Octreotide

Octreotide

[1 vial $31.24]

ADMINISTRATION ROUTES:

• SC, IV

ALTERNATIVE NAMES:

Sandostatin

ICU INDICATIONS:

1. varicealbleeding
2. chylothorax
3. carcinoid tumours, VIPomas and acromegally

PRESENTATION AND ADMINISTRATION:

• SC:
  Inject the required dose as undiluted solution by subcutaneous injection. Allow solution to come to room temperature to minimise pain at the injection site.

• IV:
  50mcg/ml, 100mcg/ml and 500mcg/ml ampoules
  For continuous infusion dilute 500mcg ampoule in 50ml of normal saline
  Dilutions stable for 24 hours at room temperature
  Refrigerate ampoules for prolonged storage; may be stored at room temperature for up to two weeks. Protect from light.

DOSAGE:

• SC:
  Chylothorax: 100mcg 8 hourly
  
• IV:
  When commencing an octreotide infusion, start with 50mcg SC undiluted stat then run infusion at 25mcg/hr.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

• No dosage adjustment is required

DOSAGE IN PAEDIATRICS:

• Diarrhoea secondary to endocrine tumours:
  1 mcg/kg stat then 1-5mcg/kg/kg IV

CLINICAL PHARMACOLOGY:

• Octreotide exerts pharmacologic actions similar to the natural hormone somatostatin. It is an even more potent inhibitor of growth hormone, glucagon, and insulin than somatostatin. Like somatostatin, it also suppresses LH response to GnRH, decreases splanchnic blood flow, and inhibits release of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide.

CONTRAINDICATIONS:

1. sensitivity to octreotide

WARNINGS

• Octreatide inhibits gallbladder contractility and may predispose to biliary tract disease such as cholecystitis and ascending cholangitis.

PRECAUTIONS

• General: Nil
• Laboratory Tests:
  Baseline thyroid function tests should be performed for people who require chronic therapy (although such patients are extremely rare in ICU)
• Drug/Laboratory Test Interactions: None reported

IMPORTANT DRUG INTERACTIONS FOR THE ICU

• Concomitant administration of octreotide with cyclosporine may decrease blood levels of cyclosporine and result in transplant rejection. Patients receiving insulin, oral hypoglycemic agents, beta blockers, calcium channel blockers, or agents to control fluid and electrolyte balance, may require dose adjustments of these therapeutic agents.

ADVERSE REACTIONS

• Gastrointestinal:
  Diarrhoea, vomiting, abdominal distention, constipation, biliary sludge, gallstones, nausea and abdominal discomfort Cardiac bradycardia
• Metabolic and endocrine:
  Hypoglycemia, hyperglycemia, hypothyroidism
• Neurological:
  headache