Somatostatin Analogue Pregnancy: Limited data (fewer than 300 pregnancy outcomes); congenital anomalies were reported in about 4% of pregnancy cases with known outcome, with no causal relationship to octreotide suspected. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. 'As a precautionary measure, it is preferable to avoid the use of Octreotide during pregnancy.' Patients should not breast-feed during treatment. Reduction of GH and normalisation of IGF-1 in female acromegalic patients could potentially restore fertility — adequate contraception should be advised if necessary.

Octreotide (Surgical — Fistula/Carcinoid)

Brand names: Sandostatin

Octreotide is a somatostatin analogue used in the surgical setting to reduce high-output gastrointestinal or pancreatic fistula losses and to control mediator release during carcinoid tumour surgery.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Complications following pancreatic surgery: 100 micrograms three times daily by subcutaneous injection for 7 consecutive days, starting on the day of surgery at least 1 hour before laparotomy. Gastro-entero-pancreatic endocrine tumours (including carcinoid): initially 50 micrograms once or twice daily by subcutaneous injection; depending on clinical response, effect on tumour-produced hormone levels (in carcinoid tumours, on urinary 5-hydroxyindole acetic acid excretion) and tolerability, the dose can be gradually increased to 100 to 200 micrograms three times daily.

Route: Subcutaneous injection, or intravenous infusion after dilution (may be diluted with physiological saline). Patients receiving high doses of intravenous octreotide should be kept under appropriate cardiac monitoring.

Frequency: Pancreatic surgery: three times daily for 7 consecutive days. GEP endocrine tumours: once or twice daily initially, titrated up to three times daily. Bleeding gastro-oesophageal varices: continuous intravenous infusion for 5 days.

Max: Acromegaly: 'A maximum dose of 1500 micrograms per day should not be exceeded.' Continuous intravenous infusion (§4.4): 'The maximum dose of 50 microgram/hour should therefore not be exceeded' — atrioventricular block, including complete AV block, was reported at continuous infusion of 100 micrograms/hour and with a 50 micrograms bolus followed by 50 micrograms/hour.

Source product is Octreotide 100 microgram/ml solution for injection/infusion. OTHER INDICATIONS IN THE SAME SPC — Bleeding gastro-oesophageal varices: '25 micrograms/hour for 5 days by continuous intravenous (i.v.) infusion'; 'In cirrhotic patients with bleeding gastro-oesophageal varices, Octreotide has been well tolerated at continuous i.v. doses of up to 50 micrograms/hour for 5 days.' Acromegaly: initially 50 to 100 micrograms subcutaneously every 8 or 12 hours, adjusted on monthly GH and IGF-1 assessment (target GH <2.5 ng/mL, IGF-1 within normal range); optimal daily dose in most patients 300 micrograms; discontinue if no relevant GH reduction and no clinical improvement within 3 months. TSH-secreting pituitary adenomas: 100 micrograms three times a day subcutaneously, adjusted to TSH and thyroid hormone responses; at least 5 days of treatment needed to judge efficacy. STOPPING RULE for carcinoid tumours: 'if there is no beneficial response within 1 week of treatment with Octreotide at the maximum tolerated dose, therapy should not be continued.' ELDERLY: 'There is no evidence of reduced tolerability or altered dosage requirements in elderly patients.' HEPATIC IMPAIRMENT: 'In patients with liver cirrhosis, the half-life of the drug may be increased, necessitating adjustment of the maintenance dosage.' MONITORING (§4.4): ultrasonic examination of the gallbladder before and at about 6- to 12-month intervals during therapy (cholelithiasis is very common); monitor thyroid function on prolonged treatment and hepatic function during therapy; octreotide may impair glucose regulation — hyperglycaemia and hypoglycaemia both reported, and in insulinoma it may deepen and prolong hypoglycaemia. PAEDIATRIC (verbatim): 'Use in children - Experience with Octreotide in children is limited.' No paediatric dose is stated; verify against a children's formulary. The US label adds that safety and efficacy in the paediatric population have not been demonstrated and that serious adverse events, including hypoxia, necrotizing enterocolitis and death, have been reported in children, most notably under 2 years of age.

Dose adjustments

Renal

'Impaired renal function did not affect the total exposure (AUC) to octreotide administered as s.c. injection, therefore no dose adjustment of Octreotide is necessary.'

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Known hypersensitivity to the active substance or to any of the excipients

Side effects

Very common: diarrhoea, abdominal pain, nausea, constipation, flatulence
Very common: headache; common: dizziness
Very common: cholelithiasis; common: cholecystitis, biliary sludge, hyperbilirubinaemia
Very common: hyperglycaemia; common: hypoglycaemia, impaired glucose tolerance, anorexia
Very common: injection site reactions; common: asthenia, elevated transaminase levels
Common: bradycardia, hypothyroidism/thyroid disorder (decreased TSH, total T4 and free T4); post-marketing: anaphylaxis, arrhythmias, acute pancreatitis, hepatitis, thrombocytopenia

Interactions

(eMC §4.5 was not retrieved in this bundle — the following are from eMC §4.4 and the US octreotide acetate labelling §7)
Beta-blockers, calcium channel blockers and agents controlling fluid and electrolyte balance (eMC §4.4) — dose adjustment may be necessary; common cases of bradycardia have been reported, and bradycardia-inducing drugs may have an additive effect on heart rate reduction
Ciclosporin — concomitant administration may decrease blood levels of ciclosporin and result in transplant rejection
Insulin and oral hypoglycaemic drugs — octreotide inhibits insulin and glucagon secretion; monitor blood glucose when treatment is initiated or the dose altered and adjust anti-diabetic treatment accordingly
Bromocriptine — concomitant administration increases the availability of bromocriptine
Lutetium Lu 177 dotatate — discontinue octreotide injection at least 24 hours prior to each dose

Clinical monograph

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.

Reference: NICE IPG guidance on pancreatic fistula; Sandostatin SPC; Carcinoid tumour perioperative guidelines (ENETS 2017); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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