Recommended Dosage for Long-Acting Sandostatin (Octreotide)
The recommended dosage for long-acting Sandostatin (octreotide LAR) is 20-30 mg administered intramuscularly every 4 weeks for most patients with neuroendocrine tumors, with specific dosing based on the underlying condition. 1, 2
Dosing by Indication
Carcinoid Tumors
- Initial dosage of short-acting octreotide: 100-600 mcg/day in 2-4 divided doses (mean 300 mcg/day) for the first 2 weeks 2
- Conversion to long-acting formulation: Sandostatin LAR 20-30 mg every 4 weeks 1
- Maintenance dosage: Typically 20-30 mg every 4 weeks, though clinical benefits have been observed with doses as low as 50 mcg of short-acting formulation 2
- Maximum dosage: Up to 40 mg every 4 weeks, though doses above 30 mg rarely provide additional benefit 3, 4
VIPomas
- Initial dosage: 200-300 mcg/day of short-acting octreotide in 2-4 divided doses (range 150-750 mcg) 2
- Maintenance dosage: Usually doses above 450 mcg/day are not required for symptom control 2
- Long-acting formulation: 60-120 mg of lanreotide autogel or 10-30 mg of octreotide LAR monthly 1
Acromegaly
- Initial dosage: 50 mcg three times daily of short-acting octreotide 2
- Maintenance dosage: 100 mcg three times daily is most commonly effective, but some patients require up to 500 mcg three times daily 2
- Long-acting formulation: 20-30 mg every 4 weeks, with limited additional benefit from increasing to 40 mg 3, 4
Administration Guidelines
- Patients should be stabilized with short-acting octreotide for 10-28 days before converting to long-acting formulations 1, 5
- For carcinoid crisis prevention during procedures: short-acting octreotide by intravenous administration (50 mcg/h) 12 hours before, during, and 48 hours after the procedure 1, 5
- Dose escalation is often needed over time due to tachyphylaxis 1, 5
- For optimal imaging with somatostatin receptor scintigraphy, short-acting octreotide should be withdrawn 24-48 hours before imaging 5
Monitoring and Dose Adjustment
- Monitor biochemical markers specific to the condition being treated (e.g., GH and IGF-1 levels for acromegaly) 2, 3
- Titrate dose based on symptom control and hormone levels 5, 2
- For acromegaly: Target GH levels less than 5 ng/mL or normalized IGF-1 levels 2, 3
Important Considerations and Potential Pitfalls
- Somatostatin receptors are present in 70-95% of NETs but only in about half of insulinomas, affecting treatment efficacy 1, 5
- Side effects include fat malabsorption, gallstones, gallbladder dysfunction, vitamin A and D malabsorption, headaches, diarrhea, dizziness, and hypo/hyperglycemia 1, 5
- Some studies suggest that a 6-week injection interval may be as effective as a 4-week interval in selected patients with acromegaly who have achieved good control, potentially reducing costs and burden of treatment 6
- Increasing the dosage from 20 to 30 mg may provide additional IGF-1 suppression in acromegaly patients, but increasing from 30 to 40 mg rarely provides further benefit 3, 4