What is the dosage of Octreotide (Somatostatin analogue)?

From the Guidelines

Octreotide dosing should start at 50-100 mcg subcutaneously two to three times a day, with the option to increase up to 1500 mcg daily, and consideration should be given to switching to long-acting formulations like octreotide LAR at 10,20, or 30 mg every 4 weeks for chronic management and improved quality of life, as evidenced by the most recent guidelines 1. The dosing of octreotide can vary based on the specific condition being treated, such as carcinoid tumors or VIPomas, and the clinical context, including the need for symptom control and the potential for side effects.

• For chronic conditions, long-acting formulations are preferred due to their ability to improve quality of life and provide comparable or better efficacy than short-acting octreotide, with dosages such as 20-30 mg intramuscularly every 4 weeks for octreotide LAR 1.
• In cases of breakthrough symptoms, rescue doses of subcutaneous octreotide can be used, up to a maximum daily dose of around 1 mg, or the administration interval of the long-acting formulation can be reduced from 4 to 3 weeks 1.
• The effects of somatostatin analogues, including octreotide, are demonstrable as biochemical response rates (inhibition of hormone production) in 30-70% of patients and as symptomatic control in the majority of patients, highlighting their importance in the management of gastroenteropancreatic neuroendocrine tumors (NETs) 1.
• Monitoring of circulating and urinary hormone levels, as well as regular imaging, is crucial during treatment with somatostatin analogues to assess response and adjust dosing as necessary 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Octreotide acetate injection may be administered subcutaneously or intravenously. The initial dosage is usually 50 mcg administered twice or 3 times daily. Dosage information for patients with specific tumors follows. Acromegaly Dosage may be initiated at 50 mcg 3 times a day The dose most commonly found to be effective is 100 mcg 3 times a day, but some patients require up to 500 mcg 3 times a day for maximum effectiveness. Carcinoid Tumors The suggested daily dosage of octreotide acetate injection during the first 2 weeks of therapy ranges from 100 to 600 mcg/day in 2 to 4 divided doses (mean daily dosage is 300 mcg) VIPomas Daily dosages of 200 to 300 mcg in 2 to 4 divided doses are recommended during the initial 2 weeks of therapy (range, 150 to 750 mcg)

The usual dose of Octreotide is 50 mcg administered twice or 3 times daily, with possible upward dose titration.

• The dose for Acromegaly is usually 100 mcg 3 times a day, but can range from 50 mcg to 500 mcg 3 times a day.
• The dose for Carcinoid Tumors ranges from 100 to 600 mcg/day in 2 to 4 divided doses.
• The dose for VIPomas is 200 to 300 mcg in 2 to 4 divided doses daily 2

From the Research

Octreotide Dosage

• The dosage of octreotide varies depending on the formulation and the patient's response to treatment 3.
• A dose of 100 micrograms octreotide 8-hourly provided very good suppression of GH in acromegalic patients 3.
• Subcutaneous octreotide in a range of doses (50-400 micrograms) caused a very similar degree of growth hormone (GH) suppression, but the duration of suppression increased with size of dose 3.
• Oral octreotide provides a new alternative for patients responding to injectable SRLs, with a twice-daily oral capsule formulation 4, 5.

Administration Routes

• Octreotide can be administered intravenously, subcutaneously, or orally 3, 4, 5.
• The oral formulation, Mycapssa®, combines octreotide with a transient permeability enhancer technology to improve paracellular transport of octreotide across the gastrointestinal wall into the small intestine 5.
• Injectable formulations, such as monthly injections, have shown to be effective in maintaining biochemical and radiological control of acromegaly, but may cause local adverse events and increased psychological burden in some patients 4.

Efficacy and Safety

• Octreotide has been shown to be effective in suppressing excess hormone secretion in acromegaly and gastroenteropancreatic neuroendocrine tumours (GEP-NET) 6, 7, 3.
• Long-term octreotide treatment reduced GH to below 20 mU/l in most patients, with only one case being apparently unresponsive 3.
• Oral octreotide capsules (Mycapssa®) have maintained a consistent biochemical normalization of IGF-1 and GH levels, with safety profiles similar to injected somatostatin receptor ligands 5.