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Somatostatin Analogue Pregnancy: Use only if clearly needed — potential inhibition of fetal growth hormone axis. Switch to alternative management if possible during pregnancy.

Lanreotide

Brand names: Somatuline Autogel

Adult dose

Dose: Acromegaly: 60–120mg SC deep injection every 4 weeks; adjust based on IGF-1 and GH levels. Gastroenteropancreatic NETs (GEP-NETs): 120mg SC every 4 weeks. Carcinoid syndrome (unlicensed): 120mg SC every 4 weeks.
Route: Deep subcutaneous injection (buttock — self-injectable or by healthcare professional)
Frequency: Every 4 weeks
Max: 120mg per injection every 4 weeks
Somatuline Autogel prefilled syringe — delivered as a viscous gel into deep SC tissue of buttock. Does not require reconstitution. Refrigerate at 2–8°C; remove 30 minutes before injection. Monitor IGF-1 levels to guide dose adjustment in acromegaly (target: age-normalised IGF-1 in normal range).

Paediatric dose

Route: Subcutaneous injection
Frequency: Every 4 weeks
Max: Individualised
Not licensed in children. Used under specialist supervision in rare cases of paediatric acromegaly or carcinoid. Seek specialist paediatric endocrinology/oncology opinion.

Dose adjustments

Renal

No dose adjustment required — minimal renal excretion.

Hepatic

Moderate-severe hepatic impairment: reduce starting dose to 60mg every 4 weeks; adjust based on response.

Clinical pearls

  • Gallstones: baseline gallbladder ultrasound recommended before starting lanreotide — gallstones develop in 15–40% of patients within 6–12 months; if symptomatic, cholecystectomy may be required
  • Acromegaly response: check IGF-1 and random GH at 3 months; aim for IGF-1 in age-normalised range and GH <1 ng/mL (1 microgram/L) — if inadequate, increase to 120mg or add pegvisomant
  • CLARINET trial: lanreotide 120mg extended median progression-free survival significantly in non-functioning GEP-NETs — now standard of care
  • Carcinoid crisis prevention: give somatostatin analogue before any surgical procedure or anaesthesia in carcinoid patients

Contraindications

  • Hypersensitivity to lanreotide or somatostatin analogues

Side effects

  • Diarrhoea / steatorrhoea (somatostatin inhibits pancreatic enzyme secretion)
  • Abdominal pain, flatulence
  • Gallstones (biliary sludge — occurs in up to 50% long-term; usually asymptomatic)
  • Bradycardia
  • Hyperglycaemia or hypoglycaemia (variable effect on insulin)
  • Injection site pain and nodules
  • Hair thinning

Interactions

  • Cyclosporin — somatostatin analogues reduce cyclosporin absorption; monitor levels
  • Antidiabetic drugs — lanreotide alters glucose homeostasis; adjust antidiabetic therapy
  • QT-prolonging drugs — bradycardia risk; monitor ECG

Monitoring

  • IGF-1 and GH levels (3–6 monthly in acromegaly)
  • Gallbladder ultrasound (baseline and annually)
  • Blood glucose
  • Cardiac rate (ECG if symptomatic bradycardia)
  • Thyroid function (somatostatin analogues may reduce TSH)

Reference: BNFc; BNF 90; Endocrine Society Acromegaly Guidelines 2014; CLARINET Trial (NEJM 2014). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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