octreotide

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

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