Sandostatin LAR

Somatostatin and analogs

Oral Administration

Delayed-release capsules
Take with a glass of water on an empty stomach, either at least 1 hour before a meal or at least 2 hours after a meal.
Swallow whole; do not crush or chew.

Injectable Administration

Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
 
Octreotide Injection Solution (e.g., Sandostatin)
For intravenous (IV) or subcutaneous administration only.
Storage: Unopened injection solution is stored at refrigerated temperatures between 2 and 8 degrees C (36 and 46 degrees F) in the outer carton to protect from light. Unopened ampules and vials are stable for 14 days at room temperature if protected from light. Discard any unused portion of an ampul once opened. Discard multiple-dose vials 14 days after initial use.
 
Octreotide Injection Solution Pen (e.g., Bynfezia Pen)
For subcutaneous administration only.
Storage: Unopened pen is stored at refrigerated temperatures between 2 and 8 degrees C (36 and 46 degrees F) in the original outer carton to protect from light. After first use, store pen at room temperature between 20 and 25 degrees C (68 to 77 degrees F). Excursions between 15 degrees C (59 degrees F) and 30 degrees C (86 degrees F) are allowed for up to 28 days. Discard the pen 28 days after first use.
 
Octreotide Depot Injection Suspension (e.g., Sandostatin LAR depot)
For intramuscular (IM) injection once monthly into the gluteal region only. Do NOT administer by any other route.
Storage: Unopened Sandostatin LAR kits are stored in the refrigerator between 2 and 8 degrees C (36 and 46 degrees F), in the original carton to protect from light, until the time of use.
Questions about product acquisition or product preparation and/or administration can be answered by calling the PEAK (Pituitary Education, Access, and Knowledge) assistance line at 1-877-503-3377 between the hours of 8:00 AM and 8:00 PM eastern standard time (EST). Healthcare providers may also contact the Sandostatin Support Hotline at 1-800-282-7630.

Intravenous Administration

Octreotide Injection Solution (e.g., Sandostatin)
Octreotide injection solution may be allowed to reach room temperature prior to administration. Do not warm artificially.
 
IV Push
In emergency situations, octreotide may be administered undiluted by intermittent direct IV injection. Give IV slowly over 3 minutes.
 
Intermittent IV Infusion
Dilute in 50 mL to 200 mL of 0.9% Sodium Chloride or 5% Dextrose injection; infuse IV over 15 to 30 minutes.
Once diluted, the infusion solution is stable for 24 hours.
 
Continuous IV Infusion
Dilute in 50 mL to 200 mL of 0.9% Sodium Chloride or 5% Dextrose injection.
ASHP Recommended Standard Concentrations for Pediatric Continuous Infusions: 2.5 mcg/mL, 10 mcg/mL, or 50 mcg/mL.
Administer the continuous infusion at the ordered dose rate using a rate-controlled infusion device.
Once diluted, the IV infusion is stable for 24 hours.

Intramuscular Administration

Octreotide Depot Injection Suspension (e.g., Sandostatin LAR depot) ONLY
For intramuscular (IM) administration as a once monthly (every 4 weeks) injection. Do NOT give by any other route.
An instruction booklet for preparation of the depot IM drug suspension is provided in each kit. Use the provided diluent only.
Preparation:
Drug product kit should be removed from the refrigerator and should stand at room temperature for a minimum of 30 minutes (not to exceed 24 hours) prior to preparation of the suspension. If necessary, the kit may be re-refrigerated.
Remove plastic cap from vial containing Sandostatin LAR powder and clean the vial stopper with an alcohol swab.
Remove the lid film of the vial adapter packaging and position the vial adapter on top of the vial and push it down until it snaps in place, confirmed by an audible "click". Lift the packaging off the vial adapter.
Remove cap from syringe prefilled with diluent solution and screw syringe onto vial adapter.
Slowly push plunger all the way down to transfer all of the diluent solution into the vial. Do not disturb the vial while the diluent saturates the powder. After 2 to 5 minutes, without inverting the vial, check the sides and bottom of vial for dry spots. The powder must be fully saturated before withdrawing from the vial.
Once the powder is completely saturated, press plunger all the way back into the syringe. Keep plunger pressed and shake vial moderately in a horizontal direction for approximately 30 seconds to form a uniform milky suspension.
Repeat shaking for another 30 seconds if powder is not completely suspended.
Prepare Syringe to Administer Depot Injection:
Turn the syringe and vial upside down and slowly pull the plunger out to draw entire contents from vial into the syringe.
Unscrew syringe from the vial adapter.
Peel off outer syringe label.
Just prior to injection, screw safety injection needle onto syringe, pull protective cover straight off needle, and gently shake syringe to maintain a uniform suspension.
Gently tap syringe to remove any visible bubbles and eliminate air from syringe. Ensure that the powder is completely suspended at the time of injection.
Administer immediately after preparation. Failure to inject immediately after suspension preparation may cause the product to become solid. If the product 'clumps' or flocculates, it is not usable. The preparation process will need to begin again with a new kit.
Injection Administration:
Must be given only by deep intragluteal IM injection. NEVER give intravenously.
Inject immediately after product preparation.
Prepare the injection site with an alcohol wipe.
Insert the needle fully into the left or right gluteus at a 90 degree angle to the skin.
At the next monthly injection, rotate the gluteal IM injection site.

Subcutaneous Administration

Octreotide Injection Solution (e.g., Sandostatin)
Administer subcutaneously undiluted, unless the injection dose volume cannot be accurately administered without further dilution with 0.9% Sodium Chloride for Injection.
To minimize pain, use the smallest injection volume that will deliver the desired dose.
May allow the injection to reach room temperature before administration. However, do not artificially warm the injection.
 
Octreotide Injection Solution Pen (e.g., Bynfezia Pen)
For subcutaneous administration only.
Provide proper training to patients and/or caregivers regarding the proper use of the Bynfezia Pen according to the manufacturer's "Instructions for Use".
Bynfezia Pen should be at room temperature before injecting into the abdomen, the front of the middle thighs, or the back/outer area of the upper arms.
Rotate injection sites; the new injection site should be at least 2 inches between the previous injection site.

