What are the contraindications of octreotide (somatostatin analogue)?

Contraindications of Octreotide

Octreotide is contraindicated in patients with hypersensitivity to the drug or any of its components. 1

Primary Contraindications

• Hypersensitivity: Octreotide should not be used in patients with known sensitivity to this drug or any of its components 1

• Insulinoma: Octreotide should be used with extreme caution or avoided in patients with insulinoma, as it can worsen hypoglycemia by suppressing counterregulatory hormones such as growth hormone, glucagon, and catecholamines 2, 3

• Somatostatin receptor-negative tumors: Octreotide should only be administered to patients whose tumors are somatostatin scintography-positive 2

Relative Contraindications and Special Precautions

Cardiac Considerations

• Use with caution in patients with:

  • Cardiac conduction abnormalities
  • History of bradycardia or arrhythmias
  • At-risk cardiac patients 1

• Increased risk for higher degree of atrioventricular blocks

• Consider cardiac monitoring in patients receiving octreotide intravenously 1

Metabolic Considerations

• Glucose metabolism disorders: Careful monitoring required as octreotide can cause:

  • Hypoglycemia
  • Hyperglycemia
  • Glucose monitoring is recommended and anti-diabetic treatment may need adjustment 1

• Thyroid function: Monitor thyroid levels periodically as hypothyroidism may occur 1

Gastrointestinal Considerations

• Cholelithiasis: Monitor periodically for gallbladder abnormalities
• Discontinue if complications of cholelithiasis are suspected 1

Drug Interactions Requiring Special Attention

The following medications require monitoring and possible dose adjustment when used with octreotide:

• Cyclosporine

• Insulin

• Oral hypoglycemic agents

• Beta-blockers

• Bromocriptine 1

• Lutetium Lu 177 Dotatate Injection: Discontinue octreotide at least 24 hours prior to each lutetium Lu 177 dotatate dose 1

Special Populations

Pregnancy and Breastfeeding

• Advise premenopausal females of the potential for an unintended pregnancy 1

Nuclear Medicine Imaging Considerations

• For optimal imaging results:
  • Short-acting somatostatin analogues should be withdrawn for 24-48 hours before imaging
  • For long-acting analogues, schedule imaging toward the end of the dosing interval 2

Common Pitfalls and Caveats

1. Insulinoma management: The most critical contraindication to remember is in patients with insulinoma, where octreotide can precipitously worsen hypoglycemia and potentially lead to fatal complications 2

2. Somatostatin receptor status: Always verify somatostatin receptor positivity before initiating treatment, as octreotide is ineffective in receptor-negative tumors 2

3. Monitoring requirements: Regular monitoring of glucose levels, thyroid function, and gallbladder status is essential during octreotide therapy 1

4. Drug interactions: Be vigilant about potential interactions with commonly used medications, especially in diabetic patients on insulin or oral hypoglycemic agents 1

5. Cardiac effects: Remember that octreotide can cause bradycardia and conduction abnormalities, requiring careful monitoring in at-risk patients 1