Octreotide (Surgical — Fistula/Carcinoid)

How it works

As a long-acting somatostatin analogue it suppresses secretion of multiple gastrointestinal and pancreatic hormones and reduces splanchnic blood flow and exocrine secretions.

Prescribing in practice

• In carcinoid surgery, octreotide is central to preventing and treating intraoperative carcinoid crisis (profound flushing, bronchospasm and haemodynamic instability) triggered by tumour handling — ensure it is available and given perioperatively.
• Sudden cessation can cause rebound secretion; gallbladder sludge and gallstones may develop with prolonged use.
• Octreotide can alter glucose homeostasis (hypo- or hyperglycaemia) and may cause bradycardia, so review diabetic therapy and cardiac status.

Monitoring

Monitor haemodynamics during tumour manipulation, blood glucose, fluid and electrolyte balance from fistula output, and gallbladder status with prolonged therapy.

Counselling the patient

• This medicine reduces fluid losses or controls symptoms triggered by your tumour during surgery.
• Report new abdominal pain, which could indicate gallstones with longer-term use.

Evidence & guidelines

Octreotide is an established agent for carcinoid crisis prophylaxis and high-output fistula management in surgical practice.