

Carcinoid Tumor

Solution: 100-600 mcg/day SC divided q6-12hr; may titrate to 1500 mcg/day; after successful treatment with solution for 2 weeks, initiate treatment with suspension (depot injection)

Suspension (depot injection): 20 mg IM every 4 weeks if regular injection well tolerated

VIPoma

Solution: 200-300 mcg/day SC divided q6-12hr; after successful treatment with solution for 2 weeks, initiate treatment with suspension (depot injection)

Suspension (depot injection): 20 mg IM (gluteal) every 4 weeks for 2 months; continue solution for first 2 weeks; titrate suspension up or down to 10-30 mg IM every 4 weeks

Esophageal Variceal Bleeding (Off-label)

Solution: 50 mcg IV bolus, then 25-50 mcg/hr for 1-5 days

GI or Pancreatic Fistula (Off-label)

Solution: 50-200 mcg SC q8hr for 2-12 days

AIDS-Related Diarrhea (Off-label)

Solution: 100-500 mcg SC q8hr

Ileostomy-Related Diarrhea (Off-label)

Solution: 25 mcg/hr IV or 50 mcg SC q12hr 

Chemotherapy-Related Diarrhea (Off-label)

Low-grade or uncomplicated: Solution: 100-150 mcg SC q8hr for 1-30 days

Complicated: Solution: 100-150 mcg SC q8hr or 25-50 mcg/hr IV; may increase to 500 mcg q8hr until controlled

Severe: Solution: 100-150 mcg SC q8hr; may increase to 500-1500 mcg SC/IV q8hr

Dumping Syndrome (Off-label)

Solution: 50-150 mcg/day IV; may adjust to 25-600 mcg/day dose range

Suspension (depot injection): 10-20 mcg/month IM

Chylothorax (Off-label)

Solution: 50-100 mcg SC q8hr

Neuroendocrine Tumors (Orphan)

Orphan indication sponsor

  • Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936-1080

Dosing Modifications

Hepatic impairment: Cirrhosis, 10 mg IM every 4 weeks initially, then titrate to effect

Renal impairment: Without dialysis, dose adjustment not necessary; with dialysis, 10 mg IM every 4 weeks initially, then titrate to effect

Dosage Forms & Strengths

injectable solution

  • 0.05mg/mL
  • 0.1mg/mL
  • 0.2mg/mL
  • 0.5mg/mL
  • 1mg/mL

depot injection

  • 10mg/kit
  • 20mg/kit
  • 30mg/kit
more...

Safety and efficacy not established

GI Bleeding (Off-label)

1 mcg/kg bolus, then 1 mcg/kg/hr infusion; taper by 50% when no active bleeding for 24 hours 

Diarrhea (Off-label)

1-10 mcg/kg/day IV/SC 

Chylothorax (Off-label)

0.3-4 mcg/kg/hr SC/IV, depending on nature of chylothorax 

Hyperinsulinemia/Hypoglycemia of Infancy (Off-label)

2-10 mcg/kg/day SC/IV divided q12hr; increase on basis of response 

Sulfonylurea Overdose (Off-label)

1 mcg/kg SC/IV q12hr OR 25 mcg once; monitor blood glucose concentrations 

Acromegaly

Solution: 50 mcg SC q8-12hr initially; titrate up to 500 mcg SC q8hr if necessary; after successful treatment with solution for 2 weeks, initiate treatment with suspension (depot injection)

Suspension (depot injection): 20 mg IM (gluteal) every 4 weeks for 3 months; titrate up or down to 10-30 mg IM every 4 weeks, depending on response; not to exceed 40 mg

Dosing Considerations

Dose adjustment may be necessary; clearance may decrease by 26% and half-life by 46%

Monitor IGF-1 levels every 2 weeks to guide titration; goal: GH levels <5 ng/mL or IGF-1 levels <1.9 units/mL (men) and <2.2 units/mL (women)

Monitor IGF-1 or GH levels every 6 months

Withdraw drug yearly for 4 weeks (solution) or 8 weeks (suspension) from patients who have undergone irradiation to assess

Carcinoid Tumor

Solution: 100-600 mcg/day SC divided q6-12hr; may titrate to 1500 mcg/day; after successful treatment with solution for 2 weeks, initiate treatment with suspension (depot injection)

