Parenteral Manual

Octreotide

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
SANDOSTATIN
Classification: 
Synthetic long-acting somatostatin analog
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 
  • Control of symptoms in patients with metastatic carcinoid and vasoactive intestinal peptide secreting tumours (VIPomas)
  • Treatment of several other disorders in including secretory diarrhea, acromegaly, neonatal hypoglycemia, pancreatitis, variceal bleeding, intestinal fistulae, GVHD-induced diarrhea, Zollinger-Ellison syndrome, chylothorax
Reconstitution and Stability: 
  • Store in fridge.  DO NOT freeze
  • Diluted solutions stable at room temp 24 hours in D5W and 30 hours in NS
  • Protect from light
Compatibility: 

- Solutions Compatible: D5W, 0.9%NaCl

- Additive/Above Cassette: no information

- Y-site Compatible: SMOF Lipid 20%, TPN (amino acids/dextrose)

- Incompatible: no information

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES
Usual dilution: undiluted
IM NO
IV Direct

YES, emergency situation
Usual dilution: undiluted
Infusion time: > 3 minutes
IV Intermittent Infusion

YES
Usual dilution: 20 mcg/mL 
Infusion time: 15-30 minutes
IV Continuous Infusion

YES
Usual dilution: 20 mcg/mL
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

- Chylothorax:  Continuous Infusion:  1-4 mcg/kg/hr    -Max 10 mcg/kg/hr
                       Intermittent Dosing:  10-40 mcg/kg/day IV/SC divided Q8H

- Diarrhea

  • 1-10 mcg/kg/dose IV/SC Q12H or
  • 1 mcg/kg bolus dose followed by a continuous infusion or 1 mcg/kg/hour

- Esophageal varices/GI bleed

  •  1-2 mcg/kg bolus dose followed by a continuous infusion of 1-2 mcg/kg/hour

Adolescent/Adult:
- Carcinoid Tumours:

  • 100-600 mcg/day SC/IV divided Q6-12 hours
  • Doses as high as 750-1,500 mcg/day have been used

- VIPomas: 200-300 mcg/day SC/IV divided Q6-12 hours

- Diarrhea: 50-100 mcg/dose SC/IV Q8 hours up to 1,500 mcg/day

- Esophageal varices bleeding: 25-50 mcg IV bolus followed by continuous IV infusion

- Continuous Infusion:

  • Infusions fo 25-50 mcg/hour IV have been used for various indications (esophageal varices, secretory diarrhea, intestinal fistulae, pancreatitis) as seen in the adult literature.  Little information in pediatrics.
Potential hazards of parenteral administration: 
  • Pain, stinging and burning at SC injection site
    - May be reduced by allowing the solution to warm to room temperature before injection
    - Rotate injection sites
  • Hypersensitivity reactions (rare)
  • Abdominal pain, nausea, vomiting, bloating, constipation, cramping, loose stools, delayed gastric emptying
  • Hypo- or hyperglycemia due to alterations in balance between the counter regulatory hormones
Notes: 
  • May alter absorption of dietary fats (administer between meals and/or at bedtime)
  • May cause decreased gallbladder contractility and bile stasis
  • May cause decreased renal blood flow, decreased GFR and elevated serum transaminases
  • May cause a reduction of pituitary function including decreased thyroid hormone release

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