From the Guidelines
Octreotide can cause several side effects, including bradycardia, cardiac conduction abnormalities, diarrhea, loose stool, nausea, abdominal discomfort, hyperglycemia, and headache, as reported in a recent study published in 2024 1.
Common Side Effects
- Bradycardia
- Cardiac conduction abnormalities
- Diarrhea
- Loose stool
- Nausea
- Abdominal discomfort
- Hyperglycemia
- Headache
Less Common Side Effects
- Arrhythmia
- Abdominal distension
- Hypoglycemia
- Dizziness
- Fatigue It is essential to note that the severity and risk of these side effects can be dose-dependent, as mentioned in the study 1. However, adverse events can still develop in patients receiving these treatments at a lower dose.
Important Considerations
- Patients should be closely monitored for any adverse events, especially those with pre-existing conditions that may be exacerbated by octreotide.
- The benefits and risks of octreotide should be carefully weighed, considering the potential impact on morbidity, mortality, and quality of life. The study published in Gastroenterology in 2024 1 provides the most recent and highest quality evidence on the side effects of octreotide, guiding clinical decision-making and patient management.
From the FDA Drug Label
PRECAUTIONS General Octreotide acetate injection alters the balance between the counter-regulatory hormones, insulin, glucagon and growth hormone (GH), which may result in hypoglycemia or hyperglycemia. Hyperglycemia and Hypoglycemia The hypoglycemia or hyperglycemia which occurs during octreotide acetate injection therapy is usually mild, but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents Hypoglycemia and hyperglycemia occurred on octreotide acetate injection in 3% and 16% of acromegalic patients, respectively. Thyroid Function Abnormalities In acromegalic patients, 12% developed biochemical hypothyroidism only, 8% developed goiter, and 4% required initiation of thyroid replacement therapy while receiving octreotide acetate injection. Cardiac Function Abnormalities (see WARNINGS, Complete Atrioventricular Block) In acromegalics, bradycardia (<50 bpm) developed in 25%; conduction abnormalities occurred in 10% and arrhythmias occurred in 9% of patients during octreotide acetate injection therapy Pancreatitis Several cases of pancreatitis have been reported in patients receiving octreotide acetate injection therapy. Dietary Fats Malabsorption Octreotide acetate injection may alter absorption of dietary fats in some patients Decreased Vitamin B12 Levels and Abnormal Schilling’s Tests Depressed vitamin B12 levels and abnormal Schilling’s tests have been observed in some patients receiving octreotide acetate injection therapy, and monitoring of vitamin B12 levels is recommended during chronic octreotide acetate injection therapy
The potential side effects of octreotide include:
- Hypoglycemia and hyperglycemia
- Thyroid function abnormalities, such as biochemical hypothyroidism, goiter, and the need for thyroid replacement therapy
- Cardiac function abnormalities, including bradycardia, conduction abnormalities, and arrhythmias
- Pancreatitis
- Dietary fats malabsorption
- Decreased vitamin B12 levels and abnormal Schilling’s tests 2, 2
From the Research
Octreotide Side Effects
The potential side effects of octreotide include:
- Gastrointestinal side effects, which are usually transient 3
- Gallstone formation, which may increase with longer treatment periods 3, 4
- Biliary tract dysfunction 3
- Inhibition of gallbladder emptying, hepatic bile secretion, and sphincter of Oddi motility 3
- Modification of bile composition, leading to increased risk of gallstone formation 3
- Gastric stasis, which may lead to increased bile concentration, precipitation of cholesterol and calcium salts, retention of biliary precipitates, and maturation of gallstones 3
- Asymptomatic gallstones, which do not require surgical or medical therapy 3
- Symptomatic gallstones, which may require surgery or nonsurgical treatments 3
- Inhibitory effect on antral contractility, which may worsen clinical symptoms in patients with gastroparesis 5
- Stimulatory effect on phase III migrating motor complex activity, which may benefit patients with small bowel dysmotility and diarrhea from bacterial overgrowth 5
- Decline in serum vitamin B-12 concentrations, which may become abnormally low in some patients 6
- Active gastritis, with damage to the superficial and deeper layers of the mucosa, and focal atrophy 6
- Presence of Campylobacter pylori in the antral mucosa 6
- Impaired meal-stimulated cholecystokinin release, leading to gallbladder hypomotility 4
- Increased fasting gall bladder volume, and abolition of interdigestive gall bladder emptying and plasma motilin peaks 7
Specific Patient Populations
- Patients with acromegaly may be at higher risk of developing gallstones during octreotide therapy 3, 6, 7
- Patients with gastroparesis may experience worsening of clinical symptoms due to octreotide's inhibitory effect on antral contractility 5
- Patients with small bowel dysmotility and diarrhea from bacterial overgrowth may benefit from octreotide's stimulatory effect on phase III migrating motor complex activity 5