Severe

bradycardia / Rapid / 2.0-25.0
biliary obstruction / Delayed / 1.0-10.0
cholecystitis / Delayed / 0-4.0
visual impairment / Early / 1.0-4.0
seizures / Delayed / 0-1.0
cranial nerve palsies / Delayed / 0-1.0
peptic ulcer / Delayed / Incidence not known
GI obstruction / Delayed / Incidence not known
enterocolitis / Delayed / Incidence not known
GI bleeding / Delayed / Incidence not known
ileus / Delayed / Incidence not known
pancreatitis / Delayed / Incidence not known
cardiac arrest / Early / Incidence not known
pulmonary hypertension / Delayed / Incidence not known
heart failure / Delayed / Incidence not known
AV block / Early / Incidence not known
myocardial infarction / Delayed / Incidence not known
diabetes insipidus / Delayed / Incidence not known
pituitary apoplexy / Early / Incidence not known
angioedema / Rapid / Incidence not known
anaphylactoid reactions / Rapid / Incidence not known
intracranial bleeding / Delayed / Incidence not known
suicidal ideation / Delayed / Incidence not known
retinal thrombosis / Delayed / Incidence not known
pancytopenia / Delayed / Incidence not known
thrombosis / Delayed / Incidence not known
pulmonary embolism / Delayed / Incidence not known
pleural effusion / Delayed / Incidence not known
pneumothorax / Early / Incidence not known
hearing loss / Delayed / Incidence not known
ocular hypertension / Delayed / Incidence not known
renal failure (unspecified) / Delayed / Incidence not known

Moderate

cholelithiasis / Delayed / 2.0-27.0
hyperglycemia / Delayed / 6.0-27.0
antibody formation / Delayed / 0-25.0
constipation / Delayed / 0-18.8
edema / Delayed / 1.0-16.0
hypertension / Early / 0-12.6
hypothyroidism / Delayed / 2.0-12.0
goiter / Delayed / 2.0-8.0
hematoma / Early / 1.0-4.0
hypoglycemia / Early / 1.5-4.0
blurred vision / Early / 1.0-4.0
sinus tachycardia / Rapid / 2.0-2.0
cholangitis / Delayed / 0-1.0
chest pain (unspecified) / Early / 0-1.0
palpitations / Early / 0-1.0
depression / Delayed / 0-1.0
neuritis / Delayed / 0-1.0
anemia / Delayed / 0-1.0
nephrolithiasis / Delayed / 0-1.0
hematuria / Delayed / 0-1.0
hemorrhoids / Delayed / Incidence not known
jaundice / Delayed / Incidence not known
hepatitis / Delayed / Incidence not known
steatosis / Delayed / Incidence not known
elevated hepatic enzymes / Delayed / Incidence not known
ascites / Delayed / Incidence not known
ST-T wave changes / Rapid / Incidence not known
phlebitis / Rapid / Incidence not known
QT prolongation / Rapid / Incidence not known
orthostatic hypotension / Delayed / Incidence not known
vitamin B12 deficiency / Delayed / Incidence not known
growth inhibition / Delayed / Incidence not known
vaginitis / Delayed / Incidence not known
galactorrhea / Delayed / Incidence not known
dyspnea / Early / Incidence not known
paresis / Delayed / Incidence not known
amnesia / Delayed / Incidence not known
aphasia / Delayed / Incidence not known
migraine / Early / Incidence not known
thrombocytopenia / Delayed / Incidence not known
scotomata / Delayed / Incidence not known
hyperthermia / Delayed / Incidence not known

Mild

nausea / Early / 5.0-61.0
abdominal pain / Early / 5.0-61.0
diarrhea / Early / 5.0-61.0
headache / Early / 6.0-33.0
back pain / Delayed / 6.0-27.3
arthralgia / Delayed / 1.0-26.0
flatulence / Early / 0-25.7
weakness / Early / 1.0-22.0
asthenia / Delayed / 1.0-22.0
hyperhidrosis / Delayed / 21.0-21.0
dizziness / Early / 5.0-20.0
arthropathy / Delayed / 0-19.2
myalgia / Early / 0-18.2
musculoskeletal pain / Early / 0-15.4
rash / Early / 0-15.0
vomiting / Early / 4.4-14.0
alopecia / Delayed / 1.0-13.2
fatigue / Early / 1.0-11.1
dyspepsia / Early / 4.0-11.0
sinusitis / Delayed / 11.0-11.0
influenza / Delayed / 7.0-7.0
pharyngitis / Delayed / 7.0-7.0
infection / Delayed / 0-7.0
stool discoloration / Delayed / 4.0-6.0
steatorrhea / Delayed / 4.0-6.0
tenesmus / Delayed / 4.0-6.0
flushing / Rapid / 1.0-4.0
pruritus / Rapid / 1.0-4.0
increased urinary frequency / Early / 1.0-4.0
urticaria / Rapid / 0-1.0
paranoia / Early / 0-1.0
vertigo / Early / 0-1.0
tremor / Early / 0-1.0
anxiety / Delayed / 0-1.0
syncope / Early / 0-1.0
epistaxis / Delayed / 0-1.0
injection site reaction / Rapid / 10.0
weight loss / Delayed / Incidence not known
oligomenorrhea / Delayed / Incidence not known
gynecomastia / Delayed / Incidence not known
menstrual irregularity / Delayed / Incidence not known
amenorrhea / Delayed / Incidence not known
drowsiness / Early / Incidence not known
petechiae / Delayed / Incidence not known

Mycapssa, Sandostatin, Sandostatin LAR

Rx

Synthetic analog of somatostatin
Injections used for acromegaly, vasoactive intestinal peptide tumors (VIPomas; watery diarrhea), metastatic carcinoid tumors, AIDS-associated diarrhea, esophageal varices, and other indications; oral formula used for acromegaly in adults
Gastrointestinal adverse effects are common; cholelithiasis may be a concern with long-term use

For the treatment of acromegaly.
NOTE: Octreotide has been designated an orphan drug by the FDA for this indication.
Subcutaneous dosage (solution for injection) Adults

Initiate therapy at 50 mcg subcutaneously 3 times daily. The most common effective dose is 100 to 200 mcg subcutaneously 3 times daily. Some patients require doses up to 500 mcg subcutaneously 3 times daily, but no added benefit attributed to dosages of more than 300 mcg/day. IGF-1 levels every 2 weeks can be used to guide titration or, alternatively, multiple growth hormone levels at 0 to 8 hours after octreotide injection may permit more rapid titration of the dose. If an increase in dose fails to provide any additional benefit, reduce the dose. In patients who have received irradiation, octreotide should be withdrawn yearly for approximately 1 month to assess disease activity. If growth hormone or IGF-1 levels increase and signs and symptoms recur, octreotide therapy may be restarted.

Intramuscular dosage (injectable depot suspension) Adults

Patients responding to subcutaneous octreotide may initiate with 20 mg depot injection suspension IM every 4 weeks for 3 months. After 3 months may adjust as follows: for growth hormone (GH) serum levels of 2.5 ng/mL or less, IGF-1 normal and clinical symptoms controlled, continue same dosage; for GH serum levels greater than 2.5 ng/mL, IGF-1 elevated and/or clinical symptoms uncontrolled, increase dosage to 30 mg IM every 4 weeks; for GH of 1 ng/mL or less, IGF-1 normal and clinical symptoms controlled, decrease dose to 10 mg IM every 4 weeks. In patients whose symptoms and lab parameters are not controlled at 30 mg/month, may increase to 40 mg IM every 4 weeks. Max: 40 mg IM every 4 weeks. Dosing intervals longer than 4 weeks are not recommended. On a yearly basis, patients who have received pituitary irradiation, should have the depot octreotide therapy held for 8 weeks to assess disease activity. If GH or IGF-1 levels increase and signs and symptoms recur, octreotide therapy should be restarted.

