octreotide

octreotide

Indication

• Refractory hyperinsulinemic hypoglycemia
• Adjunctive treatment of congenital and post-operative chylothorax

Dosage Guidelines

Chylothorax

Continuous infusion: Start at 1 microgram/kg/hr, then titrate by 1 microgram/kg/hr q24 hours until response. Maximum dose 10 microgram/kg/hr  

Usual duration of therapy: 7-10 days after a response is achieved, and then tapered off over additional 7 days

Intermittent dosing:

5 mcg/kg/dose IV/SC q8h x 3 doses, then

10 mcg/kg/dose IV/SC q8h x 3 doses, then

13.3 mcg/kg/dose IV/SC q8h x 5 days

Wean by 25% q24h as follows:

10 mcg/kg/dose IV/SC q8h x 3 doses, then

6.7 mcg/kg/dose IV/SC q8h x 3 doses, then

3.3 mcg/kg/dose IV/SC q8h x 3 doses, then stop

Hyperinsulinemic hypoglycemia

• Intermittent: Start at 1 microgram/kg/dose IV/SUBCUT q6 hours (Maximum dose: 40 microgram/kg/day)
• Continuous infusion: 0.08-0.4 microgram/kg/hr (Maximum 1.7 microgram/kg/hr)
• Titrate dose to effect.  Sudden tolerance may develop within several days

Administration

• SUBCUT or IV may be given undiluted for intermittent doses.  May dilute to 10 microgram/mL to allow for accurate dose measurement
• IV continuous infusion

To make 10 mL of a 10 microgram/mL solution:

1. Draw up 1 mL of the 100 microgram/mL injection
2. Add 9 mL of D5W or NS (Final concentration = 10 microgram/mL)

• Use a 20 microgram/mL concentration in fluid restricted cases

Adverse Effects

• Vomiting, diarrhea, abdominal distention, steatorrhea, biliary duct dilatation
• Hyperglycemia may occur in patients treated for chylothorax
• Edema, hypertension
• Hypothyroidism

Comments

• Initial response in hypoglycemia should be seen within 8 hours
• Chyle production should significantly decrease within 24 hours
• Monitor blood glucose and liver enzymes.  Bilirubin and thyroid levels should be monitored with long-term use.

Supplied As

• 100 microgram/mL 1 mL ampoule
• 10 microgram/mL syringes prepared by Pharmacy

References

LexiComp Sick Kids, Neofax