octreotide (Rx)

Brand and Other Names:Sandostatin, Sandostatin LAR
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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

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 intragluteally 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 for 2 months then modify dose based on response; may increase to 30mg q4wk if symptoms are inadequately controlled; decrease to 10 mg IM q4wk for trial period if initially responsive to 20 mg dose; dose >30 mg not recommended

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): Patients must be stabilized on subcutaneous octreotide for at least 2 weeks before switching to long-acting depot; upon switch, administer 20 mg IM intragluteally 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: 25-100 mcg IV bolus (usual bolus dose: 50 mcg); follow by continuous IV infusion of 25-50 mcg/hr for 2-5 days; may repeat bolus in first hr if hemorrhage not controlled

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 mg/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

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 intragluteally 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

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Interactions

Interaction Checker

and octreotide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            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
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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Use caution in patients with hepatic impairment; patients with established cirrhosis may necessitate dosage adjustment

            Use caution in patients with renal impairment; patients receiving dialysis may necessitate dosage adjustment

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

            Monitor patients for cholelithiasis; may impair gallbladder function; incidence of gallbladder stone or biliary sludge increases with duration of therapy exceeding 12 months; prophylactic cholescystectomy recommended if octreotide treatment is planned in in patients with gastrointestinal or pancreatic neuroendocrine tumors

            Advise patients to contact their healthcare provider if they experience signs or symptoms of gallstones (cholelithiasis) or complications of gallstones (e.g., cholecystitis, cholangitis, and pancreatitis); if complications of cholelithiasis are suspected, discontinue Sandostatin and treat appropriately

            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

            Use caution in patients with heart failure or concomitant medications that may alter heart rate or rhythm; arrhythmia, conduction abnormalities, and bradycardia reported in acromegalic and carcinoid syndrome patients; cardiovascular medications requirements may change

            Depot formulation, not for treatment of sulfonylurea-induced hypoglycemia

            Somatostatin analogs may affect glucose regulation; severe hypoglecemia may occur in type 1 diabetes patients; hyperglycemia may occur in type 2 diabetes or patients without diabetes; therapy may worsen hypoglycemia in patients with insulinomas; use with caution

            Dosage adjustments may be necessary in the elderly

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

            In patients maintained on total parenteral nutrition (TPN), monitoring for elevations in zinc levels recommended

            Therapy may reduce excessive fluid loss in patients with conditions that cause fluid losses

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            Pregnancy & Lactation

            Pregnancy

            The limited data in pregnant women are insufficient to inform a drug- associated risk for major birth defects and miscarriage

            Reproductive potential

            • Discuss potential for unintended pregnancy with premenopausal women as therapeutic benefits of a reduction in growth hormone (GH) levels and normalization of insulin-like growth factor 1 (IGF-1) concentration in acromegalic females treated with drug may lead to improved fertility

            Animal data

            • In animal reproduction studies, no-adverse- developmental-effects were observed with intravenous administration of drug to pregnant rats and rabbits during organogenesis at doses 7 and 13-times, respectively the maximum recommended human dose (MRHD) of 1500 mcg/day based on body surface area
            • Transient growth retardation, with no impact on postnatal development, was observed in rat offspring from a pre- and post-natal study of octreotide at intravenous doses below the MRHD based on body surface area

            Lactation

            There is no information available on presence of drug in human milk, effects on breastfed infant, or on milk production; studies show that drug administered subcutaneously passes into milk of lactating rats; however, due to species-specific differences in lactation physiology, animal data may not reliably predict drug levels in human milk; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal condition

            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.

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            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%)

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            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

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            Formulary

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            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.
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            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.