Names and pronunciation
(ok-tree′oh-tide) SandoSTATIN, SandoSTATIN LAR Depot
Source page 970
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Individual generic drug information
Extracted information for octreotide only.
(ok-tree′oh-tide) SandoSTATIN, SandoSTATIN LAR Depot
Source page 970
Func. class.: Growth hormone, antidiarrheal
Source page 970
Chem. class.: Synthetic analog of somatostatin
Source page 970
Do not confuse: SandoSTATIN/SandIMMUNE
Source page 970
ACTION: A potent growth hormone similar to somatostatin
Source page 970
USES: SandoSTATIN: acromegaly, improves symptoms of carcinoid tumors, vasoactive intestinal peptide tumors (VIPomas); LAR Depot: long-term maintenance of acromegaly, carcinoid tumors, VIPomas
Source page 970
Unlabeled uses: GI fistula, variceal bleeding, diarrheal conditions, pancreatic fistula, irritable bowel syndrome, dump- ing syndrome, short bowel syndrome, insulinoma, hepatorenal syndrome
Source pages 970, 971
Extracted information for octreotide only.
CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, children, geriatric patients, diabetes mel- litus, hypothyroidism, renal disease
Source page 971
SIDE EFFECTS CNS: Headache, dizziness, fatigue, weakness, depression, anxiety, tremors, seizure, paranoia CV: Sinus bradycardia, conduction abnormalities, dysrhythmias, chest pain, SOB, thrombophlebitis, ischemia, HF, hypertension, palpitations, QT prolongation ENDO: Hypo/hyperglycemia, ketosis, hypothyroidism, galactorrhea, diabetes insipidus GI: Diarrhea, nausea, abdominal pain, vomiting, flatulence, distention, con- stipation, increased LFTs, cholelithiasis, ileus GU: UTI HEMA: Hematoma of inj site, bruise INTEG: Rash, urticaria, pain; inflamma- tion at inj site
Source page 972
INTERACTIONS Increase: QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pent- amidine; CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromy- cin, troleandomycin); arsenic trioxide; CYP3A4 substrates (methadone, pimo- zide, QUEtiapine, quiNIDine, risperiDONE, ziprasidone) Increase: effect of β-blockers, quiNIDine, rifAMPin, reduction of dose may be required Increase: hypoglycemia: MAOIs, salicylates, SSRIs, assess for hypoglycemia Decrease: effect of insulin, oral antidia- betics, monitor blood glucose Decrease: effect of—bromocriptine Decrease: effect of—cycloSPORINE, dose may need to be modified Drug/Food Decrease: absorption of dietary fat, vit B12 levels Drug/Lab Test Increase: glucose Decrease: T4, thyroid function tests, vit B12, glucose
Source page 972
Extracted information for octreotide only.