Oral dosage Adults

Initially, 20 mg PO twice daily in those patients with response to octreotide or lanreotide injections. Monitor IGF-1 levels and patient's signs and symptoms every 2 weeks to guide titration. Increase dosage in increments of 20 mg daily. For dosages of 60 mg/day, administer 40 mg PO in the morning and 20 mg PO in the evening. For dosages of 80 mg/day, administer 40 mg PO twice daily. Max: 80 mg/day PO. Once the maintenance dosage is achieved, monitor IGF-1 levels and patient's signs and symptoms monthly or as indicated. If IGF-1 levels remain above the upper normal limit with 80 mg/day or the patients cannot tolerate oral octreotide treatment, consider switching to another somatostatin analog. Withdraw therapy periodically to assess disease activity. If IGF-1 levels increase and signs and symptoms recur, octreotide therapy may be restarted. Guidelines state that a starting dose of 60 mg/day PO may be optimal for most patients. In addition, due to lack of available data, octreotide is not recommended for patients who have tumor characteristics predictive of octreotide resistance.

For the treatment of symptoms associated with carcinoid tumors, specifically, diarrhea and cutaneous flushing.
NOTE: Octreotide has been designated an orphan drug by the FDA for this indication. 
Subcutaneous dosage (solution for injection) Adults

100 to 600 mcg/day subcutaneously, given in 2 to 4 divided doses, for the first 2 weeks. The mean dosage is 300 mcg/day; some patients may require doses up to 1,500 mcg/day.

Intramuscular dosage (injectable depot suspension) Adults

In adults with a response to subcutaneous use of octreotide, give 20 mg IM depot injection intragluteally every 4 weeks for 2 months. Patients should continue the previous subcutaneous dosage for up to 2 weeks after starting the IM injections (some patients may require up to 4 weeks). Patients who do not continue the subcutaneous injections during this time may have an exacerbation of their symptoms. After 2 months, if the patient did not respond, may increase to 30 mg IM every 4 weeks. For maintenance, give a trial of 10 mg IM every 4 weeks if the patient responded to the initial dose; if symptoms increase, then increase the dose. Max: 30 mg IM every 4 weeks. Dosing intervals greater than 4 weeks are not recommended. Some patients experience periodic exacerbations that may require temporary management with subcutaneous octreotide, which may be halted once symptoms resolve.

For the treatment of symptoms associated with vasoactive intestinal peptide tumors (e.g., VIPoma) (i.e., to reduce plasma concentrations of vasoactive intestinal peptide).
NOTE: Octreotide has been designated an orphan drug by the FDA for this indication.
Subcutaneous dosage (solution for injection) Adults

200 to 300 mcg/day subcutaneously, given in 2 to 4 divided doses, for the first 2 weeks; then titrate. Dosage range: 150 to 750 mcg/day. Maintenance doses must be individualized. Doses above 450 mcg/day are usually not required.

Intramuscular dosage (injectable depot suspension) Adults who have responded to and tolerate subcutaneous octreotide

In adults with a response to subcutaneous use of octreotide, give 20 mg IM depot injection intragluteally every 4 weeks for 2 months. Patients should continue the previous subcutaneous dosage for up to 2 weeks after starting the IM injections (some patients may require up to 4 weeks). Patients who do not continue the subcutaneous injections during this time may have an exacerbation of their symptoms. After 2 months, if the patient did not respond, may increase to 30 mg IM every 4 weeks. For maintenance, give a trial of 10 mg IM every 4 weeks if the patient responded to the initial dose; if symptoms increase, then increase the dose. Max: 30 mg IM every 4 weeks. Dosing intervals greater than 4 weeks are not recommended. Some patients experience periodic exacerbations that may require temporary management with subcutaneous octreotide, which may be halted once symptoms resolve.

For the treatment of refractory or severe diarrhea† or ileostomy-associated diarrhea†. Subcutaneous dosage Adults

50 to 100 mcg subcutaneously every 8 to 12 hours. Various regimens, titrated to effect, have been reported in published reports/studies of various patient populations.

Neonates, Infants, Children, and Adolescents

2 to 10 mcg/kg/day subcutaneously divided twice daily is the most commonly reported dosage range; begin at the lower end of the dosage range and titrate to clinical response. Doses up to 18 mcg/kg/day have been reported in patients with intractable diarrhea.

Intravenous dosage Adults

25 mcg/hour continuous IV infusion.

Neonates, Infants, Children, and Adolescents

2 to 10 mcg/kg/day IV divided twice daily is the most commonly reported dosage range; begin at the lower end of the dosage range and titrate to clinical response. Doses up to 18 mcg/kg/day have been reported in patients with intractable diarrhea.

For the management of chemotherapy-induced diarrhea† in pediatric patients. Intermittent Intravenous or Subcutaneous dosage Neonates, Infants, Children, and Adolescents

2 to 10 mcg/kg/day given in divided doses IV or subcutaneously twice daily is the most commonly reported dosage range; begin at the lower end of the dosage range and titrate to clinical response. Doses up to 18 mcg/kg/day have been reported in patients with intractable diarrhea.

Continuous Intravenous Infusion dosage Children and Adolescents

1 mcg/kg/hour as a continuous IV infusion has been reported as efficacious in a pediatric case report of diarrhea secondary to graft vs. host disease.

For the control of diarrhea secondary to AIDS-associated enteropathy†. Subcutaneous dosage (solution for injection) Adults

Uncontrolled studies indicate responsiveness with an initial dose of 50 mcg subcutaneously every 8 hours as needed, and then titrated to effectiveness, especially if no infectious etiology is present. Effective dose range reported for most patients is 100 to 250 mcg subcutaneously every 8 hours. Doses up to 500 mcg subcutaneously every 8 hours have been reported. Twenty-one (41%) patients in one study responded and in a second study (n = 11), 5 patients (45%) responded favorably to treatment. A third study involved 29 patients with AIDS-associated diarrhea. Twenty-one patients had positive stool cultures for Cryptosporidium species and 1 for Isospora belli. Seven patients had no identifiable infectious agent on stool culture. Of the 25 evaluable patients, 10 (40%) had a complete response to octreotide (defined as a reduction in the number of bowel movements to 2 bowel movements/day or less). Nine patients had a partial response (defined as a 50% reduction in stool output or an increase in stool consistency). All 3 studies suggest that response is more likely in patients with negative stool cultures than in those whose diarrhea had an infectious etiology.

For the treatment of dumping syndrome†. Subcutaneous dosage (solution for injection) Adults

Single doses of 50 to 100 mcg subcutaneously were studied in placebo-controlled crossover trials in meal-stimulated dumping syndrome. Octreotide reduced symptoms in patients with early dumping syndrome including a significantly decreased pulse rate. Patients with late dumping syndrome showed an inhibition of insulin secretion and did not experience hypoglycemia. In patients with severe postvagotomy or postgastrectomy symptoms, octreotide 50 mcg subcutaneously twice daily showed benefit in 6 of 14 patients after 3 months.

