What is the initial dose of octreotide (somatostatin analogue) for a drip?

Initial Octreotide Drip Dosage

The initial dose of octreotide for an intravenous drip is 50 μg/hour, typically preceded by an IV bolus of 50 μg. 1, 2

Standard Dosing Protocol

• Octreotide administration for continuous IV infusion should begin with an initial IV bolus of 50 μg followed by a continuous infusion at 50 μg/hour 1
• For IV administration, octreotide can be diluted in sterile isotonic saline solutions or 5% dextrose in water, remaining stable for 24 hours 2
• The dilution can be prepared in volumes of 50-200 mL and infused over 15-30 minutes, or administered by IV push over 3 minutes in emergency situations 2

Clinical Applications and Dose Adjustments

• In variceal hemorrhage management, octreotide can be safely administered continuously for 3-5 days 1
• For carcinoid syndrome or carcinoid crisis, the infusion rate may need to be increased based on clinical response 2
• In patients with VIPomas (causing watery diarrhea), even small doses of octreotide can produce dramatic cessation of diarrhea 1
• For chemotherapy-induced diarrhea that is severe or refractory to loperamide, higher doses (up to 500 μg three times daily) may be more effective than lower doses 1

Special Considerations

• For procedures in patients with carcinoid syndrome, prophylactic octreotide should be administered by intravenous infusion at 50 μg/hour, starting 12 hours before and continuing 24-48 hours after the procedure to prevent carcinoid crisis 1
• In emergency situations such as carcinoid crisis, octreotide can be given as a rapid bolus followed by continuous infusion 2, 3
• No evidence of drug tachyphylaxis (decreased response over time) has been observed in patients maintained on stable doses 4

Monitoring and Adverse Effects

• Most common adverse effects include gastrointestinal symptoms such as diarrhea, abdominal discomfort, loose stools, and nausea, which typically resolve within 3 months of treatment 4
• Long-term use (>1 year) may lead to gallstone formation in approximately 20-25% of patients, though most remain asymptomatic 4
• Other potential side effects include fat malabsorption, vitamin A and D malabsorption, headaches, dizziness, and alterations in glucose metabolism 1

Important Caveats

• Dose escalation beyond 800 μg daily often provides limited additional benefit in terms of hormone suppression 4
• Octreotide is not compatible with Total Parenteral Nutrition (TPN) solutions due to formation of glycosyl octreotide conjugate which may decrease efficacy 2
• Multiple subcutaneous injections at the same site within short periods should be avoided; sites should be rotated systematically if using the subcutaneous route 2

Remember that while the standard initial dose is 50 μg/hour, clinical response should guide subsequent dosing, with the possibility of increasing the dose if symptoms are not adequately controlled.