Octreotide

Administration

Type: Octapeptide
Dosage Forms:
Routes of Administration: IV, IM, or SQ
Common Trade Names: Sandostatin, Sandostatin LAR

Adult Dosing

Variceal bleeding

Initial Bolus: 50mcg IV (range 25-100mcg)^[1]
Drip rate: 25-50 mcg/hr IV

Sulfonylurea toxicity

50-75 mpg SQ or IM every 6 hrs as needed

Pediatric Dosing

Sulfonylurea Overdose

1-2 mpg/kg SQ or IM

Special Populations

Pregnancy Rating: Octreotide crosses the placenta and can be detected in newborn at birth. Limited data on risk, case studies have not demonstrated any congenital malformations in fetuses.
Lactation risk:

Renal Dosing

Dialysis patients: dosage adjustment may be required as clearance is reduced by ~50%.

Hepatic Dosing

No adjustments needed but clearance is reduced in patients with cirrhosis.

Contraindications

Allergy to class/drug

Adverse Reactions

Hypoglycemia is rare but more common in older adults and type I diabetics^[2]

Serious

pancreatitis
bradycardia
arrhythmias
anaphylaxis
thrombocytopenia

Common

nausea/vomiting/diarrhea
dizziness
fatigue
edema
pruritus

Pharmacology

Half-life: 1.5-2 hrs^[3]
Metabolism: Hepatic^[3]
Excretion: Renal

Mechanism of Action

A peptide that mimics endogenous somatostatin. Somatostatin is released by the pancreas, pyloric antrum, and duodenum and inhibits Growth Gormone, Gastrin, Vasoactive intestinal peptide (VIP), Gastrin, Serotonin, and decreases Insulin like growth factor-1 (IGF-1), serotonin and it decreases splanchnic blood flow.

Comments

Although used in the ED mainly for sulfonylurea overdose and variceal bleeding, it is used in outpatient and inpatient medicine for the treatment of acromegaly, carcinoid tumors, and VIPomas
Octreotide was originally used as a opiod antagonist and is still used off label as a second/third line therapy for diarrhea from opiod withdrawal because of antidiarrheal properties.^[4]

References

↑ Garbuzenko DV. Current approaches to the management of patients with liver cirrhosis who have acute esophageal variceal bleeding. Curr Med Res Opin. 2016:1-9.
↑ Howland MA, Smith SW. Antidotes in depth. In: Robert S. Hoffman, et al., ed. Goldfrank’s toxicologic emergencies. 10e ed. ; 2015.
↑ ^3.0 ^3.1 Chanson P et al. Clinical pharmacokinetics of octreotide. Therapeutic applications in patients with pituitary tumours. Clin Pharmacokinet. 1993 Nov;25(5):375-91.
↑ Carreno JE et al. 24-hour opiate detoxification and antagonist induction at home– the ‘asturian method’: A report on 1368 procedures. Addict Biol. 2002;7(2):243-250.

Authors:

[1] Garbuzenko DV. Current approaches to the management of patients with liver cirrhosis who have acute esophageal variceal bleeding. Curr Med Res Opin. 2016:1-9.

[2] Howland MA, Smith SW. Antidotes in depth. In: Robert S. Hoffman, et al., ed. Goldfrank’s toxicologic emergencies. 10e ed. ; 2015.

[metabolism-3] 3.0 ^3.1 Chanson P et al. Clinical pharmacokinetics of octreotide. Therapeutic applications in patients with pituitary tumours. Clin Pharmacokinet. 1993 Nov;25(5):375-91.

[4] Carreno JE et al. 24-hour opiate detoxification and antagonist induction at home– the ‘asturian method’: A report on 1368 procedures. Addict Biol. 2002;7(2):243-250.

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