Gastroenterology Book



Aka: Octreotide, L-Cysteinamide, Sandostatin, Sandostatin LAR
  1. 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
  2. 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
  3. 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
  4. 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
  5. Adverse Effects
    1. Bradycardia (<25%)
    2. Hyperglycemia (<27%)
    3. Fatigue (<10%)
    4. Gall Bladder sludging and Biliary Colic
    5. QT Prolongation
  6. References
    1. Kraus and LoVecchio (2018) Crit Dec Emerg Med 32(9): 28
Medication Costs
octreotide (on 10/19/2016 at Medicaid.Gov 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
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

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
Derived from the NIH UMLS (Unified Medical Language System)

Sandostatin (C0678117)

Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH D015282
English Sandostatin, sandostatin, sandostatine, SandoSTATIN, Sandostatine
Derived from the NIH UMLS (Unified Medical Language System)

Sandostatin LAR (C0723209)

Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
English Sandostatin LAR, SandoSTATIN LAR, Sandostatin-LAR
Derived from the NIH UMLS (Unified Medical Language System)

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