Octreotide

Scottish Palliative Care Guidelines
Healthcare Improvement Scotland
Amber – For medicines normally initiated by a specialist but may be used by generalists

Introduction

Description
A synthetic analogue of somatostatin used in palliative care to relieve symptoms associated with unresectable hormone-secreting tumours (for example carcinoid), intractable diarrhoea related to high output ileostomies or inoperable bowel obstruction in patients with cancer.

Preparations

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For prolonged storage, keep all unopened ampoules, vials and pre-filled syringes in a refrigerator.

Generally, the depot formulation is used only when symptoms have first been controlled with subcutaneous (SC) octreotide and has a relative bioavailability of about 60% compared to SC octreotide.

SC octreotide may require to continue for 14 days after commencing depot treatment.

Preparation Presentation Comments
Injection (as acetate) 50 microgram/mL, 1mL amp 100 microgram/mL, 1mL amp 500 microgram/mL, 1mL amp -
Injection (as acetate) 200 microgram/mL multidose
vial, 1mg in 5mL		 Once opened, a multidose vial can be kept for up to 2
weeks at room temperature for day-to-day use
Sandostatin LAR® (Novartis) (octreotide as acetate) Depot injection (microsphere powder for aqueous suspension) 10mg vial, 20mg vial, 30mg vial All supplied with diluent filled syringe for deep intramuscular (IM) injection every 28 days

Indications

May be recommended by a palliative care specialist for treatment of symptoms from hormone secreting tumours (neuro-endocrine), cancer-related bowel obstruction or tumour antisecretory effects.

 

Cautions

  • Insulin requirements in type 1 diabetes may be reduced by up to 50%; monitor plasma glucose concentrations to guide dose reductions with both insulin and oral hypoglycaemic agents. Insulinoma may exacerbate hypoglycaemia.
  • Cirrhosis or renal failure requiring dialysis may reduce elimination which may necessitate a dose reduction.
  • Avoid abrupt withdrawal of short-acting octreotide after long-term treatment (may precipitate biliary colic caused by gallstones/biliary sludge).
  • Use with caution in cardiac patients at risk of bradycardia.
  • Hypothyroidism.

Contra-indications

Hypersensitivity to octreotide, lanreotide or any of the ingredients.

Drug interactions

  • Increases bioavailability of bromocriptine, reduces bioavailability of ciclosporin.
  • May reduce vitamin B12 levels.

Side effects

  • Very common: hyperglycaemia, headache, flatulence, nausea, abdominal pain, constipation, diarrhoea, gall stones (10 to 20% of patients on long term treatment), injection site pain.
  • Common: impaired glucose tolerance, hypoglycaemia, hypothyroidism, dizziness, anorexia, bradycardia, dyspnoea, hyperbilirubinaemia, rash, itch.

 

Dose and administration

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Indication Dose
Carcinoid, VIPomas, glucagonomas 50micrograms once or twice daily
Intractable diarrhoea (including that caused by chemotherapy and radiotherapy) 250micrograms to 500micrograms/24h
Intestinal obstruction 250micrograms to 500micrograms/24h
Tumour antisecretory effect 50micrograms to 100micrograms twice daily

For continuous subcutaneous infusion (CSCI) use, seek specialist advice.

 

Practice points

  • Let injection reach room temperature before use to reduce pain on injection.
  • Rotate injection sites.
  • Avoid hard or red areas and areas of tenderness or bruising.
  • Depot injection recommended injection site is the gluteal muscle.
  • If necessary, the dose should be titrated upwards to achieve the desired response. When this has been achieved, it may subsequently be possible to reduce the dose to a lower maintenance level.
  • For continuous subcutaneous infusion (CSCI), sodium chloride 0.9% or water for injection (WFI) as diluent to the largest possible volume is recommended.
  • Gastrointestinal undesirable effects may be reduced by administering octreotide between meals or at bedtime.
  • Further information – contact Specialist Palliative Care services/Palliative Medicine on-call advice service.

 

References

Palliative Care Formulary (PCF).  http://www.knowledge.scot.nhs.uk/home/portals-and-topics/palliative-care.aspx.

Electronic Medicines Compendium.  Summary of Product Characteristics. www.medicines.org.uk.