Suspension (depot injection): 20 mg IM every 4 weeks if regular injection well tolerated

VIPoma

Solution: 200-300 mcg/day SC divided q6-12hr; after successful treatment with solution for 2 weeks, initiate treatment with suspension (depot injection)

Suspension (depot injection): 20 mg IM (gluteal) every 4 weeks for 2 months; continue solution for first 2 weeks; titrate suspension up or down to 10-30 mg IM every 4 weeks

Esophageal Variceal Bleeding (Off-label)

Solution: 50 mcg IV bolus, then 25-50 mcg/hr for 1-5 days

Next

Interactions

Interaction Checker

octreotide and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
            Previous
            Next

            Adverse Effects

            >10%

            Gallbladder problems (>60%): Decreased gallbladder contractility, gallstones, cholecystitis, cholestatic hepatitis

            Dysglycemia (25%)

            Hypothyroidism (25%)

            Bradycardia (25%)

            1-10%

            ECG changes (10%)

            Arrhythmia (9%)

            Pancreatitis

            Upper respiratory tract infection

            Fatigue

            Headache

            Malaise

            Rash

            Diarrhea

            Nausea

            Vomiting

            Pain at injection site

            Joint pain

            Blurred vision

            Postmarketing Reports

            Pediatric Patients

            • No formal controlled clinical trials have been performed to evaluate the safety and effectiveness of octreotide depot injection in children younger than 6 years
            • Serious adverse events, including hypoxia, necrotizing enterocolitis, and death, have been reported in children (mostly in those younger than 2 years)
            • The relation of these events to octreotide has not been established, because the majority of these pediatric patients had serious underlying comorbid conditions
            Previous
            Next

            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Hepatic or renal impairment may necessitate dosing adjustments

            May alter fat absorption in some patients (monitor for pancreatitis)

            May decrease vitamin B12 levels (monitor)

            Monitor for hypothyroidism (octreotide suppresses secretion of TSH)

            Use caution when giving drug to patients with cardiovascular disease

            May enhance toxicity of QTc-prolonging agents

            Do not use depot formulation in patients with sulfonylurea-induced hypoglycemia

            Dosage adjustments may be necessary in the elderly

            Females of childbearing age should use adequate contraception because the treatment may restore fertility

            Previous
            Next

            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Whether octreotide crosses into breast milk is not known; avoid giving to lactating women

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next

            Pharmacology

            Mechanism of Action

            Somatostatin analog; decreases GH secretion, secretion of gastrin, VIP, glucagon, secretin, serotonin release and pancreatic polypeptide; in acromegaly, octreotide decreases growth hormone and IGF-1 secretion; suppresses LH response to GnRH secretion and decreases splanchnic blood flow

            Absorption

            Absorption rapid and complete (SC)

            Bioavailability: SC, 100%; IM, 60%

            Peak plasma time: IV, immediately after injection; SC, 15-30 min; PO, 90-120 min; IM, 60 min

            Distribution

            Protein bound: 65% binds to lipoprotein

            Vd: 13.6 L

            Metabolism

            Metabolized by liver

            Elimination

            Half-life: 1.7 hr

            Total body clearance: 10 L/hr

            Excretion: Urine (32%)

            Previous
            Next

            Administration

            IV Incompatibilities

            Fat emulsion 10%

            IV Preparation

            Common diluent: 50-100 μg/50 mL NS

            Common diluent for continuous IV infusion: 1200 μg/250 mL NS

            Minimum volume: 50 mL NS

            IV/IM Administration

            IM

            • Administer suspension (depot injection) immediately after reconstitution; inject into gluteal muscle, avoiding deltoid

            IV

            • IV administration may be IVP, IVPB, or continuous infusion
            • Regular injection only: IVP should be administered undiluted over 3 minutes
            • IVPB: Administer over 15-30 minutes
            • Continuous infusion: 25-50 μg/hr for treatment of esophageal variceal bleeding
            • Do not use if solution contains particles or is discolored

            Storage

            Refrigerate solution

            Ampule may be stored at room temp for up to 14 days when protected from light

            Previous
            Next

            Images

            Previous
            Next

            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Add or Remove Plans
            Plans for
            Select State:
            Non-Medicare PlansMedicare Plans

            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
             
             
             
            All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.