Octreotide Per Kilogram Dosing
For pediatric sulfonylurea poisoning, octreotide should be dosed at 1-1.5 μg/kg IV or SC, followed by 2-3 additional doses every 6 hours. 1
Weight-Based Dosing Context
The per-kilogram dosing of octreotide is primarily established and recommended in pediatric populations, particularly for sulfonylurea-induced hypoglycemia. 1 This represents the most clearly defined weight-based dosing protocol in the medical literature.
Pediatric Sulfonylurea Poisoning Protocol
- Initial dose: 1-1.5 μg/kg IV or SC 1
- Maintenance: Repeat doses every 6 hours for 2-3 additional doses 1
- Concurrent therapy: IV dextrose should be gradually tapered during octreotide treatment 1
- Clinical context: This dosing was effective in 14 pediatric patients who ingested sulfonylureas, with 50% experiencing recurrent hypoglycemia requiring additional doses 1
Important Caveat for Pediatric Use
- One pediatric patient developed hypertension and apnea 30 minutes after IV octreotide, though the causal relationship remains unclear 1
- Recurrent hypoglycemia occurred in 50% of pediatric cases despite octreotide therapy, necessitating additional doses and IV dextrose 1
Adult Dosing (Not Weight-Based)
In contrast to pediatric protocols, adult dosing is typically fixed rather than weight-based:
Standard Adult Dosing Regimens
- Short-acting subcutaneous: 50-100 μg SC every 8 hours, with doses ranging up to 150-250 μg three times daily for breakthrough symptoms 2, 3
- IV drip: 50 μg/hour continuous infusion, typically preceded by 50 μg IV bolus 4
- Long-acting release (LAR): 20-30 mg intramuscularly every 4 weeks 2
Carcinoid Crisis Prevention
- Perioperative dosing: 50 μg/hour IV infusion starting 12 hours before procedures and continuing 24-48 hours after 4, 3, 5
Dose Escalation in Adults
- Clinical benefit may occur with doses as low as 50 μg, but some patients require up to 1500 μg/day 3
- For refractory chemotherapy-induced diarrhea, doses can be titrated up to 500 μg three times daily 4, 3
- In acromegaly studies, doses up to 3000 μg/day have been administered without serious adverse effects, though doses above 800 μg/day rarely provide additional benefit 6, 7
Clinical Pitfall
The critical distinction: Weight-based dosing (μg/kg) is established for pediatric sulfonylurea poisoning, while adult dosing across all other indications uses fixed doses regardless of body weight. 1, 2 Do not extrapolate pediatric weight-based dosing to adult populations for neuroendocrine tumors, carcinoid syndrome, or other standard indications.