What are the indications for octreotide (somatostatin analogue)?

From the Guidelines

Octreotide is primarily indicated for the treatment of carcinoid tumors, vasoactive intestinal peptide tumors (VIPomas), and other neuroendocrine tumors, as well as for managing symptoms such as diarrhea and flushing associated with these conditions. The most recent and highest quality study, 1, published in 2018, recommends the use of octreotide or lanreotide for patients with metastatic NETs and carcinoid syndrome.

Key Indications

• Carcinoid tumors
• Vasoactive intestinal peptide tumors (VIPomas)
• Other neuroendocrine tumors
• Managing symptoms such as diarrhea and flushing associated with these conditions

Dosage and Administration

• Standard doses of octreotide LAR are 20 to 30 mg intramuscularly every 4 weeks
• Short-acting octreotide (usually 150–250 mcg subcutaneously, 3 times daily) can be added to octreotide LAR or lanreotide for rapid relief of symptoms or for breakthrough symptoms, as recommended by 1 and 1

Mechanism of Action

Octreotide works by mimicking somatostatin, inhibiting the release of numerous hormones including growth hormone, insulin, glucagon, and various gut peptides, as described in 1.

Side Effects

Common side effects include injection site pain, nausea, abdominal discomfort, and potential gallstone formation with long-term use, as noted in 1. Blood glucose monitoring is important as octreotide can affect glucose regulation.

Monitoring and Follow-up

Monitoring of circulating and, where relevant, urinary hormone levels should be undertaken during periods of treatment, as recommended by 1. Patients should also have regular relevant imaging.

From the FDA Drug Label

INDICATIONS AND USAGE Acromegaly Octreotide acetate injection is indicated to reduce blood levels of growth hormone (GH) and insulin growth factor-1 (IGF-1; somatomedin C) in acromegaly patients who have had inadequate response to or cannot be treated with surgical resection, pituitary irradiation, and bromocriptine mesylate at maximally tolerated doses Carcinoid Tumors Octreotide acetate injection is indicated for the symptomatic treatment of patients with metastatic carcinoid tumors where it suppresses or inhibits the severe diarrhea and flushing episodes associated with the disease. Vasoactive Intestinal Peptide Tumors (VIPomas) Octreotide acetate injection is indicated for the treatment of the profuse watery diarrhea associated with VIP-secreting tumors.

The indications for octreotide (somatostatin analogue) are:

• Acromegaly: to reduce blood levels of growth hormone (GH) and insulin growth factor-1 (IGF-1) in patients who have had inadequate response to or cannot be treated with surgical resection, pituitary irradiation, and bromocriptine mesylate at maximally tolerated doses
• Carcinoid Tumors: for the symptomatic treatment of patients with metastatic carcinoid tumors to suppress or inhibit severe diarrhea and flushing episodes
• Vasoactive Intestinal Peptide Tumors (VIPomas): for the treatment of profuse watery diarrhea associated with VIP-secreting tumors 2

From the Research

Indications for Octreotide

The indications for octreotide, a somatostatin analogue, include:

• Acromegaly: Octreotide has been shown to be effective in reducing growth hormone levels and improving clinical symptoms in patients with acromegaly 3, 4, 5.
• Thyrotrophinomas: Octreotide has been found to be effective in the treatment of thyrotrophinomas, a type of pituitary tumor 3.
• Carcinoid syndrome: Octreotide has been shown to be effective in managing the symptoms of carcinoid syndrome, a condition caused by the release of serotonin and other hormones from neuroendocrine tumors 3, 6, 7.
• Tumors producing vasoactive intestinal peptide (VIP): Octreotide has been found to be effective in managing the symptoms of VIP-producing tumors 3.
• Secretory diarrhea: Octreotide has been shown to be effective in reducing stool output in patients with high-output secretory diarrhea, including those with cryptosporidium-related diarrhea associated with AIDS and those with small bowel fistulas 3.
• Neuroendocrine tumors (NETs): Octreotide has been found to be effective in controlling the growth of NETs and managing their symptoms 6, 5, 7.
• Other conditions: Octreotide has also been used to treat other conditions, including neonatal hypoglycemia caused by nesidioblastosis, reactive pancreatitis, insulin-dependent diabetes mellitus, postprandial hypotension, and the dumping syndrome, although more studies are needed to confirm its effectiveness in these conditions 3.

Key Points

• Octreotide is a somatostatin analogue that inhibits the release of growth hormone and other hormones, making it effective in the treatment of various endocrine disorders 3, 5.
• Octreotide has been shown to be well-tolerated, with common side effects including pain at the site of injection, gastrointestinal symptoms, and cholelithiasis 3, 4.
• The use of octreotide in clinical practice is supported by various studies and guidelines, including those from the European Neuroendocrine Tumor Society (ENETS) and the European Society for Medical Oncology (ESMO) 6.