For the treatment of short bowel syndrome†. Subcutaneous or Intravenous dosage (solution for injection) Adults

In a randomized, double-blind, crossover study involving 6 patients, 2 octreotide regimens were used: 25 mcg/hour continuous IV infusion for 2 days or 50 mcg subcutaneously every 12 hours for 2 days. Both regimens were significantly more effective than placebo, however, treatment did not eliminate the need for IV fluids. In 3 of 4 patients who received octreotide for 4 to 6 months, reductions in fecal sodium and water loss were maintained. In an open-label, uncontrolled study, 6 patients with short bowel syndrome received octreotide 50 mcg subcutaneously or IV every 12 hours. A 73% reduction in diarrhea was reported for 5 of 6 patients. Dosages greater than 50 mcg twice daily did not provide any added benefit.

For the treatment of enterocutaneous fistula†. Subcutaneous dosage (solution for injection) Adults

Doses have ranged from 75 mcg to 100 mcg subcutaneously every 8 hours. The efficacy of octreotide in enterocutaneous fistulas was examined in a randomized, double-blind, placebo-controlled study involving 14 patients who had not responded to 7 days of total parenteral nutrition, cimetidine, and nasogastric suction. Patients received octreotide 225 to 300 mcg/day subcutaneously in divided doses for 2 days before being crossed over to placebo. All patients had a reduction in fistula output while on octreotide. Octreotide was continued after study completion. Fistulas closed in 11 (78%) patients within 2 to 10 days (mean: 4 to 5 days). Fistulas failed to close in 3 patients with high-output fistulas. Similar results were obtained in an open-label study of octreotide 100 mcg subcutaneously every 8 hours.

For reducing output from a pancreatic fistula†. Subcutaneous dosage Adults

In an uncontrolled study, octreotide 100 mcg subcutaneously every 8 hours was administered to 8 patients with high-output pancreatic fistulas. Resolution occurred at a mean of 23 days in 7 patients. According to this study, patients with fistulas secondary to obstructed ductal drainage or an infected fistular tract are unlikely to respond to octreotide therapy.

For the treatment of acute variceal bleeding† or nonvariceal upper GI bleeding†. For the treatment of acute variceal bleeding† or nonvariceal upper GI bleeding† in adults. Intravenous dosage (solution for injection) Adults

50 mcg IV bolus, then 50 mcg/hour continuous IV infusion. May repeat bolus dose in first hour if ongoing bleeding. Usual duration: 2 to 5 days.[58809] [58810] [58811] [64335]

For the treatment of acute variceal bleeding† or nonvariceal upper GI bleeding† in pediatric patients. Intravenous dosage (solution for injection) Infants, Children, and Adolescents

1 to 2 mcg/kg IV over 5 minutes followed by 1 to 2 mcg/kg/hour continuous IV infusion. Titrate infusion to clinical response. After 24 hours of no active bleeding, taper infusion rate by 50% every 12 hours; discontinue infusion when the rate is 25% of the original dose. In a review of pediatric patients with acute GI bleeding, median duration of therapy for those with portal hypertension (n = 21) was 50 hours (range 19 hours to 7 days); for patients without portal hypertension (n = 12), median duration was 43 hours (range 3 hours to 36 days).[53124] [53125]

For the treatment of hyperthyroidism† secondary to thyrotropinoma†. Subcutaneous dosage Adults

Initially, 50 to 100 mcg subcutaneously 2 to 3 times per day. Titrate to response. Max: 500 mcg subcutaneously every 8 hours. In one retrospective study, 52 cases of TSH-secreting adenomas treated with octreotide were reviewed. TSH levels were decreased in 50 patients and thyroid hormone levels were reduced in all patients. Thyroid hormone levels returned to normal levels in 73% of patients.

For the treatment of hypoglycemia in patients with hyperinsulinism, including patients with benign or malignant insulinoma†. Subcutaneous dosage (solution for injection) Adults

The optimal dosage has not been established. In small numbers of patients with insulinoma, dosages of 100 to 450 mcg/day subcutaneously given in 2 to 3 divided doses have been used to normalize blood glucose. Limited data indicate dosages of 300 to 1500 mcg/day subcutaneous continuous infusion may also normalize fasting blood glucose.

For the treatment of neurogenic orthostatic hypotension†, including due to diabetic cardiovascular autonomic neuropathy†. Subcutaneous dosage (solution for injection) Adults

12.5 to 25 mcg subcutaneously 3 times daily, initially. Titrate dose to symptomatic response. Both low (0.2 to 0.4 mcg/kg/dose) and high (up to 1.6 mcg/kg/dose) dose octreotide have been studied. Usually reserved for patients not responsive to standard therapies.

For the treatment of hepatorenal syndrome† in combination with midodrine. Intravenous or Subcutaneous dosage (solution for injection) Adults

100 to 200 mcg IV or subcutaneously every 8 hours.   In settings where terlipressin and norepinephrine are not available, a trial of midodrine plus octreotide may be given; however, efficacy is low.

Continuous Intravenous Infusion dosage (solution for injection) Adults

50 mcg/hour continuous IV infusion. In settings where terlipressin and norepinephrine are not available, a trial of midodrine plus octreotide may be given; however, efficacy is low.

For the treatment of acute cluster headache†. Subcutaneous dosage Adults

100 mcg subcutaneously once.

For the treatment of sulfonylurea overdose†. Intermittent Subcutaneous or Intravenous dosage Infants, Children, and Adolescents

1 to 1.5 mcg/kg/dose subcutaneously or IV every 6 to 12 hours. Dosage, interval, and duration may depend on amount of sulfonylurea ingested and the specific drug's half-life; titrate to clinical effect and monitor blood glucose closely. Continuous infusions (suggested initial rate 15 ng/kg/minute) have been necessary in severe refractory cases. In a retrospective review of 9 years of the American Association of Poison Control Centers National Poison Data System, a median of 1 octreotide dose (range: 1 to 4 doses) was administered to each patient; the doses were estimated to have been given at a median time of 11 hours (range: 1 to 33 hours) after sulfonylurea exposure. Of the 121 cases included in the final analysis (median patient age: 22 months; range: 8 to 60 months), glipizide was the sulfonylurea most frequently ingested (62% immediate-release, 7% extended-release).

For the treatment of hypothalamic obesity† as a result of cranial injury. Intermittent Subcutaneous dosage Children and Adolescents

5 mcg/kg/day subcutaneously given in divided doses 3 times daily. May increase dose by 5 mcg/kg/day every 2 months as needed based on weight. Max: 15 mcg/kg/day subcutaneously in divided doses. This dosage resulted in insulin suppression, stabilization of BMI, decreased leptin, decreased caloric intake, increased spontaneous physical activity, and improved quality of life during a 6-month double-blind, placebo-controlled trial of 20 pediatric patients.

For the treatment of secondary hypoglycemia† due to congenital hyperinsulinemia† (e.g., hyperinsulinemic hypoglycemia). Intermittent Subcutaneous or Intravenous dosage Neonates, Infants, and Children

2 to 10 mcg/kg/day subcutaneously or IV given in divided doses every 6 to 8 hours. Titrate dosage to clinical response; tachyphylaxis may develop after several days. Reported range 5 to 40 mcg/kg/day. Max: 40 mcg/kg/day. Monitor blood glucose closely. If blood glucose concentrations are not maintained, may consider dividing daily dose into every 4 hour intervals or administering as a continuous infusion.

