Octreotide Starting Dose for Adults
The typical starting dose of subcutaneous octreotide for adults is 50-100 mcg administered three times daily (every 8 hours), with dose titration based on clinical response and the specific indication being treated. 1
Standard Starting Doses by Indication
Acromegaly
- Initial dose: 50 mcg subcutaneously three times daily for the first 2 weeks of therapy 1
- Maintenance dosing ranges from 100-500 mcg three times daily based on growth hormone and IGF-1 suppression 1
- The 100 mcg every 8 hours regimen provides excellent GH suppression in most acromegalic patients 2
Carcinoid Syndrome
- Initial dose: 100-150 mcg subcutaneously three times daily is recommended by the European Society for Medical Oncology 3
- FDA labeling supports a dosage range of 100-600 mcg daily in 2-4 divided doses during initial therapy 1
- Dose titration in increments of 50-100 mcg every 8 hours should continue until adequate symptom control is achieved, as up to 93% of patients achieve symptom control with maximum effective doses 4
- Rescue dosing: 150-250 mcg subcutaneously three times daily can be used for breakthrough symptoms 3
VIPomas (Vasoactive Intestinal Peptide Tumors)
- Initial dose: 200-300 mcg daily in 2-4 divided doses during the first 2 weeks 1
- Small doses can provide dramatic relief when titrated against VIP levels 3
Critical Dosing Considerations
Maximum Daily Doses
- The maximum daily dose can reach up to 1500 mcg per day (500 mcg three times daily) for symptom control 1, 5
- For breakthrough symptoms with carcinoid syndrome, rescue doses of subcutaneous octreotide can be used 2-3 times daily up to a maximum of approximately 1 mg (1000 mcg) per day 6
Long-Acting Formulations
- Octreotide LAR: 20-30 mg intramuscularly every 4 weeks is the standard long-acting dose and should be considered standard of care for chronic symptomatic treatment 3
- A 10-14 day therapeutic delay occurs after LAR injection before therapeutic levels are achieved 3
- Continue short-acting octreotide for approximately 2 weeks after initiating LAR to maintain symptom control 7
Special Clinical Scenarios
Carcinoid Crisis Prevention
- 50 mcg/hour by continuous intravenous infusion, starting 12 hours before procedures and continuing for 48 hours after 6, 3
- This prevents life-threatening carcinoid crisis during surgical or invasive procedures 3
Hepatorenal Syndrome (Off-Label)
- Target dose: 200 mcg subcutaneously three times daily when combined with midodrine and albumin 6
- This regimen can be administered outside intensive care settings 6
Chemotherapy-Induced Diarrhea (Off-Label)
- Initial: 100-150 mcg subcutaneously or intravenously three times daily 3
- Can escalate to 500 mcg three times daily or 25-50 mcg/hour by continuous IV infusion 3
Important Caveats and Monitoring
Ineffective Scenarios
- Insulinomas: Octreotide is often ineffective as only 50% have type II somatostatin receptors; diazoxide is preferred 3
- Gastrinomas: PPIs are first-line; somatostatin analogues should only be used in refractory cases 6
Cardiac Monitoring Requirements
- Increased risk for higher-degree atrioventricular blocks when administered intravenously 1
- Bradycardia, arrhythmias, and conduction abnormalities may occur, requiring cardiac monitoring in at-risk patients 1
Common Side Effects Requiring Monitoring
- Cholelithiasis: Monitor periodically with imaging; gallstones develop in a significant proportion of patients 1
- Glucose metabolism: Both hypoglycemia and hyperglycemia can occur; glucose monitoring and adjustment of anti-diabetic medications may be necessary 1
- Thyroid function: Hypothyroidism may develop; monitor thyroid levels periodically 1
- GI effects: Injection site pain, abdominal cramps, diarrhea, nausea, bloating, and flatulence are common but generally mild 3, 1