Octreotide: Difference between revisions
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==Adult Dosing== | ==Adult Dosing== | ||
===Variceal | ===[[Variceal bleeding]]=== | ||
*Initial Bolus: 50mcg IV (range 25-100mcg)<ref>Garbuzenko DV. Current approaches to the management of patients with liver cirrhosis who have acute esophageal variceal bleeding. Curr Med Res Opin. 2016:1-9.</ref> | *Initial Bolus: 50mcg IV (range 25-100mcg)<ref>Garbuzenko DV. Current approaches to the management of patients with liver cirrhosis who have acute esophageal variceal bleeding. Curr Med Res Opin. 2016:1-9.</ref> | ||
*Drip rate: 25-50 mcg/hr IV | *Drip rate: 25-50 mcg/hr IV | ||
===Sulfonylurea | ===[[Sulfonylurea toxicity]]=== | ||
*50-75 mpg SQ or IM every 6 hrs as needed | *50-75 mpg SQ or IM every 6 hrs as needed | ||
| Line 18: | Line 18: | ||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: Octreotide crosses the placenta and can be detected in newborn at birth. Limited data on risk, case studies have not demonstrated any congenital malformations in fetuses. | ||
*[[Lactation risk categories|Lactation risk]]: | *[[Lactation risk categories|Lactation risk]]: | ||
===Renal Dosing=== | ===Renal Dosing=== | ||
*Dialysis patients: dosage adjustment may be required as clearance is reduced by ~50%. | |||
===Hepatic Dosing=== | ===Hepatic Dosing=== | ||
No | No adjustments needed but clearance is reduced in patients with cirrhosis. | ||
==Contraindications== | ==Contraindications== | ||
| Line 30: | Line 30: | ||
==Adverse Reactions== | ==Adverse Reactions== | ||
*Hypoglycemia is rare but more common in older adults and type I diabetics<ref>Howland MA, Smith SW. Antidotes in depth. In: Robert S. Hoffman, et al., ed. Goldfrank’s toxicologic emergencies. 10e ed. ; 2015.</ref> | *[[Hypoglycemia]] is rare but more common in older adults and type I diabetics<ref>Howland MA, Smith SW. Antidotes in depth. In: Robert S. Hoffman, et al., ed. Goldfrank’s toxicologic emergencies. 10e ed. ; 2015.</ref> | ||
====Serious==== | |||
* pancreatitis | |||
* bradycardia | |||
* arrhythmias | |||
* anaphylaxis | |||
* thrombocytopenia | |||
====Common==== | |||
* nausea/vomiting/diarrhea | |||
* dizziness | |||
* fatigue | |||
* edema | |||
* pruritus | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 1.5-2 hrs<ref name="metabolism">Chanson P et al. Clinical pharmacokinetics of octreotide. Therapeutic applications in patients with pituitary tumours. Clin Pharmacokinet. 1993 Nov;25(5):375-91.</ref> | ||
*Metabolism: | *Metabolism: Hepatic<ref name="metabolism"></ref> | ||
*Excretion: | *Excretion: Renal | ||
==Mechanism of Action== | ==Mechanism of Action== | ||
Revision as of 18:54, 26 January 2019
Administration
- Type: Octapeptide
- Dosage Forms:
- Routes of Administration: IV, IM, or SQ
- Common Trade Names: Sandostatin, Sandostatin LAR
Adult Dosing
Variceal bleeding
- Initial Bolus: 50mcg IV (range 25-100mcg)[1]
- Drip rate: 25-50 mcg/hr IV
Sulfonylurea toxicity
- 50-75 mpg SQ or IM every 6 hrs as needed
Pediatric Dosing
Sulfonylurea Overdose
- 1-2 mpg/kg SQ or IM
Special Populations
- Pregnancy Rating: Octreotide crosses the placenta and can be detected in newborn at birth. Limited data on risk, case studies have not demonstrated any congenital malformations in fetuses.
- Lactation risk:
Renal Dosing
- Dialysis patients: dosage adjustment may be required as clearance is reduced by ~50%.
Hepatic Dosing
No adjustments needed but clearance is reduced in patients with cirrhosis.
Contraindications
- Allergy to class/drug
Adverse Reactions
- Hypoglycemia is rare but more common in older adults and type I diabetics[2]
Serious
- pancreatitis
- bradycardia
- arrhythmias
- anaphylaxis
- thrombocytopenia
Common
- nausea/vomiting/diarrhea
- dizziness
- fatigue
- edema
- pruritus
Pharmacology
Mechanism of Action
A peptide that mimics endogenous somatostatin. Somatostatin is released by the pancreas, pyloric antrum, and duodenum and inhibits Growth Gormone, Gastrin, Vasoactive intestinal peptide (VIP), Gastrin, Serotonin, and decreases Insulin like growth factor-1 (IGF-1), serotonin and it decreases splanchnic blood flow.
Comments
- Although used in the ED mainly for sulfonylurea overdose and vatical bleeding, it is used in outpatient and inpatient medicine for the treatment of acromegaly, carcinoid tumors, and VIPomas
- Octreotide was originally used as a opiod antagonist and is still used off label as a second/third line therapy for diarrhea from opiod withdrawal because of antidiarrheal properties.[4]
See Also
References
- ↑ Garbuzenko DV. Current approaches to the management of patients with liver cirrhosis who have acute esophageal variceal bleeding. Curr Med Res Opin. 2016:1-9.
- ↑ Howland MA, Smith SW. Antidotes in depth. In: Robert S. Hoffman, et al., ed. Goldfrank’s toxicologic emergencies. 10e ed. ; 2015.
- ↑ 3.0 3.1 Chanson P et al. Clinical pharmacokinetics of octreotide. Therapeutic applications in patients with pituitary tumours. Clin Pharmacokinet. 1993 Nov;25(5):375-91.
- ↑ Carreno JE et al. 24-hour opiate detoxification and antagonist induction at home– the ‘asturian method’: A report on 1368 procedures. Addict Biol. 2002;7(2):243-250.