Perioperative Octreotide Dosing Regimen
For perioperative management of patients with neuroendocrine tumors (NETs), the recommended octreotide dosing is an initial IV bolus of 50 μg followed by a continuous infusion at 50 μg/hour, starting 12 hours before the procedure and continuing for 24-48 hours afterward. 1
Standard Perioperative Dosing Protocol
- Initial IV bolus: 50 μg 1, 2
- Continuous IV infusion: 50 μg/hour 1, 3
- Timing: Start 12 hours before procedure and continue 24-48 hours after procedure 1
- For carcinoid syndrome patients: Some centers use higher prophylactic doses (500 μg IV bolus followed by 500 μg/hour continuous infusion) to prevent carcinoid crisis 4
Specific Clinical Scenarios
Carcinoid Syndrome
- Short-acting octreotide is crucial for perioperative management of carcinoid syndrome to prevent potentially life-threatening carcinoid crisis 5
- Administration should begin 12 hours before, continue during, and for 48 hours after the procedure 5
- In emergency situations (e.g., carcinoid crisis), octreotide may be given as a rapid bolus 2
VIPomas
- Even small doses of octreotide can produce dramatic cessation of diarrhea in VIPoma patients 1
- Initial doses of 50-100 μg subcutaneously two to three times daily are typically effective 2
- For perioperative management, the standard IV protocol should be followed 1
Insulinomas
- Caution: Somatostatin analogues are often not effective in controlling hypoglycemia in patients without SSTR 2-positive insulinoma 5
- Diazoxide (200-600 mg orally daily) is preferred for insulinoma patients 5
Administration Considerations
- Octreotide can be diluted in volumes of 50-200 mL of sterile isotonic saline or 5% dextrose solutions and infused over 15-30 minutes 2
- Alternatively, it can be administered by IV push over 3 minutes 2
- Octreotide is stable in sterile solutions for 24 hours 2
- Not compatible with Total Parenteral Nutrition (TPN) solutions due to formation of glycosyl octreotide conjugate 2
Monitoring and Adverse Effects
- Monitor for cardiac conduction abnormalities when administering IV boluses, as octreotide can cause bradycardia and heart block 6
- When giving as a bolus, administer slowly while monitoring ECG 6
- Other potential side effects include nausea, vomiting, abdominal pain, headache, dizziness, and alterations in glucose metabolism 1, 3
- Pain with subcutaneous administration can be reduced by using the smallest volume that will deliver the desired dose 2
Important Caveats
- For patients on long-acting somatostatin analogues (LAR formulations), short-acting octreotide may still be needed perioperatively 5
- In cases of breakthrough symptoms, rescue doses of subcutaneous octreotide can be used two or three times per day up to a maximum daily dose of around 1 mg 5
- Higher doses may be required in patients with previous exposure to octreotide or with carcinoid heart disease 7
- Avoid rapid IV bolus administration when possible to minimize risk of cardiac conduction abnormalities 6