Octreotide Continuous Infusion Dosing
The recommended starting dose for octreotide continuous infusion is 50 μg/hour, preceded by an initial IV bolus of 50 μg. 1
Dosing Protocol for Different Clinical Scenarios
Variceal Hemorrhage
- Initial bolus: 50 μg IV (can be repeated within first hour if bleeding continues)
- Continuous infusion: 50 μg/hour
- Duration: 2-5 days 1
- Monitoring: Assess for control of bleeding; repeat bolus if ongoing bleeding
Carcinoid Syndrome/Neuroendocrine Tumors
- Perioperative management: 50 μg/hour by constant IV infusion
- Timing: Start 12 hours before procedure, continue 24-48 hours after
- Emergency management: For unexpected carcinoid crisis, give 100-500 μg IV bolus followed by continuous infusion 1
Chyle Leak Management
- Begin with continuous infusion at 50 μg/hour
- Always combine with conservative management (drainage, pressure dressings, nutritional modifications) 2
Chemotherapy-Induced Diarrhea
- Escalating protocol:
- 50 μg/hour for 12 hours
- Then 100 μg/hour for 12 hours
- Then 150 μg/hour for 72 hours 3
Important Clinical Considerations
Efficacy
- Octreotide is highly effective in controlling variceal bleeding, with meta-analyses showing significant improvement in hemorrhage control 1
- It is the only vasoactive drug available in the United States for this indication 1
Duration of Therapy
- For variceal bleeding, 2 days of octreotide infusion has been shown to be as effective as 5 days in preventing early rebleeding, with better cost-effectiveness 4
- However, most guidelines still recommend 3-5 days of therapy to prevent early rebleeding 1
Administration Pearls
- Always administer via intravenous route for continuous infusion
- Lower doses given by continuous infusion can achieve similar effects to higher doses given intermittently 5
- For patients with diabetes, monitor blood glucose closely as octreotide affects insulin, glucagon, and growth hormone levels 5
Potential Side Effects
- Generally well-tolerated
- May cause nausea, fat malabsorption, gallstones, vitamin malabsorption
- Can affect blood glucose levels (both hyper- and hypoglycemia)
- Rare cases of hypertension reported 2, 6
Special Populations
- Pediatric patients: For children, dosing is weight-based at 1-2 μg/kg/hour 7
- Renal impairment: Use with caution in patients with renal failure, especially those on beta-blockers, due to risk of hyperkalemia 6
Remember that octreotide should be initiated promptly in suspected variceal hemorrhage, along with antibiotics and before diagnostic endoscopy, as this approach has been shown to reduce mortality and transfusion requirements 1.