WHAT IS THIS MEDICINE AND WHAT IS IT USED FOR?
Sandostatin contains octreotide acetate, a synthetic analogue (artificial
copy) of the natural hormone somatostatin. Somatostatin is produced in the gut,
pancreas, and brain and acts as a powerful inhibitor of many hormone secretions
and processes. Octreotide mimics these effects but lasts much longer in the
body than natural somatostatin.
It is used for:
· Symptom control in neuroendocrine
tumours (NETs) — particularly carcinoid syndrome (causing severe flushing,
diarrhoea, and wheezing from serotonin and other hormones secreted by the
tumour)
· VIPomas (tumours secreting vasoactive
intestinal peptide, causing severe watery diarrhoea); Acromegaly — a condition
caused by a pituitary tumour secreting excess growth hormone, causing abnormal
growth of hands, feet, face, and internal organs;
· Management of acute bleeding from
oesophageal varices (enlarged, fragile veins in the gullet caused by liver
disease);
· Reduction of gastrointestinal and
pancreatic fistula output.
The short-acting ampoule form is used for immediate symptom control,
acute situations, and initial treatment before switching to longer-acting depot
formulations.
3. HOW TO TAKE THIS MEDICINE
Octreotide may be given subcutaneously (under the skin) or intravenously
depending on the indication.
· For subcutaneous use in
carcinoid/NETs: 50 to 200 mcg three times daily, adjusted by response.
· For acromegaly: 100 to 200 mcg three
times daily.
· For acute variceal bleeding: IV
infusion of 25 to 50 mcg/hour (diluted in saline).
Dose and route are determined by the treating specialist. Rotate
subcutaneous injection sites. Avoid injecting into the same site repeatedly.
For subcutaneous injection: allow the ampoule to reach room temperature
before injecting — cold injections are more painful. Rotate injection sites
between the upper arm, thigh, and abdomen. Press gently at the injection site
after withdrawing the needle. Do not rub the site. Injections should be given
at the same times each day.
⚠ PATIENT TIP: Octreotide injections can be
painful if given cold. Allow the ampoule to sit at room temperature for 20 to
30 minutes before injecting. Injecting at a consistent 45-degree angle into the
skin of the abdomen (well away from the navel) is comfortable for most patients
once the technique is practised.
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects |
|
Very Common |
Injection site
reactions (pain, redness, swelling), gastrointestinal symptoms (nausea,
diarrhoea, abdominal cramps, flatulence — most common in the first few weeks
and usually improves), reduced gallbladder emptying (leading to gallstones
with prolonged use) |
|
Common |
Raised blood sugar
(hyperglycaemia — monitor blood glucose in diabetic patients), hypothyroidism
with prolonged use, headache, dizziness, bradycardia (slow heart rate) |
|
Serious — Monitor /
Tell Doctor |
Gallstones: develop in
up to 30% of patients with long-term use — abdominal ultrasound is
recommended before starting and periodically during treatment. Acute
pancreatitis (rare). Significant blood sugar disturbances: both
hyperglycaemia and hypoglycaemia have been reported. Bradyarrhythmia: slow or
irregular heart rhythm — particularly relevant in patients with existing
cardiac conditions. |
5. WHO SHOULD NOT TAKE THIS MEDICINE
Octreotide is generally well tolerated. Caution is required in patients
with diabetes (blood sugar management becomes more complex), significant liver
disease (reduced clearance), and cardiac conduction disorders. Pregnancy and
breastfeeding: use only if clearly necessary — discuss with specialist.
⚠ GALLSTONES: Long-term octreotide use
significantly increases the risk of gallstone formation (up to 30% of
patients). A gallbladder ultrasound is recommended before starting and after 6
to 12 months. Report any upper right tummy pain, nausea, or jaundice — these
may indicate gallstones or cholecystitis.
⚠ BLOOD SUGAR MONITORING: Octreotide affects
both insulin and glucagon secretion. Blood sugar can rise (particularly in
patients not dependent on insulin) or fall (in insulin-dependent diabetics).
