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Somatostatin Analogue Pregnancy: Use only if clearly indicated — inhibits fetal growth hormone; limited human data

Octreotide (Surgical — Fistula/Carcinoid)

Brand names: Sandostatin

Adult dose

Dose: Pancreatic/GI fistula: 100–200 mcg SC every 8h or 25 mcg/hour IV infusion; Carcinoid crisis (intraoperative): 500 mcg IV bolus then 500 mcg/hour infusion; Variceal bleeding (before endoscopy): 50 mcg IV bolus then 25–50 mcg/hour for 3–5 days
Route: SC or IV
Frequency: Every 8 hours (SC) or continuous infusion (IV)
Max: 1500 mcg/day
Reduces pancreatic and GI secretions by inhibiting secretin, CCK, glucagon, insulin, VIP, serotonin. Critical in surgery for: (1) reducing pancreatic fistula output, (2) preventing carcinoid crisis during tumour manipulation, (3) controlling GI bleeding.

Paediatric dose

Dose: 1–10 mcg/day/kg
Route: SC or IV
Frequency: Divided every 8 hours
Max: 1500 mcg/day
Congenital hyperinsulinism: 5–25 mcg/kg/day SC in 2–4 divided doses under specialist endocrine guidance (BNFc).

Dose adjustments

Renal

Reduce dose in severe renal impairment — adjust by clinical response.

Hepatic

Reduce maintenance dose in cirrhosis — impaired clearance.

Paediatric weight-based calculator

Congenital hyperinsulinism: 5–25 mcg/kg/day SC in 2–4 divided doses under specialist endocrine guidance (BNFc).

Clinical pearls

  • Carcinoid crisis prevention: during resection of carcinoid tumours, tumour manipulation releases massive serotonin, histamine, and bradykinin → life-threatening flushing, bronchospasm, haemodynamic collapse. IV octreotide 500 mcg bolus before incision then continuous infusion throughout case is standard perioperative protocol in specialist centres
  • Pancreatic fistula management: octreotide reduces fistula output in high-output pancreatic fistulas (>200 mL/day) — used as adjunct to NPO, TPN, and consideration of ERCP or re-operation; reduces pancreatic enzyme and fluid secretion by 50–80%
  • Post-pancreatectomy prophylaxis: MSKCC trial data supports prophylactic octreotide post-Whipple procedure to reduce pancreatic fistula rate — still debated; many centres use selectively in high-risk anastomoses

Contraindications

  • Hypersensitivity to octreotide or somatostatin analogues

Side effects

  • Cholelithiasis (long-term use — reduced gallbladder motility)
  • GI: nausea, abdominal cramps, steatorrhoea, flatulence
  • Hyperglycaemia or hypoglycaemia (disrupts insulin/glucagon balance)
  • Bradycardia (sinus node depression)
  • Injection site pain (SC)

Interactions

  • Ciclosporin (reduces absorption — monitor levels)
  • Beta-blockers (bradycardia — additive)
  • Insulin/oral hypoglycaemics (dose adjustment needed — octreotide unpredictably alters glucose homeostasis)

Monitoring

  • Blood glucose (hyperglycaemia or hypoglycaemia)
  • Fistula/drain output volume
  • LFTs and gallbladder ultrasound (long-term use)
  • HR (bradycardia during IV use)

Reference: BNFc; BNF 90; BNFc; NICE IPG guidance on pancreatic fistula; Sandostatin SPC; Carcinoid tumour perioperative guidelines (ENETS 2017). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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