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 vatical 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]

See Also

References
  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.
  3. 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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