Blood glucose monitoring is important when starting or adjusting doses,
particularly in diabetic patients.
⚠ INJECTION SITE ROTATION: Injecting repeatedly
into the same site causes local discomfort and tissue damage. Rotate sites
systematically — keep a simple diagram or use a different site at each
injection.
6. MEDICINES THAT INTERACT WITH THIS TREATMENT
Cyclosporin: octreotide reduces cyclosporin absorption — monitor levels
and adjust dose. Bromocriptine: octreotide may increase bioavailability of
bromocriptine. QT-prolonging medicines: octreotide can cause bradycardia and QT
effects — use caution with concurrent QT-prolonging drugs.
Blood glucose-lowering medicines (insulin, metformin, sulfonylureas):
dose adjustments may be needed as blood sugar control changes with octreotide.
7. HOW TO STORE THIS MEDICINE
Store in a refrigerator at 2–8°C. Do not freeze. Protect from light. Once
removed from the fridge, ampoules can be kept at room temperature (below 25°C)
for up to 2 weeks. Single-use ampoules.
8. PRESCRIPTION REQUIREMENT
|
Field |
Details |
|
Status |
Prescription Only
Medicine (POM) — Specialist (endocrinology, gastroenterology, oncology)
prescription required |
9. GUIDANCE FOR PATIENTS & CAREGIVERS
If self-injecting: take the ampoule out of the fridge 20 to 30 minutes
before injecting to let it warm to room temperature. Rotate injection sites
every time — keeping a simple record helps. Inject into the abdomen (avoiding
the area around the navel), thigh, or upper arm. Apply gentle pressure after
withdrawal — do not rub.
Attend gallbladder ultrasound checks as recommended. If you are diabetic,
monitor your blood sugar more carefully when starting octreotide or changing
doses. Report any upper right tummy pain, yellowing of the skin, or severe
nausea to your specialist.
10. PHARMACIST & PRESCRIBER NOTES
|
Field |
Details |
|
Clinical Dispensing
Notes |
Short-acting
subcutaneous octreotide — typically three times daily dosing or IV infusion
for acute indications. Cold chain: 2–8°C; stable at room temperature below
25°C for up to 2 weeks (for patient convenience). Allow to reach room
temperature before SC injection. Gallstone monitoring: baseline abdominal
ultrasound recommended; repeat at 6–12 months; ongoing as per specialist
protocol. Blood glucose monitoring: both hypo- and hyperglycaemia occur;
insulin-dependent diabetics may need dose adjustment. Cyclosporin
interaction: reduced absorption — check levels. QT considerations with
concurrent QT-prolonging medicines. Injection site rotation counselling. When
stable on short-acting formulation, most patients transition to long-acting
depot (LAR 10/20/30mg) — dispensed separately. |
11. FREQUENTLY ASKED QUESTIONS
Q: Can I inject this myself at home?
Yes — subcutaneous octreotide is frequently self-injected at home by
patients. Your specialist nurse will teach you the injection technique, site
rotation, and safe disposal of used needles. A sharps disposal bin will be
provided. Most patients quickly become confident with home injection.
Q: Why do I need gallbladder scans?
Octreotide reduces the gallbladder's ability to contract and empty
normally. Bile accumulates and can form gallstones (cholelithiasis), which
develop in up to 30% of patients with long-term use. Most are asymptomatic, but
some cause upper right tummy pain, nausea, or jaundice (cholecystitis or
biliary colic). Regular ultrasounds catch problems early.
Q: Will it affect my blood sugar?
Octreotide affects both insulin and glucagon secretion. In non-diabetic
patients, blood sugar may rise slightly. In insulin-dependent diabetics, the
effect is more complex and can cause either high or low blood sugar. Monitor
blood glucose carefully when starting and after any dose change.
Q: Why is the injection less painful at room temperature?
Cold injections cause more local tissue discomfort and can produce a
stinging sensation. Allowing the ampoule to warm to room temperature for 20 to
30 minutes before injecting makes the injection significantly more comfortable.