Somatostatin Analogue
Pregnancy: Caution — limited data; crosses placenta. Use only if clearly indicated and benefit outweighs risk.
Octreotide
Brand names: Sandostatin, Sandostatin LAR (depot)
Adult dose
Dose: Variceal haemorrhage: 50 micrograms IV bolus, then 25–50 micrograms/hour by continuous IV infusion for 2–5 days. Carcinoid tumours / VIPoma: 50–600 micrograms/day SC in 2–4 divided doses. Depot (LAR): 10–30mg IM every 4 weeks (specialist).
Route: IV infusion (variceal haemorrhage); SC (carcinoid/acromegaly); IM depot (maintenance)
Frequency: Continuous IV infusion (acute); 2–4 times daily SC; monthly IM depot
Max: 50 micrograms/hour IV (variceal haemorrhage); 1500 micrograms/day SC (specialist indications)
Variceal haemorrhage: start alongside endoscopy and antibiotics (ceftriaxone 1g/day). Continue infusion for 2–5 days post-endoscopy. Reduces splanchnic blood flow by inhibiting glucagon and vasodilatory peptides. Acromegaly: 100–200 micrograms SC TDS — monitor GH and IGF-1 levels.
Paediatric dose
Dose: 1 micrograms/hour/kg
Route: IV infusion (acute variceal bleed) or SC (other indications)
Frequency: Continuous IV infusion (variceal bleed) or 2–4 times daily SC (other indications)
Max: 50 micrograms/hour (variceal bleed)
BNFc paediatric variceal haemorrhage (off-label): 1–2 micrograms/kg/hour by IV infusion, max 50 micrograms/hour. SC for carcinoid syndrome / congenital hyperinsulinism (nesidioblastosis): 1–10 micrograms/kg three times daily under specialist supervision. Source: BNF for Children 2024.
Dose adjustments
Renal
Use with caution — reduce SC dose in severe renal impairment.
Hepatic
Reduce maintenance dose in cirrhosis — prolonged half-life. Primary use is in hepatic portal hypertension complications.
Paediatric weight-based calculator
BNFc paediatric variceal haemorrhage (off-label): 1–2 micrograms/kg/hour by IV infusion, max 50 micrograms/hour. SC for carcinoid syndrome / congenital hyperinsulinism (nesidioblastosis): 1–10 micrograms/kg three times daily under specialist supervision. Source: BNF for Children 2024.
Clinical pearls
- Baveno VII: octreotide (or terlipressin) started as soon as variceal haemorrhage suspected — before endoscopy. Continue for 2–5 days post-haemostasis to reduce early re-bleeding.
- Terlipressin vs octreotide: terlipressin has stronger evidence for survival benefit in variceal haemorrhage. Octreotide used when terlipressin contraindicated (ischaemic disease) or unavailable.
- Gallstones: inform patients on long-term octreotide of gallstone risk — consider prophylactic ursodeoxycholic acid. Annual ultrasound surveillance.
- Carcinoid crisis prevention: give octreotide 300–500 micrograms SC before any procedure in carcinoid syndrome patients (anaesthesia, tumour manipulation).
Contraindications
- Known hypersensitivity to octreotide or somatostatin analogues
Side effects
- GI: nausea, diarrhoea, abdominal cramps, steatorrhoea (inhibits pancreatic enzyme secretion)
- Gallstones (long-term use — bile stasis; up to 50% develop gallstones with prolonged use)
- Hyperglycaemia or hypoglycaemia (alters insulin, glucagon secretion)
- Bradycardia (sinus bradycardia — monitor ECG)
- Injection site reactions (SC route)
- Hypothyroidism (long-term depot use)
Interactions
- Ciclosporin: reduced absorption (reduce ciclosporin dose if needed)
- Insulin / oral hypoglycaemics: glucose homeostasis altered — monitor blood glucose
- QT-prolonging drugs: octreotide may prolong QT — use with caution
Monitoring
- Blood glucose (before and after starting, then periodically)
- Thyroid function (TSH — long-term use)
- Gallbladder ultrasound (annually on long-term treatment)
- GH and IGF-1 (acromegaly)
- ECG (bradycardia, QT monitoring)
Reference: BNFc; BNF 90; Baveno VII Consensus 2022; ENETS Guidelines — Carcinoid Tumours; SPC Sandostatin. Verify against your local formulary and the latest BNF before prescribing.
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