DOSAGE AND ROUTES Acromegaly • Adult: SUBCUT (SandoSTATIN) 50- 100 mcg bid-tid, adjust q2wk based on growth hormone levels or IM (Sando STATIN LAR) 20 mg q4wk × 3 mo, ad- just based on growth hormone levels; PO 20 mg bid VIPomas (watery diarrhea) • Adult: SUBCUT (SandoSTATIN) 200- 300 mcg/day in 2-4 doses for 2 wk, or IM(SandoSTATIN LAR) 20 mg q4wk × 2 mo, adjust dose Flushing/diarrhea in carcinoid tumors • Adult: SUBCUT (SandoSTATIN) 100- 600 mcg/day in 2-4 doses for 2 wk, ti- trated to patient response or IM (Sand- oSTATIN LAR) 20 mg q4wk × 2 mo, adjust dose GI fistula • Adult: SUBCUT (SandoSTATIN) 50- 200 mcg q8hr Antidiarrheal in AIDS patients (unlabeled) • Adult: SUBCUT (SandoSTATIN) 50 mcg q8hr prn, titrate up to 500 mcg q8hr Dumping syndrome (unlabeled) • Adult: SUBCUT (SandoSTATIN) 50- 150 mcg/day Variceal bleeding (unlabeled) • Adult: IV bolus 50 mcg; then 50 mcg/ hr continuous infusion Continuous IV infusion 50 mcg/hr for 2-5 days
Source page 971
Available forms: Inj (SandoSTATIN) 0.05, 0.1, 0.2, 0.5, 1 mg/mL; inj powder for susp (LAR depot) 10, 20, 30 mg/5 mL; delayed-release capsule 20 mg
Source page 971
Administer: • Store in refrigerator for unopened amps, vials or at room temperature for 2 wk; protect from light; do not use discol- ored or cloudy sol • Do not use if discolored or if particu- lates are present IM route • Reconstitute with diluent provided; give in gluteal region, immediately after re- constitution, rotate injection sites SUBCUT route • Rotate inj site; use hip, thigh, abdomen • Avoid using medication that is cold; allow to reach room temperature; do not use LAR depot, do not use if discolored or if particulates are present IV route • IV direct: give over 3 min; may give undiluted • Intermittent IV infusion: dilute in 50-200 mL D5W, 0.9% NaCl; give over 15-30 min • Solution is stable for 24 hr, protect from light Y-site compatibilities: Acyclovir, alfentanil, allopurinol, amifostine, amikacin, amino- O caproic acid, aminophylline, amiodarone, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidula- fungin, argatroban, arsenic trioxide, ateno- lol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, cal- cium chloride/gluconate, capreomycin, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefepime, cefotaxime, cefo- TEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chlorampheni- col, chlorproMAZINE, cimetidine, cipro- floxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPO- RINE, cytarabine, dacarbazine, DACTINo- mycin, DAPTOmycin, DAUNOrubicin, DAU- NOrubicin liposome, dexamethasone, digoxin, diltiaZEM, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enala- prilat, ePHEDrine, EPINEPHrine, epiRUBi- cin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldo- pam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furo- semide, gallium nitrate, ganciclovir, gati- floxacin, gemcitabine, gentamicin, glyco- pyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubi- cin, ifosfamide, imipenem-cilastatin, insulin (regular), irinotecan, isoproterenol, ketor- olac, labetalol, lansoprazole, leucovorin, levoFLOXacin, lidocaine, linezolid, LORaze- pam, magnesium sulfate, mannitol, mech- lorethamine, melphalan, meperidine, meropenem, mesna, methohexital, metho- trexate, methyldopate, methylPREDNISo- lone, metoclopramide, metoprolol, metro- NIDAZOLE, midazolam, milrinone, minocycline, mitoMYcin, mitoXANTRONE, mivacurium, morphine, moxifloxacin, mycophenolate, nafcillin, nalbuphine, nal- oxone, nesiritide, niCARdipine, nitroglyc- erin, nitroprusside, norepinephrine, ondansetron, oxaliplatin, PACLitaxel, palo- nosetron, pamidronate, pancuronium, PEMEtrexed, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenyleph- rine, piperacillin, piperacillin-tazobactam, polymyxin B, potassium acetate/chloride/ phosphates, procainamide, prochlorpera- zine, promethazine, propranolol, quiNI- Dine, quinupristin-dalfopristin, raNITIdine, remifentanil, rocuronium, sodium acetate/ bicarbonate/phosphates, streptozocin, suc- cinylcholine, SUFentanil, sulfamethoxazole- trimethoprim, tacrolimus, teniposide, thiopental, thiotepa, ticarcillin, ticarcillin- clavulanate, tigecycline, tirofiban, tobramy- cin, topotecan, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vin- CRIStine, vinorelbine, voriconazole, zidovu- dine, zoledronic acid
Source pages 971, 972
Extracted information for octreotide only.
