Octreotide Acetate
| (ock-TREE-oh-tide ASS-uh-TATE) |
| Sandostatin |
| Sandostatin LAR Depot |
| Class: Hormone |
Action Actions mimic those of natural hormone somatostatin. Suppresses secretion of serotonin and gastroenteropancreatic peptides (eg, gastrin, insulin, glucagon, secretin, motilin). Also suppresses growth hormone.
Indications Symptomatic treatment of diarrhea associated with carcinoid tumors; treatment of profuse watery diarrhea associated with vasoactive intestinal peptide tumors (VIPoma); to reduce blood levels of growth hormone and IGF-1 in acromegaly patients who have had inadequate response to or cannot be treated with resection, pituitary irradiation and bromocriptine at maximally tolerated doses. Unlabeled use(s): To reduce output from GI fistulas; for variceal bleeding; for relief of diarrhea associated with a variety of conditions; to reduce output from pancreatic fistulas; to treat irritable bowel syndrome; to treat dumping syndrome; to treat the following conditions: Enteric fistula; pancreatitis; pancreatic surgery; glucagonoma; insulinoma; gastrinoma (Zollinger-Ellison syndrome); intestinal obstruction; local radiotherapy; chronic pain management; antineoplastic therapy; decrease insulin requirements in diabetes mellitus; thryotropin- and TSH-secreting tumors.
Contraindications Standard considerations.
Route/DosageCarcinoid Tumors
ADULTS: SC 100 to 600 mcg/day in 2 to 4 divided doses, adjusting to response.
VIPoma
ADULTS: SC 200 to 300 mcg/day in 2 to 4 divided doses, adjusting to response.
Acromegaly
ADULTS: SC 50 mcg to 500 mcg/tid. Most common dose is 100 mcg/tid; doses > 300 mcg/day seldom result in additional benefit.
InteractionsCyclosporine: May decrease plasma levels of cyclosporine. INCOMPATIBILITIES: Parenteral nutrition solutions.
Lab Test Interferences None well documented.
Adverse ReactionsCNS: Headache; dizziness; lightheadedness; fatigue; sinus bradycardia; conduction abnormalities; arrhythmias. GI: Nausea; constipation; flatulence; diarrhea; abdominal pain or discomfort; loose stools; vomiting; fat malabsorption. HEPA: Increased liver transaminase. META: Hyperglycemia; hypoglycemia. OTHER: Injection site pain; flushing; asthenia; weakness.
PrecautionsPregnancy: Category B. Lactation: Undetermined. Children: Has been used in children as young as 1 mo. Elderly: Dose adjustments may be necessary due to significant increases in half-life and significant decrease in the clearance of octreotide. Cardiac effects: In acromegalics, bradycardia, conduction abnormalities and arrhythmias have occurred. Other ECG changes observed include QT prolongation, axis shifts, early repolarization, low voltage, R/S transition and early wave progression. Dose adjustments in drugs such as beta blockers that have bradycardia effects may be necessary. Pancreatitis: Several cases have occurred in patients receiving octreotide. Cholelithiasis: Cholelithiasis may occur; periodically monitor gallbladder function. Hypoglycemia or hyperglycemia: Serum glucose control may be altered; carefully monitor patient and adjust insulin requirements accordingly. Renal impairment: Dosage reduction may be necessary.
| PATIENT CARE CONSIDERATIONS |
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Administration/Storage- Do not administer if particulate matter or discoloration is observed.
- Rotate sites for SC injection.
- Store ampules at room temperature for day of use.
- Refrigerate for prolonged storage.
Assessment/Interventions- Obtain patient history, including drug history and any known allergies.
- Monitor glucose, CBC, T3, T4, TSH, renal function tests, BUN, creatinine, and electrolytes and obtain baseline weight and BP.
- Assess for nausea, headache, shortness of breath, hyperglycemia/hypoglycemia, or abdominal pain.
- Monitor I&O and daily weight.
- Monitor BP, pulse, and respiration weekly during treatment.
- Assess frequency and consistency of stools.
- Assess lung sounds, and report any edema or decrease in urine output.
- Dietary fat absorption may be altered in some patients. Perform periodic quantitative 72-hour fecal fat and serum carotene determination to aid in assessment of possible drug-induced aggravation of fat malabsorption.
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Patient/Family Education- Instruct and observe return demonstration of correct technique for SC injection. Explain that preferred sites for injection are abdomen, thigh, and hip.
- Advise patient of importance of regular follow-up with physician.
- Caution patient to report the following symptoms to physician: Icterus, jaundice, dark urine, or clay-colored stools.
- Advise patient to notify physician of abdominal pain, edema, chest pain, fainting, dry mouth, or shortness of breath.
- Advise patient that various laboratory tests may be required during therapy.
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