Octreotide (Sandostatin®,Sandostatin LAR®)
Last Modified: January 14, 2012
Classification: Somatostatic Agent
Octreotide is a hormone that occurs naturally in the body. It is used to treat carcinoid syndrome, which is seen in patients with carcinoid or neuroendocrine tumors. These tumors cause the body to overproduce certain hormones, and these hormones in turn can lead to symptoms collectively known as "carcinoid syndrome". Common symptoms include: flushing (90% of patients), diarrhea (75%), abdominal cramping (51%), and abnormalities of the heart valves (53%) possibly leading to right heart failure. Octreotide works to reduce the production of these hormones and thereby decrease the symptoms.
How to Take Octreotide
The short acting form of octreotide is given as a subcutaneous injection (injection under the skin) or in an intravenous (IV) form. The dosage is dependent on how your body responds and is given in several times a day. For chronic treatment, patients typically receive the short acting form initially and if this results in a decrease in their symptoms, switch to the long-acting form for convenience.
The long-acting formulation, Sandostatin LAR, is octreotide contained in "microspheres", which allow the drug to be slowly released into the body over a 4-week period. This allows the patient to receive only one injection a month at their doctor's office. This injection is given into the muscle (intramuscularly or IM). You may receive the short-acting form for several weeks after starting the LAR form while the LAR reaches therapeutic levels. Some patients may still use the short-acting form to control "breakthrough symptoms" (symptoms that may occur occasionally while on the LAR form).
Possible Side Effects of Octreotide
There are a number of things you can do to manage the side effects of Octreotide. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
In studies, gallstones or bile duct abnormalities develop in more than half of patients after long- term usage, but in studies, only 1% of patients required surgery to correct them.
Pain at the Injection Site
Pain, redness or swelling may occur at the injection site. This typically lasts less than 10-15 minutes after the short-acting form and an hour with the LAR form. To reduce this side effect, take the medication out of the refrigerator ahead of time and allow it to reach room temperature. Do not heat it to warm it rapidly. Also, rotating the site of the injections is helpful.
Abdominal Side Effects
Side effects such as diarrhea, bloating, gas, and abdominal pain were reported in studies. It is difficult to tell if these are related to the medication or the disease, so discuss them with your doctor or nurse. These side effects may be decreased by giving the injections between meals or at bedtime. The LAR form is less likely to cause these side effects, which usually stop within 1-4 days of the injection and decrease with long term treatment.
Your doctor or nurse can recommend medication and other strategies to relive pain.
Nausea and/or Vomiting
Take anti-nausea medications as prescribed if needed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.
High Blood Sugar
Diabetics may find that their blood sugar levels are higher; patients who require insulin or hypoglycemic medications (glucagon) may now need higher doses to control their blood sugar. Patients without diabetes may develop high blood sugar levels. These high levels usually come and go and are mild. Diabetics in particular should monitor glucose levels closely when starting the drug or changing doses.