Octreotide

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 21.12.2021

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Synonym(s)

Minisomatostatin; Octreotidum

Definition
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Synthetic long-acting somatostatin analogue.

Pharmacodynamics (Effect)
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Inhibition of the secretion of insulin, glucagon, gastrin, GH, TSH, prolactin and vasoactive intestinal peptides (VIP).

Indication
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Approved for the symptomatic treatment of endocrine active tumors of the gastrointestinal tract:

  • Metastatic carcinoids with the characteristics of carcinoid syndrome such as flush and severe diarrhoea.
  • VIPome with severe aqueous diarrhoea.
  • Glucagonomas with inflammatory skin destruction by necrolytic, migratory erythema.
  • Prophylaxis of postoperative pancreatic complications after pancreatic surgery.
  • For symptom management and reduction of growth hormone (GH) and insulin-like growth factor I plasma levels in patients with acromegaly in whom surgical treatment, radiotherapy or treatment with a dopamine agonist has not been successful, and in acromegaly patients who are unwilling or unable to undergo surgical intervention or for bridging until radiotherapy is fully effective.
  • As an antidote in hypoglycaemia in severe sulfonylurea intoxications, as an adjunct to glucose administration.

According to studies effective in Merkel cell carcinoma ( OFF-LABEL-USE).

Pregnancy/nursing period
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Contraindicated.

Dosage and method of use
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  • Merkel cell carcinoma: 3 times/day 500-1000 µg/day s.c. until tumor regression.
  • Antidote:
    • Adults: 3 applications with 50-100 each μg s.c. (or i.v.) every 6-12 hours or 30 µg/kg/KG/minute per infusionem.
    • Children: 3 applications of 25-50 μg s.c. each (or i.v.) every 6-12 hours or 15 µg/kg/KG/minute per infusion.
  • Hormone producing tumours of the gastrointestinal tract: Initial 1-2 times/day 50 µg octreotide s.c. Subsequently dose escalation to 3 times/day 100-200 µg s.c. Exceptionally higher dosage up to 3 times/day 500 µg octreotide s.c.
  • Acromegaly: initial 50-100 µg s.c. at intervals of 8-12 hours Dosage adjustment based on the determination of growth hormone levels and/or insulin-like growth factor plasma levels.
  • Prophylaxis of postoperative pancreatic complications after pancreatic surgery: 100 µg/day s.c.

Undesirable effects
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  • Local reactions to s.c. application: pain, stinging, burning, tingling, redness, swelling at the injection site.
  • Accommodation/General: Very often: hyperglycemia, diarrhoea, cramp-like abdominal pain (tenesmus), nausea, constipation, flatulence. Also drug exanthema, anaphylactic reactions, bradycardia.

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Last updated on: 21.12.2021