What is the relationship between octreotide (somatostatin analogue) and diarrhea?

From the Guidelines

Octreotide at a dose of 500 μg tid is recommended for the treatment of loperamide-refractory diarrhea in cancer patients, as it has been shown to be effective in resolving diarrhea and improving patient outcomes 1.

Key Points

• Octreotide is a somatostatin analogue that can be used to treat severe, refractory diarrhea in cancer patients.
• The typical starting dose of octreotide is 50-100 mcg subcutaneously 2-3 times daily, but it can be titrated up to 500 mcg 3 times daily based on response.
• For loperamide-refractory diarrhea, a dose of 500 μg tid is recommended, as it has been shown to be effective in resolving diarrhea and improving patient outcomes.
• Octreotide works by binding to somatostatin receptors, inhibiting hormone secretion, reducing intestinal secretions, slowing GI motility, and increasing water and electrolyte absorption.
• Common side effects of octreotide include injection site pain, nausea, abdominal discomfort, and potential gallstone formation with long-term use.
• Blood glucose monitoring is recommended as octreotide can affect glucose metabolism.

Treatment Approach

• Loperamide is typically the first-line treatment for diarrhea in cancer patients, but if it fails to control symptoms, octreotide can be considered.
• The dose of octreotide can be titrated up to 500 μg tid based on response, and treatment duration varies by condition.
• Long-acting formulations of octreotide, such as Sandostatin LAR, can be considered for chronic management after stabilization with the short-acting form.

Evidence Summary

• A study published in the Annals of Oncology in 2013 found that octreotide at a dose of 500 μg tid was effective in treating loperamide-refractory diarrhea in cancer patients 1.
• Another study published in the Journal of Clinical Oncology in 2004 found that octreotide doses up to 2,500 μg tid were effective in resolving diarrhea and improving patient outcomes in patients receiving chemotherapy 1.

From the FDA Drug Label

Octreotide acetate has been used to treat the symptoms associated with metastatic carcinoid tumors (flushing and diarrhea), and Vasoactive Intestinal Peptide (VIP) secreting adenomas (watery diarrhea).

• Octreotide is used to treat diarrhea associated with certain conditions, such as metastatic carcinoid tumors and VIP secreting adenomas.
• The drug suppresses the release of serotonin and other hormones that can cause diarrhea.
• Octreotide can be effective in reducing the symptoms of diarrhea in these patients 2.

From the Research

Octreotide Diarrhea Treatment

• Octreotide is an effective therapeutic option in controlling secretory diarrhea of varied etiology 3
• The drug has been shown to be more effective than loperamide in controlling diarrhea and eliminating the need for replenishment of fluids and electrolytes 4
• Octreotide long-acting formulation has been found to resolve refractory chemotherapy-induced diarrhea (CID) in cancer patients 5, 6

Dosage and Administration

• The recommended initial dose of octreotide varies, with some studies using 0.1 mg subcutaneously twice per day 4 and others using 0.5 mg three times per day subcutaneously 7
• The long-acting formulation of octreotide has been administered at a dose of 20-40 mg intramuscularly once every 28 days 5, 6

Efficacy and Safety

• Octreotide has been found to be highly effective in the management of chemotherapy-related diarrhea, with complete resolution of loose bowel movements achieved in 80% of patients within 4 days of therapy 7
• The drug is generally well tolerated, with mild side effects such as abdominal pain and pain at the injection site reported in some cases 3, 7
• Octreotide has been found to improve the overall health and quality of life of patients with secretory diarrhea, and to lessen healthcare costs in the long run 3