Continuous Subcutaneous or Intravenous Infusion dosage Neonates, Infants, and Children

0.08 to 0.4 mcg/kg/hour (2 to 10 mcg/kg/day) subcutaneously or IV as a continuous infusion. Titrate to clinical effect. Max: 1.67 mcg/kg/hour (40 mcg/kg/day). Some experts recommend octreotide infusion with concurrent administration of glucagon; if administered concurrently, an octreotide dose of 0.4 mcg/kg/hour (10 mcg/kg/day) is recommended. Monitor blood glucose closely.

For the treatment of chylothorax†. Continuous Intravenous Infusion dosage Neonates, Infants, and Children

1 to 4 mcg/kg/hour IV as an initial infusion rate; gradually titrate (i.e., 1 mcg/kg/hour increase every 24 hours as needed) to response. Maximum: 10 mcg/kg/hour IV infusion. Doses have ranged from 0.3 to 10 mcg/kg/hour. Duration of therapy is generally determined by reduction in pleural drainage; median duration of therapy is 1 week (reported range 3 to 34 days). Gradually decrease infusion (i.e., 1 mcg/kg/hour every 24 hours) when chylothorax resolves. Monitor for reaccumulation.

Intermittent Subcutaneous dosage Neonates, Infants, and Children

40 mcg/kg/day subcutaneously given in divided doses 3 times daily is the median effective dose. Case reports have described initial doses of 10 mg/kg/day subcutaneously titrated by 5 to 10 mg/kg/day every 3 to 4 days to an effective dose. The reported dosage range is 2 to 70 mcg/kg/day subcutaneously given in divided doses. Duration of therapy is generally determined by reduction in pleural drainage; the median duration of therapy is 17 days (range 8 to 43 days). Wean octreotide after 3 days of insignificant chyle output (less than 10 mL/day); decrease by 10 mcg/kg/day. Monitor for reaccumulation.

For the management of GI bleeding from gastrointestinal angioectasias† in adults. Intramuscular dosage (suspension for injection; e.g., Sandostatin LAR) Adults

10 mg IM once monthly for a mean of 12 months (range 6 to 36 months) has been recommended by guidelines for red blood cell transfusion-dependent GI bleeding secondary to GI angioectasias that cannot be adequately controlled with endoscopic therapy. While higher doses (20 mg or 30 mg) have been studied, a lower dosage appears to provide sufficient effect. 

†Indicates off-label use

Hepatic Impairment

Oral delayed-release capsules
Adult patients with liver cirrhosis and patients with fatty liver disease showed prolonged elimination of octreotide injection in studies. Titrate the adult maintenance dosage according to IGF-1 levels and clinical symptoms.
 
IV, IM, or subcutaneous formations
Patients with cirrhosis and fatty liver disease have prolonged elimination of octreotide. Specific guidelines for dosage adjustments in hepatic impairment are not available for the immediate-release injection solution. The initial dose of the depot IM suspension should be decreased by 50% in adult patients (e.g., 10 mg IM) with cirrhosis; titrate dose based on clinical response. Once at a higher dose, the patient should be maintained or dose-adjusted as for any noncirrhotic patient. Pediatric data are not available.

Renal Impairment

Oral delayed-release capsules
Adult patients with end-stage renal disease (ESRD): Initiate at a dosage of 20 mg PO once daily. Titrate the maintenance dosage according to IGF-1 levels and clinical symptoms.
 
IV, IM, or subcutaneous formations
In adult patients with mild, moderate, or severe renal impairment (non-dialysis patients) there is no need to adjust the initial dose of octreotide; the maintenance dose should be adjusted based on clinical response and tolerability as in nonrenal patients. Data for pediatric patients with renal impairment are not specifically available.
 
Intermittent hemodialysis
See oral dosage adjustment in renal impairment for ESRD. Specific guidelines for dosage adjustments in severe renal impairment or dialysis are not available for the immediate-release injection solution. The initial dose of the depot IM injection suspension should be decreased by 50% in adult patients (e.g., 10 mg IM); titrate and dose-adjust based on clinical response and tolerability as in nonrenal patients. Pediatric data are not available.

