ADMINISTRATION ROUTES:
SC, IV
ALTERNATIVE NAMES:
Sandostatin
ICU INDICATIONS:
- Gastro-oesophageal variceal bleeding
- Chylothorax
- Carcinoid tumours with features of carcinoid syndrome
- Vasoactive intestinal peptide secreting tumours
- Insulinomas
- Gastrinomas/Zollinger-Ellis syndrome
- Acromegaly
PRESENTATION AND ADMINISTRATION:
SC:
Inject the required dose as undiluted solution by subcutaneous injection. Allow solution to come to room temperature to minimise pain at the injection site.
IV:
50 mcg/mL, 100 mcg/mL and 500 mcg/mL vials
For continuous infusion dilute 500 mcg vial in 50 mL of 0.9% saline
Dilutions stable for 24 hours at room temperature
May be stored at room temperature for up to two weeks. Refrigerate vials for prolonged storage. Protect from light.
DOSAGE:
IV:
For bleeding gastro-oesophageal varices:
Load: single dose 50 mcg SC (1 mL undiluted of 50 mcg/mL vial)
Continuous infusion: 25 mcg/hr (2.5 mL/hr) for 5 days
SC:
For chylothorax only:
100 mcg TDS SC
Other indications listed above:
50 - 100 mcg OD, BD or TDS SC
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
No dosage adjustment is required
DOSAGE IN PAEDIATRICS:
Diarrhoea secondary to endocrine tumours:
Load: single dose 1 - 2 mcg/kg stat IV
Continuous infusion: 1 - 2 mcg/kg IV for 2 - 5 days
CLINICAL PHARMACOLOGY:
Octreotide exerts pharmacologic actions similar to the natural hormone somatostatin. It is an even more potent inhibitor of growth hormone, glucagon, and insulin than somatostatin. Like somatostatin, it also suppresses LH response to GnRH, decreases splanchnic blood flow, and inhibits release of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide.
CONTRAINDICATIONS:
- Sensitivity to octreotide
WARNINGS:
Octreotide inhibits gallbladder contractility and may predispose to biliary tract disease such as cholecystitis and ascending cholangitis.
PRECAUTIONS:
General:
Nil
Laboratory Tests:
Baseline thyroid function tests should be performed for people who require chronic therapy (although such patients are extremely rare in ICU)
Drug/Laboratory Test Interactions:
None reported
IMPORTANT DRUG INTERACTIONS IN ICU:
Concomitant administration of Octreotide with cyclosporin may decrease blood levels of cyclosporin and result in transplant rejection.
Patients receiving insulin, oral hypoglycaemic agents, beta blockers, calcium channel blockers, or agents to control fluid and electrolyte balance may require dose adjustments of these therapeutic agents.
ADVERSE REACTIONS:
Gastrointestinal:
Diarrhoea, vomiting, abdominal distention, constipation, biliary sludge, gallstones, nausea and abdominal discomfort
Cardiac:
Bradycardia
Metabolic and endocrine:
Hypoglycaemia, hyperglycaemia, hypothyroidism
Neurological:
Headache