Octreotide

Aka: Octreotide, L-Cysteinamide, Sandostatin, Sandostatin LAR

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II. Physiology

  1. Similar to Somatostatin, an endogenous Hormone
    1. Octreotide is a synthetic long-acting cyclic octapeptide that mimics Somatostatin activity
  2. Broad hormonal release inhibition
    1. Inhibits Serotonin release
    2. Inhibits Gastrin release
    3. Inhibits vasoactive intestinal peptide (VIP) release
    4. Inhibits Insulin release
    5. Inhibits Glucagon release
    6. Inhibits Secretin release
    7. Inhibits motilin release
    8. Inhibits pancreatic peptide release
    9. Inhibits Growth Hormone and IGF-1 release
    10. Decreases Luteinizing Hormone (LH) release in response to Gonadotrophin-Releasing Hormone (GnRH)
    11. Decreases Thyroid Stimulating Hormone release (TSH)
  3. Activity
    1. Vasoconstriction
    2. Decreases portal vessel pressure
    3. Decreased splanchnic Blood Flow

III. Indications

  1. Emergency Indications
    1. Bleeding Esophageal Varices
      1. Decreases pressure in Portal Hypertension
      2. May decrease Upper Gastrointestinal Bleeding rate
    2. Sulfonylurea Toxicity
      1. Decreases recurrent Hypoglycemia risk
  2. Endocrine Indications
    1. Diarrhea associated with endocrine tumors
      1. Carcinoid Tumors
      2. Intestinal peptide-Secreting tumors
      3. Has also been used in HIV related Diarrhea, Irritable Bowel Syndrome and gastrointestinal fistulas
    2. Endocrine conditions in children
      1. Congenital hyperinsulinism
      2. Hypothalamic Obesity

IV. Dosing: Emergent Conditions (off-label)

  1. Esophageal Varices
    1. Bolus: 50 mcg IV every 1 hour for up to 2 doses
    2. Maintenance: 25-50 mcg/hour for 2-5 days
  2. Sulfonylurea Toxicity
    1. Subcutaneous (preferred): 50 mcg SQ every 6 hours as needed
    2. IV infusion: 25-50 mcg/hour for up to 1-2 days as needed for persistent and recurrent Hypoglycemia

V. Dosing: Endocrine

  1. Diarrhea associated with Carcinoid Tumors or intestinal peptide-Secreting tumors
    1. Sandostatin 200-300 mcg divided 2-4 times daily given SQ or IV
    2. Sandostatin LAR 20 mg IM every 4 weeks for 2 months
      1. Do not start Sandostatin LAR until stabilized on the short-acting Sandostatin
  2. Endocrine conditions in children
    1. Congenital hyperinsulinism
    2. Hypothalamic Obesity

VI. Adverse Effects

  1. Bradycardia (<25%)
  2. Hyperglycemia (<27%)
  3. Fatigue (<10%)
  4. Gall Bladder sludging and Biliary Colic
  5. QT Prolongation

VII. References

  1. Kraus and LoVecchio (2018) Crit Dec Emerg Med 32(9): 28

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