Assess: • Growth hormone antibodies, IGF-1 at 1- to 4-hr intervals for 8-12 hr after dose (acromegaly); 5-HIAA, plasma serotonin; blood glucose, serotonin levels (carcinoid tumors), plasma substance P, plasma va- soactive intestinal peptide (VIP) (VIPoma) • Thyroid function tests: T3, T4, T7, TSH to identify hypothyroidism • Vital signs B/P, pulse, hydration status • Fecal fat, serum carotene, somatome- din-C q14days, glucose; plasma sero- tonin levels (carcinoid tumors); plasma vasoactive intestinal peptide levels (VI- Poma); serum growth hormone, serum IGF-1 baseline and periodically, diabetes to monitor blood glucose • Chronic therapy may cause B12 absorp- tion issues; monitor B12 and replace if necessary • Allergic reaction: rash, itching, fever, nausea, wheezing • Cardiac status: bradycardia, conduc- tion abnormalities, dysrhythmias; monitor ECG for QT prolongation, low voltage, axis shifts, early repolarization, R/S transition, early wave progression • Gallbladder disease, monitor for ab- dominal pain, ultrasound of gallbladder baseline, periodically • Ileus: assess character of stools, bowel sounds, baseline and throughout treatment • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; cautious use in breastfeeding, excreted in breast milk
Source pages 972, 973
Evaluate: • Therapeutic response: relief of diar- rhea in patients with AIDS; improved symptoms of carcinoid or VIP tumors; decreasing symptoms of acromegaly
Source page 973
CLINICAL CONSIDERATIONS
Source page 972
Patient and caregiver information: • That regular assessments are required; that diabetics need to monitor blood glucose • About SUBCUT inj if patient or other persons will be giving inj • That product may cause dizziness, drowsiness, weakness; to avoid hazard- ous activities if these occur; to report abdominal pain immediately • That pregnancy may occur in acro- megaly because fertility may be restored • That patients with diabetes need to monitor glucose regularly
Source page 973
Extracted information for octreotide only.
PHARMACOKINETICS Absorbed rapidly, completely; peak 1⁄2 hr (subcut/IV), 2-3 wk (IM); half-life 1.7 hr, duration 12 hr, excreted unchanged in urine 32%, protein binding 65%
Source page 972
Filter the extracted dose blocks for this individual drug.
Acromegaly
• Adult: SUBCUT (SandoSTATIN) 50- 100 mcg bid-tid, adjust q2wk based on growth hormone levels or IM (Sando STATIN LAR) 20 mg q4wk × 3 mo, ad- just based on growth hormone levels; PO 20 mg bid VIPomas (watery diarrhea)
Candidate age grouping · source page 971
Acromegaly
• Adult: SUBCUT (SandoSTATIN) 200- 300 mcg/day in 2-4 doses for 2 wk, or IM(SandoSTATIN LAR) 20 mg q4wk × 2 mo, adjust dose Flushing/diarrhea in carcinoid tumors
Candidate age grouping · source page 971
Acromegaly
• Adult: SUBCUT (SandoSTATIN) 100- 600 mcg/day in 2-4 doses for 2 wk, ti- trated to patient response or IM (Sand- oSTATIN LAR) 20 mg q4wk × 2 mo, adjust dose GI fistula
Candidate age grouping · source page 971
Acromegaly
• Adult: SUBCUT (SandoSTATIN) 50- 200 mcg q8hr Antidiarrheal in AIDS patients (unlabeled)
Candidate age grouping · source page 971
Acromegaly
• Adult: SUBCUT (SandoSTATIN) 50 mcg q8hr prn, titrate up to 500 mcg q8hr Dumping syndrome (unlabeled)
Candidate age grouping · source page 971
Acromegaly
• Adult: SUBCUT (SandoSTATIN) 50- 150 mcg/day Variceal bleeding (unlabeled)
Candidate age grouping · source page 971
Acromegaly
• Adult: IV bolus 50 mcg; then 50 mcg/ hr continuous infusion Continuous IV infusion 50 mcg/hr for 2-5 days
Candidate age grouping · source page 971