Drug Interactions between lutetium lu 177 dotatate and pasireotide

ADJUST DOSING INTERVAL: Somatostatin and its analogs may interfere with the therapeutic effects of lutetium Lu 177 dotatate by competitively binding to somatostatin receptors, the site of action for the radiolabeled agent. Lutetium Lu 177 dotatate is internalized upon binding to somatostatin receptor expressing cells, including malignant somatostatin receptor-positive tumor cells, and subsequent beta emission from Lu 177 induces cellular damage by formation of free radicals in both target and neighboring cells.

MANAGEMENT: Long-acting formulations of somatostatin analogs should be discontinued for at least 4 weeks and short-acting formulations for at least 24 hours prior to each dose of lutetium Lu 177 dotatate. During treatment with lutetium Lu 177 dotatate, long-acting octreotide should be administered intramuscularly between 4 to 24 hours after each dose of lutetium Lu 177 dotatate (but not within 4 weeks of each subsequent dose of lutetium Lu 177 dotatate), while short-acting octreotide may be given as needed for symptomatic management (but not within 24 hours before each subsequent dose of lutetium Lu 177 dotatate). Following completion of lutetium Lu 177 dotatate treatment, long-acting octreotide should be continued every 4 weeks until disease progression or up to 18 months following treatment initiation.