Octreotide Cannot Be Given Orally
Octreotide must be administered parenterally—either subcutaneously or intravenously—as it is not available in an oral formulation and would not be absorbed if given by mouth. This is a peptide hormone analog that is rapidly degraded in the gastrointestinal tract, making oral administration ineffective 1.
Available Routes of Administration
Subcutaneous Administration (Standard Route)
- Short-acting octreotide is given subcutaneously at doses of 50-100 μg two to three times daily, with titration up to 1500 μg daily as needed 1
- This is the most common route for chronic management and allows for rapid absorption with an elimination half-life of 1.5-2 hours 2, 3
- Higher doses (12-24 mg at a time) may be needed in specific conditions like short bowel syndrome where enterohepatic circulation is disrupted 1
Intravenous Administration
- Used in acute situations requiring rapid effect, such as preventing carcinoid crisis during surgery or procedures 1
- Typical dosing is 50 μg/hour by continuous infusion in high-risk situations 1
- Also used when subcutaneous absorption may be compromised 1
Long-Acting Depot Formulations
- Octreotide LAR (long-acting release) is administered intramuscularly every 4 weeks at doses of 20-30 mg 1
- Lanreotide is given as a deep subcutaneous injection every 2-4 weeks 1
- These depot formulations require 10-14 days to reach therapeutic levels, so short-acting octreotide should be continued during initiation 1
Clinical Implications
When Oral Route Is Not Available
- In palliative care settings where the oral route is unavailable, octreotide can be administered via continuous subcutaneous infusion using a syringe driver 4
- It demonstrates good compatibility with other drugs in the same infusion for up to 48 hours at room temperature 4
Comparison to Oral Antisecretory Drugs
- While octreotide requires parenteral administration, oral proton pump inhibitors (omeprazole 40 mg once daily) and H2 antagonists (ranitidine 300 mg twice daily) are equally effective for reducing jejunostomy output in short bowel syndrome 1
- These oral agents should be considered first-line when gastric acid suppression is the primary goal, reserving octreotide for refractory cases or when additional antisecretory effects are needed 1
Practical Considerations
- The subcutaneous route is preferred over intravenous for chronic therapy as it is not sedative, not addictive, and can be self-administered 1
- Most common adverse effects include injection site pain, abdominal cramping, nausea, and diarrhea, which typically abate with continued use 2, 3
- Long-term use may cause gallstones, fat malabsorption, and vitamin A and D deficiency, requiring monitoring 1