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octreotide

Pronunciation

Generic Name: octreotide (injection) (ok TREE oh tide)
Brand Name: SandoSTATIN, SandoSTATIN LAR Depot

What is octreotide?

Octreotide is a man-made protein that is similar to a hormone in the body called somatostatin. Octreotide lowers many substances in the body such as insulin and glucagon (involved in regulating blood sugar), growth hormone, and chemicals that affect digestion.

Octreotide is used to treat acromegaly. Octreotide is also used to reduce flushing episodes and watery diarrhea caused by cancerous tumors (carcinoid syndrome) or tumors called vasoactive intestinal peptide tumors (VIP adenomas).

Octreotide may also be used for purposes not listed in this medication guide.

What is the most important information I should know about octreotide?

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

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What should I discuss with my healthcare provider before using octreotide?

You should not use octreotide if you are allergic to it.

To make sure you can safely use octreotide, tell your doctor if you have any of these other conditions:

  • diabetes;

  • gallbladder disease;

  • heart disease, high blood pressure, or heart rhythm disorder;

  • thyroid problems;

  • pancreatitis;

  • liver disease; or

  • kidney disease (or if you are on dialysis).

Octreotide is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Using octreotide can affect certain hormones that may make it easier for you to get pregnant, even if you were unable to get pregnant before. Talk to your doctor about using birth control to avoid unwanted pregnancy.

It is not known whether octreotide passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use octreotide?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Octreotide is injected under the skin, or into a vein through an IV. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine. Be sure to follow the instructions for the exact type of octreotide your doctor has prescribed for you.

Store octreotide in the original carton in the refrigerator. Protect from light.

Octreotide should be at room temperature when you inject it. Take the medicine out of the refrigerator 30 to 60 minutes before preparing your dose. Do not heat the medicine. After mixing your dose, give the injection right away. Do not save it for later use.

Prepare your dose only when you are ready to give yourself an injection. Do not use octreotide if it has changed colors or has particles in it. Call your pharmacist for new medication.

Your care provider will show you the best places on your body to inject octreotide. Use a different place each time you give an injection. Do not inject into the same place two times in a row.

Use a disposable needle and syringe only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

While using octreotide, you may need frequent medical tests.

Each single-use ampul is for one use only. Throw away after one use, even if there is still some medicine left in it after injecting your dose.

If refrigeration is not available, you may store an unopened single-use ampul or multi-dose vial at room temperature for up to 14 days. Keep away from moisture and heat.

Throw away any medicine left in the multi-use vial after 14 days of use. Then start a new vial.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of octreotide.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe upper stomach pain, diarrhea, weight loss, warmth or tingling, numbness or cold feeling, unexplained muscle pain, weakness, weak pulse, fainting, or slow breathing (breathing may stop).

What should I avoid while using octreotide?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Octreotide side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • severe stomach pain or tenderness, severe constipation;

  • slow or uneven heartbeats;

  • severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate;

  • high blood sugar--increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss;

  • low blood sugar--headache, hunger, weakness, sweating, confusion, irritability, dizziness, fast heart rate, or feeling jittery; or

  • underactive thyroid--extreme tired feeling, dry skin, joint pain or stiffness, muscle pain or weakness, hoarse voice, feeling more sensitive to cold temperatures, weight gain.

Common side effects may include:

  • diarrhea, constipation;

  • vomiting, upset stomach;

  • bloating, gas;

  • headache, dizziness; or

  • pain when injecting the medicine.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Octreotide dosing information

Usual Adult Dose for Carcinoid Tumor:

Initial dose: 100 to 200 mcg subcutaneously 3 times a day.
Maintenance dose: 50 to 300 mcg/day.
Maximum dose: 1,500 mcg/day.

Octreotide acetate for injectable suspension (depot):
Patients who are not currently receiving octreotide should begin therapy with the subcutaneous injection as described above. Patients should be maintained on octreotide subcutaneous injection for at least two weeks to determine tolerance to octreotide. Patients who are considered to be "responders" to the drug, and who tolerate the drug, can then be switched to octreotide acetate for injectable suspension (depot).

Patients currently receiving octreotide injection can be switched directly to octreotide acetate for injectable suspension (depot) at a dose of 20 mg IM intragluteally at 4 week intervals for 2 months. (Deltoid injections should be avoided because of the significant discomfort at the injection site when given in that area.) Gluteal injection sites should be alternated to avoid irritation.

Because of the need for serum octreotide to reach therapeutically effective levels following the initial injection of octreotide acetate for injectable suspension (depot), carcinoid tumor patients should continue to receive subcutaneous injections for at least 2 weeks in the same dosage they were taking before the switch. Failure to continue subcutaneous injections for this period may result in exacerbation of symptoms. Some patients may require 3 or 4 weeks of subcutaneous injections after the switch to the depot form.

After 2 months of a 20 mg depot dosage, the dosage may be increased to 30 mg every 4 weeks if symptoms are not adequately controlled. Patients who achieve good control on a 20 mg dose may have their dose lowered to 10 mg for a trial period. If symptoms recur, dosage should then be increased to 20 mg every 4 weeks. Many patients can be maintained at a 10 mg dosage every 4 weeks. However, a dose of 10 mg is not recommended as a starting dose because therapeutically effective levels of octreotide are reached more rapidly with a 20 mg dose.

Dosages higher than 30 mg are not recommended because there is no information on their usefulness.

Despite good overall control of symptoms, patients with carcinoid tumors often experience periodic exacerbation of symptoms. During these periods, they may be the subcutaneous injection for a few days at the dosage they were receiving prior to their switch to the depot form. When symptoms are again under control, the subcutaneous injection can again be discontinued.

Administration of octreotide acetate for injectable suspension (depot) at intervals greater than four weeks is not recommended because there is no adequate information on whether such patients could be adequately controlled.

Usual Adult Dose for Vasoactive Intestinal Peptide Tumor:

Initial dose: 100 mcg subcutaneously 2 to 3 times a day.
Maintenance dose: 150 to 300 mcg/day.
Maximum dose: 450 mcg/day.

Octreotide acetate for injectable suspension (depot):
Patients who are not currently receiving octreotide should begin therapy with the subcutaneous injection as described above. Patients should be maintained on octreotide subcutaneous injection for at least two weeks to determine tolerance to octreotide. Patients who are considered to be "responders" to the drug, and who tolerate the drug, can then be switched to octreotide acetate for injectable suspension (depot).

Patients currently receiving octreotide injection can be switched directly to octreotide acetate for injectable suspension (depot) at a dose of 20 mg IM intragluteally at 4 week intervals for 2 months. (Deltoid injections should be avoided because of the significant discomfort at the injection site when given in that area.) Gluteal injection sites should be alternated to avoid irritation.

Because of the need for serum octreotide to reach therapeutically effective levels following the initial injection of octreotide acetate for injectable suspension (depot), VIPoma patients should continue to receive subcutaneous injections for at least 2 weeks in the same dosage they were taking before the switch. Failure to continue subcutaneous injections for this period may result in exacerbation of symptoms. Some patients may require 3 or 4 weeks of subcutaneous injections after the switch to the depot form.

After 2 months of a 20 mg depot dosage, the dosage may be increased to 30 mg every 4 weeks if symptoms are not adequately controlled. Patients who achieve good control on a 20 mg dose may have their dose lowered to 10 mg for a trial period. If symptoms recur, dosage should then be increased to 20 mg every 4 weeks. Many patients can be maintained at a 10 mg dosage every 4 weeks. However, a dose of 10 mg is not recommended as a starting dose because therapeutically effective levels of octreotide are reached more rapidly with a 20 mg dose.

Dosages higher than 30 mg are not recommended because there is no information on their usefulness.

Despite good overall control of symptoms, patients with VIPoma often experience periodic exacerbation of symptoms. During these periods, they may be the subcutaneous injection for a few days at the dosage they were receiving prior to their switch to the depot form. When symptoms are again under control, the subcutaneous injection can again be discontinued.

Administration of octreotide acetate for injectable suspension (depot) at intervals greater than four weeks is not recommended because there is no adequate information on whether such patients could be adequately controlled.

Usual Adult Dose for Acromegaly:

Initial dose: 50 mcg subcutaneously 3 times a day.
Maintenance dose: 100 to 300 mcg/day.

Octreotide acetate for injectable suspension (depot):
Patients who are not currently receiving octreotide should begin therapy with the subcutaneous injection as described above. Although responsiveness of growth hormone (GH) to octreotide can be ascertained quickly, patients should be maintained on octreotide subcutaneous injection for at least two weeks to determine tolerance to octreotide. Patients who are considered to be "responders" to the drug (based on GH and IGF-1 levels), and who tolerate the drug, can then be switched to octreotide acetate for injectable suspension (depot).

Patients currently receiving octreotide injection can be switched directly to octreotide acetate for injectable suspension (depot) at a dose of 20 mg IM intragluteally at 4 week intervals for 3 months. (Deltoid injections should be avoided because of the significant discomfort at the injection site when given in that area.) Gluteal injection sites should be alternated to avoid irritation.

At the end of three months octreotide acetate for injectable suspension (depot) may be continued at the same level, increased, or decreased based on the following:
GH less than or equal to 2.5 ng/mL, IGF-1 normal and clinical symptoms controlled: maintain the depot dose at 20 mg every 4 weeks.
GH greater than 2.5 ng/mL, IGF-1 elevated and/or clinical symptoms uncontrolled: increase the depot dose to 30 mg every 4 weeks.
GH less than or equal to 1 ng/mL, IGF-1 normal and clinical symptoms controlled: reduce the depot dose to 10 mg every 4 weeks.

Patients whose GH, IGF-1, and symptoms are not adequately controlled at a dose of 30 mg may have the dose increased to 40 mg every four weeks. Doses higher than 40 mg are not recommended.

Administration of octreotide acetate for injectable suspension (depot) at intervals greater than four weeks is not recommended because there is no adequate information on whether such patients could be adequately controlled.

In patients who have received pituitary irradiation, octreotide acetate for injectable suspension (depot) should be withdrawn yearly for approximately 8 weeks to assess disease activity. If GH or IGF1 levels increase and signs and symptoms recur, octreotide acetate for injectable suspension (depot) should be resumed.

Usual Adult Dose for Gastrinoma:

Initial dose: 100 to 200 mcg subcutaneously 3 times a day.
Maintenance dose: 100 to 300 mcg/day.
Maximum dose: 1,500 mcg/day.

Usual Adult Dose for Pituitary Adenoma:

Initial dose: 100 to 200 mcg subcutaneously 3 times a day.
Maintenance dose: 100 to 300 mcg/day.
Maximum dose: 1,500 mcg/day.

Usual Adult Dose for Insulinoma:

Initial dose: 100 to 200 mcg subcutaneously 3 times a day.
Maintenance dose: 100 to 300 mcg/day.

Usual Adult Dose for Glucagonoma:

Initial dose: 100 to 200 mcg subcutaneously 3 times a day for 2 weeks.
Maintenance dose: 300 to 1,500 mcg/day.

Usual Adult Dose for Small Bowel or Pancreatic Fistula:

50 to 100 mcg subcutaneously 3 times a day for 2 to 3 days.

Usual Adult Dose for Diarrhea:

Initial dose: 50 to 100 mcg subcutaneously 3 times a day.
Maintenance dose: 50 to 300 mcg/day. (10 to 300 mcg when AIDS associated).

Usual Adult Dose for Diabetes Type 1:

Initial dose: 50 mcg subcutaneously 3 times a day.
Maintenance dose: 100 to 600 mcg/day.

What other drugs will affect octreotide?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with octreotide, especially:

  • bromocriptine (Cycloset, Parlodel);

  • cyclosporine (Neoral, Sandimmune, Gengraf);

  • insulin or oral diabetes medicine;

  • a diuretic or "water pill"; or

  • medicine for heart disease or high blood pressure.

This list is not complete. Other drugs may interact with octreotide, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about octreotide.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 5.01. Revision Date: 2015-01-07, 9:32:44 PM.

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