OCTREOTIDE ACETATE
(oc-tre'o-tide)
Sandostatin, Sandostatin LAR depot
Classifications: hormones and synthetic substitutes; antidiarrheal
Pregnancy Category: B

Availability

0.05 mg/mL, 0.1 mg/mL, 0.2 mg/mL, 0.5 mg/mL, 1 mg/mL injection; 10 mg/5 mL, 20 mg/5 mL, 30 mg/5 mL depot injection

Actions

A long-acting peptide that mimics the natural hormone somatostatin. Suppresses secretion of serotonin, pancreatic peptides, gastrin, vasoactive intestinal peptide, insulin, glucagon, secretin, and motilin.

Therapeutic Effects

Stimulates fluid and electrolyte absorption from the GI tract, prolongs intestinal transit time, and also inhibits the growth hormone.

Uses

Symptomatic treatment of severe diarrhea and flushing episodes associated with metastatic carcinoid tumors. Also watery diarrhea associated with vasoactive intestinal peptide (VIP) tumors.

Unlabeled Uses

Acromegaly associated with pituitary tumors, fistula drainage, variceal bleeding.

Contraindications

Hypersensitivity to octreotide.

Cautious Use

Cholelithiasis, renal impairment; pregnancy (category B); diabetes, and hypothyroidism. It is not known whether drug is excreted in breast milk.

Route & Dosage

Carcinoid Syndrome
Adult: SC 100–600 mcg/d in 2–4 divided doses, titrate to response IM May switch to depot injection after 2 wk at 20 mg q4wk times 2 mo
Child: SC 1–10 mcg/kg/d in 2–4 divided doses, titrate to response

VIPoma
Adult: SC 200–300 mcg/d in 2–4 divided doses, titrate to response IM May switch to depot injection after 2 wk at 20 mg q4wk times 2 mo
Child: SC 1–10 mcg/kg/d in 2–4 divided doses, titrate to response

Acromegaly
Adult: SC 50 mcg t.i.d., titrate up to 100 mcg–500 mcg t.i.d. IM May switch to depot injection after 2 wk at 20 mg q4wk times at least 3 mo, then reassess

Administration

Subcutaneous/Intramuscular
Intravenous

PREPARE: Direct: Give undiluted.  Intermittent: Dilute in 50–200 mL D5W.  

ADMINISTER: Direct: Give a single dose over 3 min. In carcinoid give rapid IV bolus over 60 sec.  Intermittent: Give over 15–30 min.  

Adverse Effects (1%)

CNS: Headache, fatigue, dizziness. GI: Nausea, diarrhea, abdominal pain and discomfort. Metabolic: Hypoglycemia, hyperglycemia, increased liver transaminases, hypothyroidism (after long-term use). Body as a Whole: Flushing, edema, injection site pain.

Interactions

Drug: May decrease cyclosporine levels; may alter other drug and nutrient absorption because of alterations in GI motility.

Pharmacokinetics

Absorption: Rapidly absorbed from SC injection site. Peak: 0.4 h. Duration: Up to 12 h. Metabolism: 68% metabolized in liver. Elimination: Excreted in urine. Half-Life: 1.5 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug