ASTEROTIDE
OCTREOTIDE · by ASTER
Composition
Inj 0.05 mg/0.1 mg: Per 1 ml amp: Octreotide (as acetate) 0.05 mg/0.1 mg; soln. LAR Inj: Octreotide (as acetate) 20 mg; micro-spheres for susp; in vials plus 2 amp of diluent, syringe and 2 n
Indications & Dosage
Symptoms associated with carcinoid tumours with features of carcinoid syndrome, VIPomas, glucagonomas: BY SC INJ: Adult: Initially 50 mcg 1-2 times a day, adjusted according to response; increased to 200 mcg 3 times a day, higher doses may be required exceptionally; maintenance doses are variable; in carcinoid tumours, discontinue after 1 week if no effect, if rapid response required, initial dose may be given by IV injection (with ECG monitoring and after dilution). Acromegaly, short-term treatment before pituitary surgery or long-term treatment in those inadequately controlled by other treatment or until radiotherapy becomes fully effective: BY SC INJ: Adult: 100-200 mcg 3 times a day, discontinue if no improvement within 3 months. Prevention of complications following pancreatic surgery: BY SC INJ: Adult: (consult product literature). Test dose before use of depot preparation: BY SC INJ: Adult: Test dose 50-100 mcg for 1 dose, test dose should be given if subcutaneous octreotide not previously given. Acromegaly, Neuroendocrine (particularly carcinoid) tumour adequately controlled by subcutaneous octreotide: BY DEEP IM INJ USING DEPOT INJ: Adult: Initially 20 mg LAR injection every 4 weeks for 3 months then adjusted according to response, increased if necessary up to 30 mg LAR injection every 4 weeks, to be administered into the gluteal muscle, for acromegaly, start depot 1 day after the last dose of subcutaneous octreotide, for neuroendocrine tumours, continue subcutaneous octreotide for 2 weeks after first dose of depot octreotide. Advanced neuroendocrine tumours of the mid gut, or tumours of unknown primary origin where non-mid gut sites of origin have been excluded: BY DEEP IM INJ USING DEPOT INJ: Adult: 30 mg LAR injection every 4 weeks. Reduce intestinal secretions in palliative care, Reduce vomiting due to bowel obstruction in palliative care: BY CONTINUOUS SC INF: Adult: 0.25-0.5 mg/24 hours (max. per dose0.75 mg/24 hours), occasionally doses higher than the max. are sometimes required.
Administration
Depot formulation: Administer immediately after reconstitution, IM injections are administered in gluteal muscle. Avoid deltoid administration. IV: Regular injection only IV administration may be IVP, IVPB or continuous infusion. IVP should be administered undiluted over 3 min. IVPB should be administered over 15-30 min. Continuous IV infusion rates have ranged from 25-50 mcg/hour for the treatment of esophageal variceal bleeding.
Compatibility
Stable in D5W, NS. Incompatible with fat emulsion 10%.
Stability
Should be stored under refrigeration. Ampoules may be stored at room temperature for up to 14 days when protected from light. Stability of parenteral admixture in NS at room temperature (25C) and at refrigeration temperature (4C) is 48 hours.
Contraindications
Pregnancy, lactation.
Precautions
Sudden escape from symptomatic control may occur. Diabetics may show reduced hypoglycaemic requirements, in case of carcinoid tumour; stop if no beneficial effect seen within one week, in long term therapy; monitor thyroid function and for gall stones. Administering non-depot injections of octreotide between meals and at bedtime may reduce gastro-intestinal side-effects. Effective contraception required during treatment. Monitor liver function. ECG monitoring required with intravenous administration. Reduce dose in liver cirrhosis.
Interactions
Cyclosporin, cimetidine, bromocriptine.
Side Effects
Alopecia, arrhythmias, biliary colic (associated with abrupt withdrawal of subcutaneous octreotide), bradycardia, dehydration, dizziness, dyspnea, headache, hepatitis, pancreatitis (associated with abrupt withdrawal of subcutaneous octreotide), rash