What is the typical subcutaneous dosage of octreotide?

Octreotide Subcutaneous Dosage

The typical subcutaneous dosage of octreotide ranges from 50-100 mcg administered three times daily for most indications, with dose titration up to 500 mcg three times daily based on clinical response. 1

Standard Dosing by Indication

Neuroendocrine Tumors and Carcinoid Syndrome

• Initial dosing: Start with 100-150 mcg subcutaneously three times daily for symptom control 2, 3
• Maintenance dosing: The median daily maintenance dose is approximately 450 mcg (150 mcg three times daily), though clinical benefit occurs in some patients with as little as 50 mcg daily 1
• Maximum dosing: Doses may be titrated up to 500 mcg three times daily for maximum effectiveness, though doses above 300 mcg/day seldom provide additional biochemical benefit 1
• Typical range: For carcinoid tumors specifically, the FDA-approved dosage during the first 2 weeks ranges from 100-600 mcg/day in two to four divided doses (mean daily dosage is 300 mcg) 1

Acromegaly

• Initial dosing: 50 mcg subcutaneously three times daily 1
• Maintenance dosing: The most common dosage is 100 mcg three times daily 1
• Maximum dosing: Some patients require up to 500 mcg three times daily for maximum effectiveness 1

VIPomas (Vasoactive Intestinal Peptide Tumors)

• Initial dosing: 200-300 mcg daily in two to four divided doses during the initial 2 weeks 1
• Maintenance dosing: Usually doses above 450 mcg/day are not required 1

Specialized Clinical Scenarios

Dumping Syndrome

• Standard dosing: 50-100 mcg subcutaneously administered before meals 2
• Frequency: Typically given every 12 hours (50/100 mcg/12h) 2
• Long-term therapy: Doses ranging from 25-200 mcg have been used in long-term management studies 2

Carcinoid Crisis Prevention

• Perioperative dosing: 50 mcg/hour by intravenous administration, starting 12 hours before procedures, continuing during, and for 48 hours after procedures that may trigger crisis 3
• Emergency situations: May be given by rapid IV bolus 1

Chemotherapy-Induced Diarrhea

• Initial dosing: 100-150 mcg subcutaneously or intravenously three times daily 2
• Dose escalation: Can be titrated up to 500 mcg subcutaneously/intravenously three times daily or 25-50 mcg/hour by continuous IV infusion 2
• Optimal efficacy: Higher doses (up to 2,000 mcg three times daily) show significantly better efficacy, with the maximum tolerated dose being 2,000 mcg 4

Practical Administration Considerations

Injection Technique

• Volume reduction: Use the smallest volume that will deliver the desired dose to reduce pain with subcutaneous administration 1
• Site rotation: Rotate injection sites in a systematic manner 1
• Visual inspection: Do not use if particulates and/or discoloration are observed 1

Dose Titration Strategy

• Starting approach: Begin with 100 mcg subcutaneously three times daily for mild to moderate symptoms 5
• Titration increments: Increase in increments of 50-100 mcg every 8 hours until adequate symptom control is achieved 5
• Response assessment: Monitor every two weeks after initiating therapy or with dosage changes 1
• Maximum benefit threshold: Doses greater than 300 mcg/day seldom result in additional biochemical benefit; if an increase fails to provide additional benefit, reduce the dose 1

Transition to Long-Acting Formulations

When to Consider Long-Acting Preparations

• Long-acting formulations should be considered standard of care for chronic symptomatic treatment, as they provide comparable or better efficacy than short-acting octreotide with significantly improved quality of life 2, 3
• Standard long-acting doses: Octreotide LAR 20-30 mg intramuscularly every 4 weeks 2, 3
• Therapeutic delay: Therapeutic levels are not achieved for 10-14 days after LAR injection 2

Breakthrough Symptom Management

• Rescue dosing: Short-acting octreotide 150-250 mcg subcutaneously three times daily can be added to octreotide LAR for rapid relief or breakthrough symptoms 2
• Alternative strategy: If breakthrough symptoms occur mainly during the week before the next long-acting injection, reduce administration intervals from 4 to 3 weeks 2

Common Pitfalls and Monitoring

Side Effects to Anticipate

• Gastrointestinal: Diarrhea, nausea, abdominal cramps, bloating, flatulence, and steatorrhea 2, 3
• Metabolic: Both hypoglycemia and hyperglycemia can occur; hypoglycemia is dose-limiting at very high doses (2,500 mcg) 3, 4
• Hepatobiliary: Gallstone formation and gallbladder dysfunction 2, 3
• Local: Pain at injection site 2, 3
• Nutritional: Fat malabsorption, vitamin A and D malabsorption 3

Monitoring Requirements

• Biochemical markers: Monitor urinary 5-HIAA, plasma serotonin, or plasma Substance P for carcinoid tumors 1
• Hormone levels: Monitor plasma VIP for VIPomas 1
• Growth factors: Monitor GH or IGF-1 every two weeks for acromegaly 1
• Thyroid function: Assess total and/or free T4 levels at baseline and periodically during chronic therapy 1
• Cardiac monitoring: Required in patients receiving octreotide intravenously due to increased risk for higher degree atrioventricular blocks 3