What is the dose of octreotide (Sandostatin) for hepatorenal syndrome?

From the Guidelines

For hepatorenal syndrome, octreotide is typically administered at a dose of 200 mcg subcutaneously three times daily, as part of a combination therapy with midodrine and albumin, to improve renal function and reduce mortality. This recommendation is based on the most recent and highest quality study available, which reported superior results with this regimen compared to dopamine and albumin 1. The combination therapy aims to reverse the pathophysiologic mechanisms of hepatorenal syndrome by increasing systemic vascular resistance and improving renal blood flow. Key components of the therapy include:

• Octreotide: 200 mcg subcutaneously three times daily
• Midodrine: titrated up to a maximum of 12.5 mg orally three times daily
• Albumin: 10-20 g intravenously per day It is essential to monitor renal function, blood pressure, and urine output during treatment, as the goal is to improve renal function, achieve liver transplantation, or until death. While this treatment may temporarily improve renal function, it is not curative, and definitive treatment for hepatorenal syndrome is liver transplantation when feasible 1.

From the Research

Dose of Octreotide for Hepatorenal Syndrome

• The dose of octreotide for hepatorenal syndrome is 100 μg subcutaneously, 3 times daily, with a maximum dose of 200 μg subcutaneously, 3 times daily 2, 3, 4
• This dose is often used in combination with midodrine and albumin, as an alternative treatment when terlipressin is not available 2, 3, 4
• The combination of midodrine and octreotide has been compared to other treatments, such as norepinephrine and terlipressin, in the management of hepatorenal syndrome 2, 3, 4

Comparison with Other Treatments

• Studies have shown that terlipressin is more effective than midodrine and octreotide in improving renal function in patients with hepatorenal syndrome 3, 5
• Norepinephrine has also been shown to be more effective than midodrine and octreotide in some studies 2
• However, the combination of midodrine and octreotide is still used as an alternative treatment, especially in areas where terlipressin is not available 3, 6

Clinical Use

• The use of octreotide in the treatment of hepatorenal syndrome is based on its vasoconstrictive properties, which help to improve renal function in patients with this condition 5, 6
• The dose and duration of treatment with octreotide may vary depending on the individual patient's response and the severity of their condition 2, 3, 4