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Somatostatin Analogue Pregnancy: Avoid unless essential — limited data; may impair fetal growth

Octreotide

Brand names: Sandostatin, Sandostatin LAR (depot)

Adult dose

Dose: Acromegaly: 100–200 mcg SC TDS (short-acting) or 20–30 mg IM every 28 days (LAR). VIPoma/glucagonoma: 50–200 mcg SC TDS. Variceal haemorrhage: 25–50 mcg/h IV infusion.
Route: SC (short-acting) or IM (LAR depot) or IV (acute)
Frequency: TDS (SC); monthly (LAR); continuous IV infusion (acute GI bleed)
Max: 600 mcg/day SC (short-acting); 30 mg/28 days (LAR)
For acromegaly, carcinoid syndrome, VIPoma, variceal haemorrhage, and refractory hypoglycaemia (congenital hyperinsulinism). LAR formulation given IM by healthcare professional only.

Paediatric dose

Dose: 0.33 mcg/kg
Route: Subcutaneous
Frequency: Three times daily (initial; total 1 mcg/kg/day in 3 divided doses, titrate)
Max: Up to 5 mcg/kg/day in divided doses — titrate to clinical effect
Concentration: 0.05 mg/mL, 0.1 mg/mL, 0.5 mg/mL mcg/ml
BNFc paediatric (specialist initiation): congenital hyperinsulinism 1–5 mcg/kg/day SC in 3–4 divided doses or continuous infusion; carcinoid/VIPoma/neuroendocrine — specialist oncology protocol; sulfonylurea poisoning antidote per TOXBASE/NPIS.

Dose adjustments

Renal

Dose reduction may be needed in severe renal impairment (adjusted half-life)

Hepatic

Reduce dose in hepatic impairment

Paediatric weight-based calculator

BNFc paediatric (specialist initiation): congenital hyperinsulinism 1–5 mcg/kg/day SC in 3–4 divided doses or continuous infusion; carcinoid/VIPoma/neuroendocrine — specialist oncology protocol; sulfonylurea poisoning antidote per TOXBASE/NPIS.

Clinical pearls

  • Gallstone prophylaxis: consider ursodeoxycholic acid during long-term treatment
  • Acromegaly: first-line medical therapy when surgery fails or contraindicated (normalises GH and IGF-1 in ~50%)
  • Variceal haemorrhage: IV octreotide 25 mcg/h often started with terlipressin in some centres; equivalent to terlipressin in some meta-analyses
  • LAR: inject into upper outer quadrant of buttock — not deltoid (atrophy risk); alternate sides

Contraindications

  • Hypersensitivity to octreotide or related somatostatin analogues

Side effects

  • Gallstones (biliary sludge — 20–30% with long-term use)
  • GI effects: nausea, diarrhoea, steatorrhoea, abdominal pain
  • Hyperglycaemia (and paradoxically hypoglycaemia)
  • Bradycardia
  • Hypothyroidism (long-term)
  • Injection site reactions

Interactions

  • Ciclosporin — reduced ciclosporin absorption
  • Insulin/oral hypoglycaemics — altered glycaemic control
  • Bromocriptine — increased bioavailability

Monitoring

  • GH and IGF-1 levels (acromegaly)
  • Blood glucose (hyper/hypoglycaemia)
  • Gallbladder USS every 6–12 months
  • TFTs (long-term)
  • Tumour size (MRI)

Reference: BNFc; BNF; UK Acromegaly Register; Pituitary Society Guidelines; BNF for Children. Verify against your local formulary and the latest BNF before prescribing.

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