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Gastrointestinal Emergency Pregnancy: Caution — limited data; used in pregnancy for acromegaly and carcinoid; octreotide crosses placenta; seek specialist advice

Octreotide

Brand names: Sandostatin

Adult dose

Dose: 50 mcg IV bolus, then 50 mcg/hour infusion
Route: IV
Frequency: Continuous infusion for up to 5 days (variceal haemorrhage)
Max: 50 mcg/hour
For variceal haemorrhage: start immediately, continue for 5 days post-endoscopy. For hypoglycaemia from sulfonylurea: 50–100 mcg SC every 6–8 hours. For carcinoid crisis: 300–500 mcg SC or IV bolus

Paediatric dose

Dose: 1–10 mcg/kg/day mcg/day/kg
Route: IV or SC
Frequency: Divided every 6–8 hours
Max: 50 mcg/hour
For neonatal hyperinsulinaemic hypoglycaemia: 2–10 mcg/kg/day SC in 2–3 divided doses; seek specialist paediatric endocrinology opinion

Dose adjustments

Renal

No dose adjustment required; octreotide inhibits insulin secretion and glucagon which may worsen glucose control

Hepatic

Cirrhosis — half-life prolonged; reduce dose or extend interval

Paediatric weight-based calculator

For neonatal hyperinsulinaemic hypoglycaemia: 2–10 mcg/kg/day SC in 2–3 divided doses; seek specialist paediatric endocrinology opinion

Clinical pearls

  • Mechanism: somatostatin analogue — inhibits release of GI hormones (glucagon, insulin, gastrin, secretin, VIP, motilin); directly vasoconstricts splanchnic vessels by reducing glucagon-mediated vasodilation; reduces portal pressure
  • Variceal haemorrhage: BAVENO VII — octreotide is a vasoactive drug alternative to terlipressin where terlipressin is unavailable or contraindicated; octreotide + endoscopy + antibiotics; 5-day course
  • Sulfonylurea-induced hypoglycaemia: octreotide 50–100 mcg SC q6h is PREFERRED over repeated dextrose alone — suppresses ongoing endogenous insulin secretion that perpetuates hypoglycaemia; admission mandatory for 24h observation
  • Carcinoid crisis: intraoperative cardiovascular instability in carcinoid tumours — 300–500 mcg IV bolus; continue infusion perioperatively
  • Gallstones: risk 50% with long-term octreotide LAR (monthly depot) — baseline and annual abdominal ultrasound recommended
  • MHRA: short-acting Sandostatin 50 mcg/mL and long-acting LAR formulations are NOT interchangeable — emergency use should always use short-acting IV or SC

Contraindications

  • Known hypersensitivity to octreotide
  • Insulin-secreting tumours (insulinoma) — paradoxical hypoglycaemia possible with long-acting formulations

Side effects

  • GI: nausea, cramping, diarrhoea, steatorrhoea (somatostatin inhibits pancreatic exocrine function)
  • Gallstone formation (reduced cholecystokinin — biliary stasis; especially with long-term use)
  • Hypoglycaemia or hyperglycaemia (complex effect on insulin and glucagon)
  • Bradycardia and conduction abnormalities
  • Injection site reactions (SC use)

Interactions

  • Insulin and oral hypoglycaemics (octreotide inhibits insulin secretion — complex glucose effects; monitor closely)
  • Cyclosporin (octreotide reduces cyclosporin absorption by 30%)
  • Bromocriptine (octreotide increases bioavailability)

Monitoring

  • Blood glucose (hypoglycaemia and hyperglycaemia both possible)
  • Heart rate and ECG (bradycardia, QT changes)
  • Clinical response (haemostasis in variceal haemorrhage)
  • Thyroid function with prolonged use
  • Gallbladder ultrasound (long-term use)

Reference: BNFc; BNF 90; BAVENO VII Consensus 2022; NEJM 1995;333(9):555-560; BSG Variceal Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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