Octreotide Dosing and Administration
Route-Specific Dosing
Octreotide is administered subcutaneously or intravenously, NOT intramuscularly, except for the long-acting release (LAR) formulation which is given intramuscularly every 4 weeks. 1
Short-Acting Formulations (Subcutaneous/Intravenous)
For neuroendocrine tumors and carcinoid syndrome, initiate octreotide at 100-150 mcg subcutaneously three times daily, with dose escalation up to 500 mcg three times daily based on symptom control. 2, 3
Acromegaly: Start with 50 mcg subcutaneously three times daily for the initial 2 weeks, then titrate to maintenance doses of 100-500 mcg three times daily based on growth hormone and IGF-1 levels 1, 4
Carcinoid tumors: Use 100-600 mcg daily divided into 2-4 doses during initial therapy, with most patients requiring 100-150 mcg three times daily 2, 1, 5
VIPomas: Administer 200-300 mcg daily in 2-4 divided doses during the initial 2 weeks 1
Dumping syndrome: Give 50-100 mcg subcutaneously before meals, typically every 12 hours 2
Chemotherapy-induced diarrhea: Start with 100-150 mcg subcutaneously or intravenously three times daily, escalating up to 500 mcg three times daily or 25-50 mcg/hour by continuous IV infusion for refractory cases 2, 3
Intravenous Continuous Infusion
For acute management, variceal bleeding, or carcinoid crisis, administer 50 mcg IV bolus followed by 50 mcg/hour continuous infusion. 2, 3
Carcinoid crisis prevention: Begin 50 mcg/hour IV infusion 12 hours before high-risk procedures and continue for 24-48 hours postoperatively 2, 3
Variceal bleeding: Use initial 50 mcg IV bolus followed by 50 mcg/hour continuous infusion, safe for 5 days or longer 2
Long-Acting Release (LAR) Formulation
Octreotide LAR 20-30 mg should be administered intramuscularly every 4 weeks and is considered standard of care for chronic symptomatic management of neuroendocrine tumors. 2, 3
Critical timing consideration: Therapeutic levels require 10-14 days after LAR injection to be achieved, necessitating continuation of short-acting octreotide during this bridging period 2
Breakthrough symptoms: Provide rescue dosing with short-acting octreotide 150-250 mcg subcutaneously three times daily for rapid relief 2
Long-term efficacy: LAR formulations provide comparable or superior efficacy to short-acting octreotide with significantly improved quality of life and patient compliance 2, 6
Dose Titration Strategy
Clinical benefit may occur with doses as low as 50 mcg, but some patients require up to 1500 mcg/day; titrate in increments of 50-100 mcg every 8 hours until adequate symptom control is achieved. 3, 5
Increasing octreotide dose is associated with increased benefit for controlling flushing, diarrhea, and biochemical markers (5-HIAA levels) 5
Maximum effective therapeutic doses control symptoms in up to 93% of carcinoid patients 5
For acromegaly, 53-68% of patients achieve biochemical control with standard dosing, with no additional benefit from higher doses (750 mcg vs 300 mcg daily) 4
Common Pitfalls and Monitoring Requirements
Monitor for gallbladder dysfunction and cholelithiasis, which occur in 10-18% of patients on long-term therapy, though only 1% become symptomatic. 2, 4, 6
Gastrointestinal effects: Expect diarrhea, nausea, abdominal cramps, bloating, flatulence, and steatorrhea in approximately 30% of patients, though most are transient and mild 2, 6
Glucose metabolism: Monitor for both hypoglycemia and hyperglycemia; approximately 15% develop mild hyperglycemia 2, 6
Cardiac monitoring: Required for patients receiving intravenous octreotide due to increased risk of higher-degree atrioventricular blocks 2
Vitamin malabsorption: Monitor for fat-soluble vitamin deficiencies (A and D) during chronic therapy 2
Injection site reactions: Local pain at injection sites is common but typically mild 2
Biochemical monitoring: Track circulating and urinary hormone levels (5-HIAA, growth hormone, IGF-1) during treatment to guide dose adjustments 2, 5