Acarbose: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Acebutolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Alogliptin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Alogliptin; Metformin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Alogliptin; Pioglitazone: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Aluminum Hydroxide: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Aluminum Hydroxide; Magnesium Carbonate: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Aluminum Hydroxide; Magnesium Hydroxide: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Aluminum Hydroxide; Magnesium Trisilicate: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Amoxicillin; Clarithromycin; Omeprazole: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Antacids: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Antidiabetic Agents: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Aspirin, ASA; Omeprazole: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Atenolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Atenolol; Chlorthalidone: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Beta-adrenergic blockers: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Betaxolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Bisoprolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Brimonidine; Timolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Bromocriptine: (Major) When bromocriptine is used for diabetes, do not exceed a dose of 1.6 mg once daily during concomitant use of octreotide. Use this combination with caution in patients receiving bromocriptine for other indications. Concurrent use may increase bromocriptine concentrations. Bromocriptine is extensively metabolized in the liver via CYP3A4; octreotide is a moderate inhibitor of CYP3A4. The concomitant treatment of acromegalic patients with bromocriptine and octreotide increased the bromocriptine AUC by 38%.
Calcium Carbonate: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Calcium Carbonate; Famotidine; Magnesium Hydroxide: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability. (Moderate) Coadministration of oral octreotide with H2-blockers may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including H2-blockers, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Calcium Carbonate; Magnesium Hydroxide: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Calcium Carbonate; Magnesium Hydroxide; Simethicone: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Calcium Carbonate; Simethicone: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Calcium; Vitamin D: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Canagliflozin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Canagliflozin; Metformin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Carbonic anhydrase inhibitors: (Moderate) Patients receiving diuretics or other agents to control fluid and electrolyte balance may require dosage adjustments while receiving octreotide due to additive effects.
Carteolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Carvedilol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Chlorpropamide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Cimetidine: (Moderate) Coadministration of oral octreotide with H2-blockers may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including H2-blockers, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Cyanocobalamin, Vitamin B12: (Minor) Depressed levels of cyanocobalamin, vitamin B12, and abnormal Schilling's test have been reported in patients receiving octreotide.
Cyclobenzaprine: (Moderate) Octreotide decreases GI motility. Agents that inhibit intestinal motility or prolong intestinal transit time have been reported to induce toxic megacolon. Other drugs that also decrease GI motility, such as cyclobenzaprine, may produce additive effects with antidiarrheals if used concomitantly.
Cyclosporine: (Major) Octreotide may induce cyclosporine metabolism, thereby increasing the clearance of cyclosprone. In addition, administration of octreotide to patients receiving oral cyclosporine has been shown to decrease the oral bioavailability of cyclosporine. Since oral cyclosporine is administered in an olive oil vehicle, the mechanism of this interaction is thought to be due to the decreased absorption of fat by octreotide. If octreotide is added to an existing cyclosporine regimen, monitor cyclosporine concentrations closely to avoid loss of clinical efficacy until a new steady-state concentration is achieved. Conversely, if octreotide is discontinued, cyclosporine concentrations could increase.
Dapagliflozin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Dapagliflozin; Metformin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Dapagliflozin; Saxagliptin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Dexlansoprazole: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Dextromethorphan; Quinidine: (Moderate) Monitor ECG and for quinidine-related adverse reactions if coadministration with octreotide is necessary; monitor quinidine concentrations as clinically indicated. Concomitant use may result in increased plasma concentrations of quinidine.
Diltiazem: (Moderate) Monitor for bradycardia during concomitant use of diltiazem and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Dorzolamide; Timolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Dulaglutide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Empagliflozin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Empagliflozin; Linagliptin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Empagliflozin; Linagliptin; Metformin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Empagliflozin; Metformin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Ertugliflozin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Ertugliflozin; Metformin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Ertugliflozin; Sitagliptin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Esmolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Esomeprazole: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Everolimus: (Minor) Consider additional monitoring for everolimus-related adverse effects in patients receiving long-acting depot octreotide. Concomitant use of depot octreotide has been observed to increase everolimus trough concentrations by approximately 50%.
Exenatide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Famotidine: (Moderate) Coadministration of oral octreotide with H2-blockers may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including H2-blockers, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Gallium Ga 68 Dotatate: (Moderate) Image patients with gallium Ga 68 dotatate just prior to dosing with non-radioactive, long-acting somatostatin analogs. Short-acting analogs of somatostatin can be used up to 24 hours before imaging with gallium Ga 68 dotatate. These drugs may competitively bind to the same somatostatin receptors.
Glimepiride: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Glipizide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Glipizide; Metformin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Glyburide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Glyburide; Metformin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
H2-blockers: (Moderate) Coadministration of oral octreotide with H2-blockers may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including H2-blockers, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Ibuprofen; Famotidine: (Moderate) Coadministration of oral octreotide with H2-blockers may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including H2-blockers, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Insulin Aspart: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Insulin Aspart; Insulin Aspart Protamine: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Insulin Degludec; Liraglutide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Insulin Detemir: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Insulin Glargine: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Insulin Glargine; Lixisenatide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Insulin Glulisine: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Insulin Lispro: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Insulin Lispro; Insulin Lispro Protamine: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Insulin, Inhaled: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Isophane Insulin (NPH): (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Labetalol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Lansoprazole: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Lansoprazole; Amoxicillin; Clarithromycin: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Levobunolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Linagliptin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Linagliptin; Metformin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Liraglutide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Lixisenatide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Loop diuretics: (Moderate) Patients receiving diuretics or other agents to control fluid and electrolyte balance may require dosage adjustments while receiving octreotide due to additive effects.
Lutetium Lu 177 dotatate: (Major) Discontinue long-acting octreotide at least 4 weeks prior to beginning treatment with lutetium Lu 177 dotatate. Short-acting octreotide may be administered as-needed; discontinue at least 24 hours prior to each lutetium Lu 177 dotatate dose. Somatostatin and its analogs, such as octreotide, competitively bind to somatostatin receptors and may interfere with the efficacy of lutetium Lu 177 dotatate.
Magnesium Hydroxide: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Mannitol: (Moderate) Patients receiving diuretics or other agents to control fluid and electrolyte balance may require dosage adjustments while receiving octreotide due to additive effects.
Mecasermin, Recombinant, rh-IGF-1: (Moderate) Octreotide has been shown to lower endogenous plasma IGF-1 concentrations. Combination therapy may lessen the effectiveness of mecasermin, recombinant, rh-IGF-1 by decreasing the amount of available IGF-1.
Metformin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Metformin; Repaglinide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Metformin; Rosiglitazone: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Metformin; Saxagliptin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Metformin; Sitagliptin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Metoprolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Metoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Miglitol: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Nadolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Naproxen; Esomeprazole: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs t

hat alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Nateglinide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Nebivolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Nebivolol; Valsartan: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Nizatidine: (Moderate) Coadministration of oral octreotide with H2-blockers may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including H2-blockers, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Omeprazole: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Omeprazole; Amoxicillin; Rifabutin: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Omeprazole; Sodium Bicarbonate: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability. (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Pantoprazole: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Pindolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Pioglitazone: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Pioglitazone; Glimepiride: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Pioglitazone; Metformin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Potassium-sparing diuretics: (Moderate) Patients receiving diuretics or other agents to control fluid and electrolyte balance may require dosage adjustments while receiving octreotide due to additive effects.
Pramlintide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Propranolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Propranolol; Hydrochlorothiazide, HCTZ: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Proton pump inhibitors: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Quinidine: (Moderate) Monitor ECG and for quinidine-related adverse reactions if coadministration with octreotide is necessary; monitor quinidine concentrations as clinically indicated. Concomitant use may result in increased plasma concentrations of quinidine.
Rabeprazole: (Moderate) Coadministration of oral octreotide with proton pump inhibitors (PPIs) may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including PPIs, may alter the absorption of octreotide and lead to a reduction in bioavailability. This interaction has been documented with esomeprazole and can occur with the other PPIs.
Ranitidine: (Moderate) Coadministration of oral octreotide with H2-blockers may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including H2-blockers, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Regular Insulin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Regular Insulin; Isophane Insulin (NPH): (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Repaglinide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Rosiglitazone: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Saxagliptin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Semaglutide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Sincalide: (Moderate) Sincalide-induced gallbladder ejection fraction may be affected by concurrent octreotide. False study results are possible in patients with drug-induced hyper- or hypo-responsiveness; thorough patient history is important in the interpretation of procedure results.
Sitagliptin: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Sodium Bicarbonate: (Moderate) Coadministration of oral octreotide with antacids may require increased doses of octreotide. Coadministration of oral octreotide with drugs that alter the pH of the upper GI tract, including antacids, may alter the absorption of octreotide and lead to a reduction in bioavailability.
Sotalol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Telotristat Ethyl: (Moderate) Administer short-acting octreotide at least 30 minutes after the administration of telotristat ethyl if concomitant use is necessary. Telotristat ethyl is indicated for use in combination with somatostatin analogs, including octreotide, and patients in clinical trials received rescue treatment with short-acting octreotide and antidiarrheal medications (i.e., loperamide). However, systemic exposures of telotristat ethyl and its active metabolite were significantly decreased by short-acting octreotide in a pharmacokinetic study. When a single telotristat ethyl 500-mg PO dose (twice the recommended dose) was administered with a short-acting octreotide 200-mcg subcutaneous dose, the mean telotristat ethyl Cmax decreased by 86% and the mean telotristat ethyl AUC(0-last) decreased by 81% in healthy volunteers. Additionally, the mean Cmax and AUC(0-last) values for the active metabolite, telotristat, were decreased by 79%, and 68%, respectively.
Thiazide diuretics: (Moderate) Patients receiving diuretics or other agents to control fluid and electrolyte balance may require dosage adjustments while receiving octreotide due to additive effects.
Timolol: (Moderate) Monitor for bradycardia during concomitant use of beta-blockers and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Tolazamide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Tolbutamide: (Moderate) Monitor patients receiving octreotide concomitantly with insulin or other antidiabetic agents for changes in glycemic control and adjust doses of these medications accordingly. Octreotide alters the balance between the counter-regulatory hormones of insulin, glucagon, and growth hormone, which may result in hypoglycemia or hyperglycemia. The hypoglycemia or hyperglycemia which occurs during octreotide acetate therapy is usually mild but may result in overt diabetes mellitus or necessitate dose changes in insulin or other hypoglycemic agents. In patients with concomitant type1 diabetes mellitus, octreotide is likely to affect glucose regulation, and insulin requirements may be reduced. Symptomatic hypoglycemia, which may be severe, has been reported in type 1 diabetic patients. In Type 2 diabetes patients with partially intact insulin reserves, octreotide administration may result in decreases in plasma insulin levels and hyperglycemia.
Trandolapril; Verapamil: (Moderate) Monitor for bradycardia during concomitant use of verapamil and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Urea: (Moderate) Patients receiving diuretics or other agents to control fluid and electrolyte balance may require dosage adjustments while receiving octreotide due to additive effects.
Verapamil: (Moderate) Monitor for bradycardia during concomitant use of verapamil and octreotide and adjust drug dosage based on response as appropriate. Both medications may cause bradycardia and concomitant use may increase bradycardia risk.
Vonoprazan; Amoxicillin: (Moderate) Concomitant use of oral octreotide with vonoprazan may require increased doses of octreotide. Vonoprazan reduces intragastric acidity, which may decrease the absorption of oral octreotide reducing its efficacy.
Vonoprazan; Amoxicillin; Clarithromycin: (Moderate) Concomitant use of oral octreotide with vonoprazan may require increased doses of octreotide. Vonoprazan reduces intragastric acidity, which may decrease the absorption of oral octreotide reducing its efficacy.

