Health Improvement Scotland and NHS Scotland Logos

Scottish Palliative Care Guidelines print pdf

Octreotide


Introduction

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

Preparations

Preparation

Presentation

Comments

Injection (as acetate)

50microgram/mL, 1mL amp
100microgram/mL, 1mL amp
500microgram/mL, 1mL amp

 

Injection (as acetate)

200microgram/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 IM injection every 28 days.

Lanreotide
Somatuline LA® (Ipsen) (lanreotide as acetate)
Long acting injection (copolymer microparticles for aqueous suspension),

30mg vial

With vehicle for IM injection every 14 days

Somatuline Autogel® (Ipsen)
Depot injection (prefilled syringe), (lanreotide as acetate)

60mg, 90mg, 120mg

for deep SC injection into the superior, external quadrant of the buttock every 28 days.

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 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.

 

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 where reduced 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

Contraindications
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 – 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

Indication

SC stat

Carcinoid, VIPomas, glucagonomas

50microgram once or twice daily

Intractable diarrhoea (including that caused by chemotherapy and radiotherapy)

250 to 500microgram/24h

Intestinal obstruction

300 to 500microgram/24h

Tumour-antisecretory effect

50 to 100microgram twice daily

 For 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, sodium chloride 0.9% or WFI as diluent to the largest possible volume is recommended.

Patient and carer advice points
GI undesirable effects may be reduced by administering octreotide between meals or at bedtime
Patient Information leaflet (last revised 08/12) on the Electronic Medicines Compendium at www.medicines.org.uk

Further information
Specialist Palliative Care services/Palliative Medicine on-call advice service.

References