What is the recommended dose and frequency of octreotide (somatostatin analogue) for managing gastrointestinal (GI) bleed?

Octreotide Dosing for Gastrointestinal Bleeding

For gastrointestinal bleeding, octreotide should be administered as an initial intravenous bolus of 50 μg followed by a continuous infusion at 50 μg/hour for 2-5 days. 1, 2

Standard Dosing Protocol

• Initial IV bolus: 50 μg (can be repeated in the first hour if bleeding continues) 1, 2
• Continuous IV infusion: 50 μg/hour 1, 2
• Duration: 2-5 days (can be discontinued after definitive hemostasis is achieved) 1

Clinical Applications

Variceal Bleeding

• Octreotide is the only vasoactive drug available in the United States for managing variceal hemorrhage 1
• Should be started as soon as possible, together with antibiotics and before diagnostic endoscopy 1
• Meta-analyses show that octreotide significantly improves control of acute hemorrhage 1
• When combined with endoscopic variceal ligation, octreotide significantly reduces recurrent bleeding and the need for balloon tamponade 3

Non-Variceal Bleeding

• Not recommended for routine management of non-variceal upper GI bleeding 1
• May be useful in specific situations:
  • Patients bleeding uncontrollably while awaiting endoscopy 1
  • Patients awaiting surgery or for whom surgery is contraindicated 1

Duration Considerations

• Traditional recommendation: 2-5 days of continuous infusion 1
• Recent evidence suggests a 24-hour infusion may be non-inferior to a 72-hour infusion for prevention of re-bleeding in patients with esophageal variceal hemorrhage who have undergone endoscopic variceal band ligation 4
• Shorter duration (24 hours) may help reduce hospital stay and related costs 4

Pharmacokinetics and Special Considerations

• Octreotide is rapidly absorbed after administration 5
• Half-life is approximately 1.7-1.9 hours (compared to 1-3 minutes for natural somatostatin) 5
• Duration of action extends up to 12 hours depending on the type of condition being treated 5
• Dose adjustments may be necessary in:
  • Elderly patients: due to significant increase in half-life (46%) and decrease in clearance (26%) 5
  • Renal impairment: elimination from plasma is prolonged and total body clearance reduced 5
  • Liver cirrhosis: prolonged elimination with increased half-life (3.7 hours) and decreased clearance 5

Comparative Efficacy

• Octreotide has similar efficacy to terlipressin and somatostatin for controlling acute variceal bleeding 1, 6
• Octreotide has fewer side effects than vasopressin in controlling acute esophageal variceal bleeding 7
• Initial hemostasis rates of 96-98% have been reported when octreotide is combined with endoscopic variceal ligation 6

Monitoring and Adverse Effects

• Common side effects include nausea/vomiting, abdominal pain, headache, and hyperglycemia 1, 2
• Monitor for alterations in glucose metabolism 2
• Side effects are generally minor and well-tolerated 8