Alternate Name(s):
Sandostatin
Classification:
Synthetic somatostatin analog
Original Date:
November 2022
Indications:
- Treatment of chylothorax (acquired or congenital)
Administration:
IV Continuous Infusion (preferred route)
- Usual dilution 20 mcg/mL
IV Intermittent/Direct
- Intermittent: Usual dilution 20 mcg/mL over 15-30 minutes
SC Direct
- Give undiluted
Dosage:
Chylothorax (Congenital):
- IV Infusion: Usual initial dose: 0.5 to 2 mcg/kg/hour, increase by 1 mcg/kg/hr Q24H until a response is noted (chest tube output decreased) or to the usual max dose of 10 mcg/kg/hr (range reported in the literature up to 20 mcg/kg/hr).
Chylothorax (Acquired):
- IV Infusion: Usual initial dose: 1 to 2 mcg/kg/hour, increase by 1 mcg/kg/hr Q24H based on clinical response to a maximum dose of 4 mcg/kg/hr (reported range 0.5-15 mcg/kg/hr).
Side Effects:
- CVS: Sinus bradycardia (direct administration, high dose), hypertension
- ENDO: Hypo- or hyperglycemia, hypothyroidism
- HEPATIC: cholestasis, transient increase in liver function tests
- GI: Loose stools, abdominal cramps and pain, N/V
Parameters to Monitor:
- Output from chest tube(s)/chest imaging
- Blood pressure and heart rate
- Liver Function Tests, Bilirubin
- Blood Glucose
- Thyroid (longer term infusions)
Reconstitution and Stability:
- Continuous Infusion: Prepared by pharmacy as 20 mcg/mL syringe
Compatibility:
- Solutions Compatible: D5W, 0.9% NaCl
- Y-Site Compatible: KCl (max 40 mmol/L), TPN (amino acids/dextrose), SMOF Lipid 20%
- Incompatible: pantoprazole
Notes:
- Once response obtained, may hold at current dose for 24H, then consider tapering over several days. Taper is expected to be longer for higher max doses, and patient must be monitored closely for re-accumulation of chylothorax
- Infusion MUST be tapered off. Monitor glucose daily while doing so.
- SC/IV intermittent dosing can be used in cases of limited IV access
- Tachyphylaxis can occur, especially when used in patients with hyperinsulinism. Thus, higher doses may be required to maintain a similar effect.
- Persistent pulmonary hypertension of the newborn (PPHN) and necrotizing enterocolitis (NEC) have been reported in premature infants.
References:
- Bellini, C., Cabano, R., De Angelis, L.C., Bellini, T., Calevo, M.G., Gandullia, P. and Ramenghi, L.A. (2018), Octreotide for congenital and acquired chylothorax in newborns: A systematic review. J Paediatr Child Health, 54: 840-847. https://doi.org/10.1111/jpc.13889
- Das A, Shah PS. Octreotide for the treatment of chylothorax in neonates. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD006388. DOI: 10.1002/14651858.CD006388.pub2. Accessed 31 October 2022.
- Rocha, G, Arnet, V, Soares, P, et al. Chylothorax in the neonate—A stepwise approach algorithm. Pediatric Pulmonology. 2021; 56: 3093- 3105. https://doi.org/10.1002/ppul.25601
- IBM Micromedex Databse, accessed online November 2022
- Lexicomp Database, accessed online November 2022