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

VII. References

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

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Related Studies

Cost: Medications

octreotide (on 10/19/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
OCTREOTIDE 1,000 MCG/5 ML VIAL Generic $14.07 per ml
OCTREOTIDE 1,000 MCG/ML VIAL Generic $41.76 per ml
OCTREOTIDE 5,000 MCG/5 ML VIAL Generic $41.76 per ml
OCTREOTIDE ACET 200 MCG/ML VL Generic $14.07 per ml

Ontology: Octreotide (C0028833)

Definition (NCI_NCI-GLOSS) A drug similar to the naturally occurring growth hormone inhibitor somatostatin. Octreotide is used to treat diarrhea and flushing associated with certain types of tumors.
Definition (NCI) A synthetic long-acting cyclic octapeptide with pharmacologic properties mimicking those of the natural hormone somatostatin. Octreotide is a more potent inhibitor of growth hormone, glucagon, and insulin than somatostatin. Similar to somatostatin, this agent also suppresses the luteinizing hormone response to gonadotropin-releasing hormone, decreases splanchnic blood flow, and inhibits the release of serotonin, gastrin, vasoactive intestinal peptide (VIP), secretin, motilin, pancreatic polypeptide, and thyroid stimulating hormone.
Definition (MSH) A potent, long-acting synthetic SOMATOSTATIN octapeptide analog that inhibits secretion of GROWTH HORMONE and is used to treat hormone-secreting tumors; DIABETES MELLITUS; HYPOTENSION, ORTHOSTATIC; HYPERINSULINISM; hypergastrinemia; and small bowel fistula.
Definition (CSP) potent, long-acting synthetic somatostatin octapeptide analog.
Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH D015282
SnomedCT 109053000, 126155003
LNC LP97954-9, MTHU035158
English Octreotide, L-Cysteinamide, D-phenylalanyl-L-cysteinyl-L-phenylalanyl-D-tryptophyl-L-lysyl-L-threonyl-N-(2-hydroxy-1-(hydroxymethyl)propyl)-, cyclic (2-7)-disulfide, (R-(R*,R*))-, D-Phenylalanyl-L-cysteinyl-L-phenyl-alanyl-D-tryptophyl-L-lysyl-L-threonyl-N-[2-hydroxy-1-(hydroxymethyl)propyl]-L-cysteinamide Cyclic (2->7)-Disulfide, D-Phenylalanyl-L-cysteinyl-L-phenylalanyl-D-tryptophyl-L-lysyl-L-threonyl-L-cysteinyl-L-threoninol Cyclic (2->7)-Disulfide, octreotide, OCTREOTIDE, Octreotide [Chemical/Ingredient], D-Phenylalanyl-L-cysteinyl-L-phenylalanyl-D-tryptophyl-L-lysyl-L-threonyl-N-[(1R,2R)-2-hydroxy-1-(hyroxymethyl)propyl]-L-cysteinamide, Cyclic (2->7)-disulfide, Octreotide (substance), Octreotide preparation (product), Octreotide preparation, Octreotide preparation (substance)
Swedish Oktreotid
Spanish preparado de octreotida, octreótido (sustancia), octreotida, octreotida (sustancia), octreotida (producto), preparado de ocreotide, preparado con octreotida (producto), preparado con octreotida, octreótido, Octreótido, preparado de octreotida (sustancia), preparado de octreotida (producto)
Czech oktreotid
Finnish Oktreotidi
Japanese オクトレオチド, 酢酸オクトレオチド, サンドスタチン, オクトレオチド酢酸塩
Polish Oktreotyd
Portuguese Octreotide, Octreotida
French Octréotide
German Octreotid
Italian Octreotide

Ontology: Sandostatin (C0678117)

Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH D015282
English Sandostatin, sandostatin, sandostatine, SandoSTATIN, Sandostatine

Ontology: Sandostatin LAR (C0723209)

Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
English Sandostatin LAR, SandoSTATIN LAR, Sandostatin-LAR