Octreotide

Octreotide is an analogue of somatostatin. It is used to provide relief from symptoms associated with carcinoid tumours and acromegaly. It may also be used for the prevention of complications following pancreatic surgery.For patients undergoing pancreatic surgery, the peri- and post-operative administration of octreotide reduces the incidence of typical post-operative complications (e.g. pancreatic fistula, abscess and subsequent sepsis, post-operative acute pancreatitis). Octreotide exerts an inhibiting effect on gallbladder motility, bile acid secretion and bile flow, and there is an acknowledged association with the development of gallstones in prolonged usage.

Uses
Prevention of complications following pancreatic surgery
Pancreatic leak (unlicensed)
Variceal haemorrhage (2nd line to terlipressin)

Administration
• Prevention of complications following pancreatic surgery
SC or IV: 100 μg 8 hourly for 7 days, starting on the day of operation
at least one hour before laparotomy
• Pancreatic leak
SC or IV: 100–200 μg 8 hourly

To reduce pain and irritation on injection, allow solution to reach room temperature and rotate injection site IV dose should be diluted with 5 ml sodium chloride 0.9% Available as 50, 100 and 500 μg/1 ml ampoules. Use the 500 μg/1 ml ampoule for SC injection of doses > 200 μg to reduce pain arising from the injection volume Variceal haemorrhage (unlicensed indication): only use if terlipressin is contra indicated (e.g. ischaemic ECG). Dose 100 μg IV stat then a continuous infusion of 50 μg/h continued for 24 hours after variceal banding. Then reduce dose to 25 μg/h for 12 hours then stop. To prepare solution dilute 5 x 100 μg ampoules to 50 ml with sodium chloride 0.9% = 10 μg/ml solution. 50 μg/h = 5 ml/h; 25 μg/h = 2.5 ml/h. Dilute to a ratio of not less than 1:1 and not more than 1:9 by
volume

Stored in fridge at 2–8°C

How not to use octreotide
Abrupt withdrawal (biliary colic and pancreatitis)
Dilution with solution containing glucose is not recommended
Adverse effects
GI disturbances (nausea, vomiting, pain, bloating and diarrhoea)
Pain and irritation at injection site (allow solution to reach room temperature and rotate injection sites)
Elevated LFTs
Gallstone formation with prolonged use

Cautions
Growth hormone-secreting pituitary tumour (may increase in size)
Insulinoma (hypoglycaemia)
Requirement for insulin and oral hypoglycaemic drugs may be reduced in diabetes mellitus

Organ failure
Hepatic: reduce dose