Octreotide Oral Cap DR Pellets: 20mg
Octreotide/Octreotide Acetate/Sandostatin Intravenous Inj Sol: 1mL, 50mcg, 100mcg, 200mcg, 500mcg, 1000mcg
Octreotide/Octreotide Acetate/Sandostatin Subcutaneous Inj Sol: 1mL, 50mcg, 100mcg, 200mcg, 500mcg, 1000mcg
Sandostatin LAR Intramuscular Inj Pwd F/Susp: 10mg, 20mg, 30mg

Adults

80 mg/day PO for acromegaly. Injectable doses are dependent on indication for therapy, route of administration, and patient response.

Geriatric

80 mg/day PO for acromegaly. Injectable doses are dependent on indication for therapy, route of administration, and patient response.

Adolescents

Dependent on indication for therapy, route of administration, and patient response. For hypothalamic obesity, 15 mcg/kg/day subcutaneously.

Children

Dependent on indication for therapy, route of administration, and patient response. For chylothorax, 10 mcg/kg/hour IV continuous infusion is the maximum recommended rate; for congenital hyperinsulinemia, 40 mcg/kg/day subcutaneously or IV; for hypothalamic obesity, 15 mcg/kg/day subcutaneously.

Infants

Dependent on indication for therapy, route of administration, and patient response. For chylothorax, 10 mcg/kg/hour IV continuous infusion is the maximum recommended rate; for congenital hyperinsulinemia, 40 mcg/kg/day subcutaneously or IV.

Neonates

Dependent on indication for therapy, route of administration, and patient response. For chylothorax, 10 mcg/kg/hour IV continuous infusion is the maximum recommended rate; for congenital hyperinsulinemia, 40 mcg/kg/day subcutaneously or IV.

The pharmacologic effects of octreotide are similar to those of somatostatin, a hypothalamic peptide. Although the exact mechanism of action is not known, octreotide is believed to act at somatostatin receptors. Octreotide inhibits the secretion of both pituitary and gastrointestinal hormones including serotonin, gastrin, vasoactive intestinal peptide (VIP), insulin, glucagon, secretin, motilin, pancreatic polypeptide, growth hormone, and thyrotropin. Due to the number of hormones affected by octreotide, the actions of octreotide are diverse. Inhibiting the secretion of serotonin and other gastroenteropancreatic peptides results in increased intestinal absorption of water and electrolytes, decreased pancreatic and gastric acid secretions, and increased intestinal transit time. In contrast, cisapride, a serotonin receptor agonist, stimulates peristalsis. Thus, with regard to serotonin, octreotide and cisapride exert opposite actions in the GI tract.
 
Octreotide can inhibit the secretion of hormones involved in vasodilation. This property makes octreotide useful in treating variceal bleeding and orthostatic hypotension. Octreotide increases splanchnic arteriolar resistance and decreases gastrointestinal blood flow, hepatic-vein wedge pressure, hepatic blood flow, portal vein pressure, and variceal pressure. Decreased blood flow to the portal vein reduces portal venous pressure in patients with cirrhosis or portal hypertension. A majority of patients with portal hypertension have a reduction in variceal bleeding when given octreotide. In patients with orthostatic or postprandial hypotension due to autonomic neuropathy, it is believed that their condition occurs as a result of inadequate sympathetic reflexes in conjunction with splanchnic vasodilation and VIP secretion. Administration of octreotide results in increases in both semirecumbent and standing blood pressures. Octreotide's effects were seen in patients with progressive autonomic failure, multiple-organ-system atrophy, and diabetic autonomic neuropathy but not in patients with sympathotonic orthostatic hypotension.
 
Because octreotide affects many GI hormones, octreotide is useful in controlling many types of secretory diarrhea including patients with VIPomas and AIDS-associated diarrhea. In patients with VIPomas, octreotide reduces serum levels of VIP. As a result, stool volume decreases and hypokalemia and achlorhydria improve. Tachyphylaxis to octreotide, however, has been observed in treating this condition. In patients with AIDS, diarrhea is caused by an infectious agent such as Cryptosporidium or is secondary to HIV infection. Human immunodeficiency virus contains an amino acid sequence similar to VIP which is believed to cause manifestations similar to VIP. Because of its inhibitory effects on VIP, octreotide is effective in patients with diarrhea due to HIV.
 
In patients with carcinoid syndrome, octreotide's ability to inhibit serotonin secretion results in decreased flushing, diarrhea, and wheezing, as well as reduced urinary excretion of 5-hydroxyindoleacetic acid (5-HIAA), the primary metabolite of serotonin. Improvements in the musculoskeletal symptoms of carcinoid have been reported with octreotide. In combination with other therapies, octreotide has also been effective in improving symptoms and decreasing tumor size in patients with metastatic carcinoid tumors.
 
