Octreotide

Inhibition of the secretion of insulin, glucagon, gastrin, GH, TSH, prolactin and vasoactive intestinal peptides (VIP).

Approved for the symptomatic treatment of endocrine active tumors of the gastrointestinal tract:

• Metastatic carcinoids with the characteristics of carcinoid syndrome such as flush and severe diarrhoea.
• VIPome with severe aqueous diarrhoea.
• Glucagonomas with inflammatory skin destruction by necrolytic, migratory erythema.
• Prophylaxis of postoperative pancreatic complications after pancreatic surgery.
• For symptom management and reduction of growth hormone (GH) and insulin-like growth factor I plasma levels in patients with acromegaly in whom surgical treatment, radiotherapy or treatment with a dopamine agonist has not been successful, and in acromegaly patients who are unwilling or unable to undergo surgical intervention or for bridging until radiotherapy is fully effective.
• As an antidote in hypoglycaemia in severe sulfonylurea intoxications, as an adjunct to glucose administration.

According to studies effective in Merkel cell carcinoma ( OFF-LABEL-USE).

• Merkel cell carcinoma: 3 times/day 500-1000 µg/day s.c. until tumor regression.
• Antidote:
• Adults: 3 applications with 50-100 each μg s.c. (or i.v.) every 6-12 hours or 30 µg/kg/KG/minute per infusionem.
• Children: 3 applications of 25-50 μg s.c. each (or i.v.) every 6-12 hours or 15 µg/kg/KG/minute per infusion.
• Hormone producing tumours of the gastrointestinal tract: Initial 1-2 times/day 50 µg octreotide s.c. Subsequently dose escalation to 3 times/day 100-200 µg s.c. Exceptionally higher dosage up to 3 times/day 500 µg octreotide s.c.
• Acromegaly: initial 50-100 µg s.c. at intervals of 8-12 hours Dosage adjustment based on the determination of growth hormone levels and/or insulin-like growth factor plasma levels.
• Prophylaxis of postoperative pancreatic complications after pancreatic surgery: 100 µg/day s.c.

• Local reactions to s.c. application: pain, stinging, burning, tingling, redness, swelling at the injection site.
• Accommodation/General: Very often: hyperglycemia, diarrhoea, cramp-like abdominal pain (tenesmus), nausea, constipation, flatulence. Also drug exanthema, anaphylactic reactions, bradycardia.