What is the dosage of Octreotide (Somatostatin analogue) per hour for gastrointestinal (GI) bleeding?

From the Guidelines

For GI bleeding, octreotide should be administered as an intravenous infusion at a rate of 50 micrograms per hour, following an initial bolus dose of 50 micrograms, as recommended by the most recent guidelines 1. The infusion should be continued for 2-5 days or until bleeding has stopped for at least 24 hours. Octreotide works by reducing splanchnic blood flow and decreasing portal pressure, which helps control bleeding from varices or other sources in the gastrointestinal tract. It also inhibits the secretion of gastric acid and digestive enzymes, further promoting hemostasis. When administering octreotide, it's essential to monitor the patient for potential side effects, including hyperglycemia, hypoglycemia, nausea, abdominal discomfort, and bradycardia, as noted in previous studies 1. The medication should be prepared in normal saline or dextrose solution according to your institution's protocol. For patients with severe liver disease, dose adjustments may not be necessary as octreotide is primarily eliminated through renal excretion. Some key points to consider when using octreotide for GI bleeding include:

• The importance of early endoscopy to confirm the source of bleeding and guide treatment 1
• The use of vasoactive drugs, such as octreotide, as an adjunct to endoscopic treatment and other interventions 1
• The need for careful monitoring of patients receiving octreotide, including assessment for potential side effects and adjustment of treatment as needed 1 Remember that octreotide is an adjunctive therapy and should be used alongside other appropriate interventions, such as endoscopic treatment, correction of coagulopathy, and volume resuscitation.

From the Research

Octreotide Administration for GI Bleed

• The use of octreotide in the management of acute variceal bleeding has been studied in several trials 2, 3, 4, 5.
• A study published in 2004 found that octreotide was useful in the management of acute variceal bleeding, with a haemostasis rate of 69% in patients receiving octreotide alone 2.
• Another study published in 1993 compared octreotide infusion with emergency sclerotherapy in the treatment of acute variceal haemorrhage, and found that both treatments were equally effective in controlling variceal haemorrhage 3.
• A meta-analysis published in 1995 found that somatostatin or octreotide therapy was significantly better than other vasoactive drugs in controlling bleeding, and had a lower complication rate compared to endoscopic sclerotherapy 4.
• However, a randomized controlled trial published in 2007 found that octreotide associated with sclerotherapy was not superior to sclerotherapy alone in terms of 7-day mortality, frequency of rebleeding, and number of units of blood transfused 5.

Dosage and Administration

• The dosage of octreotide used in these studies varied, but typically consisted of a bolus dose followed by a continuous infusion 2, 3, 5.
• For example, a study published in 2004 used a bolus dose of 50 microg followed by a continuous infusion of 50 microg/h for 5 days 2.
• Another study published in 1993 used a bolus dose of 50 micrograms followed by a continuous infusion of 50 micrograms per hour for 48 hours 3.

Efficacy and Safety

• The efficacy and safety of octreotide in the management of acute variceal bleeding have been evaluated in several studies 2, 3, 4, 5.
• Overall, the results suggest that octreotide is a safe and effective treatment for acute variceal bleeding, with a low risk of side effects 2, 3, 4.
• However, the optimal dosage and duration of treatment with octreotide remain unclear, and further studies are needed to determine the best approach to using this medication in the management of acute variceal bleeding 5.