Studies supporting the role of octreotide in the treatment of other gastroenteropancreatic tumors (i.e., gastrinomas, glucagonomas, insulinomas) are limited. In the treatment of gastrinomas (e.g., Zollinger-Ellison syndrome), octreotide may be more costly and no more effective than conventional therapies (H2-antagonists, proton-pump inhibitors or PPIs), however, a benefit may be derived from combination therapy because octreotide inhibits gastrin release whereas H2-antagonists and PPIs cause significant increases in gastrin serum concentrations. Octreotide may provide benefits in patients with unresectable insulinomas by decreasing insulin secretion and improving hypoglycemia in patients unresponsive to other therapies. In the treatment of the very rare glucagonomas, octreotide has only demonstrated improvement in the dermatosis (necrolytic migratory dermatitis) associated with this condition and has minimal effects on serum glucagon levels.
 
Octreotide also inhibits the secretion of some anterior pituitary hormones. Octreotide has been studied in the treatment of acromegaly and thyrotropinomas. Octreotide's effects in treating acromegaly results from its inhibition of growth hormone (GH). In acromegalic patients, octreotide reduces serum levels of GH resulting in a decrease in associated symptoms such as headache, hyperhidrosis, arthralgia, and finger circumference. In the treatment of thyrotropinomas, Chanson et al reported that thyroid-stimulating hormone (TSH) levels were decreased in the majority of patients treated with octreotide. Because these tumors are rare, data on the use of octreotide in this condition are limited to case reports. Further investigation is needed to determine octreotide's role as an alternative for patients with thyrotropinomas that are refractory to surgery and radiation.

Octreotide acetate is administered orally and parenterally; the immediate-release injection solution should be given intravenously or subcutaneously, while the depot injection suspension formulation should only be given intramuscularly. Approximately 65% of a parenteral dose is bound to lipoprotein and albumin in a concentration-dependent manner. The volume of distribution is estimated to be 13.6 L in adult patients. Octreotide undergoes extensive hepatic metabolism. Total body clearance ranges from 7 to 10 L/hour in adult patients. The apparent elimination half-life of immediate-release octreotide injection is 1.7 to 1.9 hours, which is significantly greater than somatostatin's half-life of 1 to 3 minutes. In patients with acromegaly, the half-life is 3.2 to 4.5 hours for all oral doses (20 to 80 mg per day) and elimination is complete approximately 48 hours after the last dose in patients who have achieved steady-state plasma levels. Minimal accumulation (approximately 10%) was observed in patients after repeat oral octreotide administration. Approximately 32% of a dose is excreted in the urine as unchanged drug.
 
Affected cytochrome P450 (CYP450) isoenzymes and drug transporters: CYP3A4
Octreotide suppresses growth hormone secretion, which may decrease the metabolic clearance of drugs metabolized by CYP3A4. A potential for drug-drug interactions exists with medications metabolized by CYP3A4 with a narrow therapeutic index.

Oral Route

The exposure of octreotide (AUC) is similar between a single oral dose of octreotide 20 mg and a single subcutaneous dose of octreotide 0.1 mg in healthy adult patients, however, the maximum concentration (Cmax) was 33% lower after oral administration compared to subcutaneous administration. Absorption time was longer after oral administration compared to subcutaneous administration; Cmax was reached at a median of 1.67 to 2.5 hours after 20 mg of oral octreotide compared to 0.5 hours for subcutaneous injection administration. In healthy adult patients, the Cmax and AUC of octreotide increased dose-proportionally at doses ranging from 3 to 40 mg. In adult patients with acromegaly, there was a dose-related increase in the mean Cmax after chronic oral administration of octreotide. The Cmax after chronic dosing was lower in patients with acromegaly compared to single-dose peak concentrations observed in healthy adult patients at the same dose. In healthy patients, the administration of an octreotide 20 mg capsule with food led to an approximate 90% decrease in the Cmax and AUC; thus, the delayed-release capsules should be administered on an empty stomach and not with food.

Intravenous Route

Intravenous and subcutaneous octreotide are bioequivalent; peak concentrations and AUC are dose-proportional.

Intramuscular Route

After intramuscular (IM) administration of the long-acting depot formulation, octreotide is slowly released as the glucose star polymer (D,L-lactic and glycolic acids copolymer) biodegrades in the muscle, primarily through hydrolysis. Once octreotide is released from the polymer, it has the same pharmacokinetic and mechanistic characteristics as the immediate-release dosage form. The relative bioavailability of the depot injection as compared to the immediate release injection given subcutaneously is 60% to 63%. After a single IM injection in healthy adult patients, peak serum concentrations reach a transient initial peak of 0.03 ng/mL/mg within 1 hour. Subsequently, concentrations decline over 3 to 5 days (nadir less than 0.01 ng/mL/mg) before increasing and reaching a plateau 2 to 3 weeks after injection. Plateau concentrations are maintained for 2 to 3 weeks, with dose-proportional peak concentrations of 0.07 ng/mL/mg. Octreotide concentrations start to decrease slowly 6 weeks after the IM injection. By week 12 to 13, serum concentrations are less than 0.01 ng/mL/mg. After multiple injections of the depot formulation given every 4 weeks, steady state serum concentrations are reached after the third dose. After administration of octreotide depot injection 20 mg and 30 mg every 4 weeks in adult patients, respective steady-state concentrations are 1.6 ng/mL and 2.6 ng/mL at peak and 1.2 ng/mL and 2.1 ng/mL at trough. The depot formulation has smaller peak-to-trough concentration variations than the 3 times daily subcutaneous injections (44% to 68% versus 163% to 209%, respectively).

Subcutaneous Route

Octreotide is absorbed rapidly and completely after subcutaneous injection. Distribution of octreotide from plasma occurs rapidly, with an apparent distribution half-life of 12 minutes. In adult patients, peak concentrations of 5.2 ng/mL occur within 25 minutes after a 100 mcg dose. The effects of subcutaneous octreotide are variable but can last for up to 12 hours, depending on the indication for use.

Pregnancy

Available data from case reports with octreotide acetate use in pregnant women are insufficient to identify a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Use octreotide during pregnancy only if clearly needed. A limited number of exposed pregnancies have been reported in women with acromegaly in postmarketing surveillance of octreotide at subcutaneous doses of 100 to 300 mcg/day or IM doses of 20 to 30 mg/month. Most exposures occurred during the first trimester; however, some women continued octreotide treatment throughout their pregnancy. No congenital malformations have been reported in cases with a known outcome. During animal studies, no adverse developmental effects were observed with intravenous administration of octreotide to pregnant rats and rabbits during organogenesis at doses 7 and 13 times, respectively, the clinical dose based on octreotide injection body surface area. Transient growth retardation, with no impact on postnatal development, was observed in rat offspring from a pre- and post-natal study of octreotide at intravenous doses below the clinical dose based on octreotide injection body surface area.

There is no adequate information available on the presence of octreotide in human milk, the effects of the drug on the breastfed infant, or the effects of the drug on milk production; use octreotide with caution in women who are breast-feeding. The developmental and health benefits of breast-feeding should be considered along with the mother's clinical need for octreotide. There is a published report of a woman receiving octreotide for acromegaly who breastfed an infant for 4 months with no adverse effects or problems with feeding in the infant.[29113] [47392] [51310]