What is the standard octreotide dosing regimen (including hourly infusion rates) for adults?

Octreotide Hourly Dosing for Continuous Infusion

The standard octreotide continuous intravenous infusion rate is 50 μg/hour, preceded by an initial IV bolus of 50 μg. 1, 2

Standard Dosing Protocol

• Start with an IV bolus of 50 μg followed immediately by continuous infusion at 50 μg/hour 1, 2
• This bolus can be repeated within the first hour if ongoing bleeding persists in variceal hemorrhage cases 1
• The infusion should continue for 2-5 days depending on the clinical indication 1, 2

Dose Titration for Specific Conditions

Variceal Hemorrhage

• Maintain 50 μg/hour continuously for 2-5 days after endoscopic intervention 1, 2
• If bleeding is not controlled within the first 12 hours, add hourly boluses of 50 μg for 24 hours on top of the continuous infusion 3
• Duration should be at least 2 days but can extend to 5 days based on clinical stability 1

Chemotherapy-Induced Diarrhea (Severe/Refractory)

• For continuous infusion: 25-50 μg/hour until diarrhea resolves 2, 4
• Alternatively, use subcutaneous dosing at 500 μg three times daily (not hourly infusion), which can be titrated up to 2,500 μg three times daily if needed 1, 4
• The usual starting dose is 100-150 μg subcutaneously three times daily, with titration up to 500 μg three times daily 1

Carcinoid Crisis Prevention (Perioperative)

• Start 50 μg/hour by continuous IV infusion 12 hours before the procedure 2, 4
• Continue during the procedure and for 24-48 hours postoperatively 2, 4

Important Clinical Considerations

• Do not discontinue prematurely in variceal bleeding before achieving hemodynamic stability 2
• Octreotide levels from the initial bolus decline rapidly, making continuous infusion essential for sustained effect 1
• For carcinoid syndrome symptom control (non-emergency), transition to long-acting formulations (LAR 20-30 mg IM every 4 weeks) after stabilization rather than prolonged continuous infusion 1, 4

Common Pitfalls to Avoid

• Inadequate initial bolus: Failing to give the 50 μg IV bolus before starting the infusion reduces immediate efficacy 1, 2
• Premature discontinuation: Stopping infusion before 48 hours in variceal bleeding increases rebleeding risk 2
• Wrong route for chronic management: Continuous IV infusion is for acute situations only; chronic carcinoid syndrome requires subcutaneous or LAR formulations 1, 4
• Underdosing in refractory diarrhea: If 50 μg/hour infusion fails for chemotherapy-induced diarrhea, consider switching to subcutaneous 500 μg three times daily rather than increasing infusion rate 1, 4