OCTREOTIDE ACETATE

(oc-tre'o-tide)

Sandostatin, Sandostatin LAR depot
Classifications: hormone; somatostatin analog;
Therapeutic: hormone suppressant; acromegaly agent; antidiarrheal
Pregnancy Category: B

Availability

0.05 mg/mL, 0.1 mg/mL, 0.2 mg/mL, 0.5 mg/mL, 1 mg/mL injection; 10 mg/5 mL, 20 mg/5 mL, 30 mg/5 mL depot injection

Action

A long-acting peptide that mimics the natural hormone somatostatin. Suppresses secretion of serotonin, pancreatic peptides, gastrin, vasoactive intestinal peptide, insulin, glucagon, secretin, and motilin.

Therapeutic Effect

Stimulates fluid and electrolyte absorption from the GI tract, prolongs intestinal transit time, and also inhibits the growth hormone.

Uses

Symptomatic treatment of severe diarrhea and flushing episodes associated with metastatic carcinoid tumors. Also watery diarrhea associated with vasoactive intestinal peptide (VIP) tumors.

Unlabeled Uses

Acromegaly associated with pituitary tumors, fistula drainage, variceal bleeding.

Contraindications

Hypersensitivity to octreotide.

Cautious Use

Cholelithiasis, renal impairment; dialysis; hepatic disease; cardiac disease; diabetes, hypothyroidism; pregnancy (category B); lactation.

Route & Dosage

Carcinoid Syndrome
Adult: SC/IV 100–600 mcg/d in 2–4 divided doses, titrate to response IM May switch to depot injection after 2 wk at 20 mg q4wk x 3 mo

VIPoma
Adult: SC/IV 200–300 mcg/d in 2–4 divided doses, titrate to response IM May switch to depot injection after 2 wk at 20 mg q4wk x 2 mo

Acromegaly
Adult: SC 50 mcg t.i.d., titrate up to 100 mcg–500 mcg t.i.d. IM May switch to depot injection after 2 wk at 20 mg q4wk x at least 3 mo, then reassess

Administration

Subcutaneous/Intramuscular

Note: Subcutaneous is the preferred route.
Minimize GI side effects by giving injections between meals and at bedtime.
Avoid multiple injections into the same site. Rotate SC sites on abdomen, hip, and thigh.
Give deep IM into a large muscle. To reduce local irritation, allow solution to reach room temperature before injection and administer slowly.

Intravenous

PREPARE: Direct: Give undiluted. Intermittent: Dilute in 50–200 mL D5W.

ADMINISTER: Direct: Give a single dose over 3 min. In emergency (eg, carcinoid crisis), give rapid IV bolus over 60 sec. Intermittent: Give over 15–30 min.

INCOMPATIBILITIES Solution/additive: Fat emulsion, regular insulin.

Adverse Effects (≥1%)

CNS: Headache, fatigue, dizziness. GI: Nausea, diarrhea, abdominal pain and discomfort. Metabolic: Hypoglycemia, hyperglycemia, increased liver transaminases, hypothyroidism (after long-term use). Body as a Whole: Flushing, edema, injection site pain.

Interactions

Drug: May decrease cyclosporine levels; may alter other drug and nutrient absorption because of alterations in GI motility.

Pharmacokinetics

Absorption: Rapidly from SC injection. Peak: 0.4 h. Duration: Up to 12 h. Metabolism: In liver. Elimination: In urine. Half-Life: 1.5 h.

Nursing Implications

Assessment & Drug Effects

Lab tests: Periodic blood glucose, liver function tests, and serum electrolytes.
Monitor for hypoglycemia and hyperglycemia (see Appendix F), because octreotide may alter the balance between insulin, glucagon, and growth hormone.
Monitor fluid and electrolyte balance, as octreotide stimulates fluid and electrolyte absorption from GI tract.
Monitor vitals signs, especially BP.
Monitor bowel function, including bowel sounds and stool consistency.
Dietary fat absorption may be altered in some clients. Monitor fecal fat and serum carotene to aid in the assessment of possible drug-induced aggravation of fat malabsorption.

Patient & Family Education

Learn proper technique for SC injection if self-medication is required.
Note: Preferred sites for SC injections of octreotide are the hip, thigh, and abdomen. Multiple injections at the same SC injection site within short periods of time are not recommended. This is to avoid irritating the area.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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