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Octreotide Intravenous for Adults
Who can administer
May be administered by registered competent doctor or nurse/midwife
Important information
- Liver cirrhosis: increased half-life possible, consider reduction of maintenance dose
- May restore fertility in female acromegalic patients, those of child-bearing age should be advised to ensure adequate contraception if desired
- Drug interaction potential e.g. ciclosporin (may decrease ciclosporin levels), anti-diabetic agents
Available preparations
Sandostatin 50 micrograms per 1ml ampoule
Sandostatin 100 micrograms per 1ml ampoule
Sandostatin 500 micrograms per 1ml ampoule
Reconstitution
Already in solution
Draw up using a 5 micron filter needle
Infusion fluids
Sodium chloride 0.9% ONLY
Methods of intravenous administration
Important
- Consider subcutaneous administration, except where a rapid response is required (ref 1)
Bolus intravenous injection (in emergencies)
- May be given undiluted (unlicensed) by rapid intravenous injection , if slow IV injection considered inappropriate (ref 1)
Slow intravenous injection (ref 2)
- For each 1ml of octreotide dilute with 1 to 9ml sodium chloride 0.9%
- Administer over three to five minutes
Intermittent intravenous infusion
- Add required dose to 100 to 200ml infusion fluid and administer over 15 to 30 minutes (unlicensed, ref 1)
- A 50ml infusion may be used if required (eg fluid restriction) but the residual volume in the infusion line must be flushed through at the same rate to avoid significant underdosing
Continuous intravenous infusion
- Add 500 micrograms to produce a total volume of 250ml (2 micrograms/ml) and administer at a rate according to dosage section (ref 3). Alternative dilution 500 micrograms in 60ml (8.3 micrograms/ml)
Dose in adults
Important: The subcutaneous route is the preferred route in many circumstances
(doses listed below apply to IV route, subcutaneous doses sometimes vary. Refer to www.uptodate.com (ref 3))
| Indication | IV dose | Notes/Comments | |
|---|---|---|---|
| LICENSED INDICATIONS | |||
| Oesophageal varices (bleeding) | Usual dose | Give 25micrograms per hour by continuous intravenous infusion for five days. Doses of up to 50micrograms per hour have been used in cirrhotic patients | |
| UNLICENSED INDICATIONS (ref 3) | |||
| Carcinoid CRISIS (unlicensed) | Emergency surgery | 500 to 1000microgram STAT 1 to 2 hours prior to procedure | (for somatostatin analogue-naive patients) |
| Intraoperative use with HYPOtension | 500 to 1,000 microgram bolus followed by continuous infusion of 50-200microgram /hour during procedure | Adapted for safe local use. Alternatively instead of infusion can repeat 500-1000 microgram doses after 5 minutes until symptoms are controlled | |
| Postoperative | Continue infusion above if needed, then revert to preoperative schedule | ||
| Diarrhoea (complicated, associated with chemotherapy) (unlicensed) | Usual dose | 100 to 150microgram every eight hours, or an infusion at 25-50microgram/hour (may escalate to 2000microgram every eight hours until controlled) | Discontinue therapy within 24 hours of resolution of diarrhoea to reduce the risk of ileus |
| Gastro-entero-pancreatic endocrine tumours (IV route unlicensed) |
Start at: 200 to 300microgram daily in 2 to 4 divided doses Usual dose: 150 to 450micrograms per day |
Dose of greater than 450micrograms are rarely required | |
| In carcinoid tumours, if there is no beneficial response within one week of treatment at the maximum dose, therapy should not be continued | |||
Monitoring
- ECG and blood pressure monitoring is required
- Monitor heart rate (bradycardia commonly reported)
- Monitor blood glucose in all patients. This is especially important in patients with insulinomas (because octreotide is more potent at inhibiting the secretion of GH and glucagons than it is at inhibiting insulin. This is especially the case upon the introduction of the drug and at each change of dose)
- Monitor blood glucose for patients with oesophageal varices as there is an increased risk for the development of insulin-dependent diabetes or for insulin changes in patients with pre-existing diabetes
- Monitor LFTs
- Long term therapy: Monitor thyroid function, six-monthly ultrasound checks for gall stones, monitor in patients with a history of pancreatitis, and also monitor vitamin B12 levels.
Further information
Conversion to LA formulations
- Long acting formulations of octreotide, or lanreotide are available (depot IM route only)
- For some of these an overlap period is required with immediate release octreotide, for others there is no overlap period. Consult BNF or SPCs for administration details.
- Sandostatin LAR is octreotide Somatuline LA and Somatuline Autogel are lanreotide
- High tech prescription required on discharge
Storage
- Store at 2-80C - do not freeze
- Unopened ampoules may be stored at room temperature (300C) for up to two weeks
References
SPC November 2021
1: Martindale, The complete Drug Reference accessed online via www.medicinescomplete.com17th Jan 2023
2: Injectable Medicines Administration Guide Medusa, accessed online 17th Jan 2023
3: UptoDate- accessed online 17th Jan 2023
Therapeutic classification
Synthetic analogue of naturally occurring somatostatin