WHAT IS THIS MEDICINE AND WHAT IS IT USED FOR?
Sandostatin LAR 20mg contains the same active ingredient and uses the
same long-acting microsphere release technology as the 30mg vial (entry 173).
The 20mg dose is typically the standard starting dose when transitioning from
short-acting octreotide to the monthly depot formulation, and is the most
commonly used maintenance dose for many patients with carcinoid syndrome, other
NETs, and acromegaly.
If 20mg every 4 weeks provides adequate symptom and hormone control,
treatment continues at this dose. If control is insufficient after 3 months,
the dose is increased to 30mg. If patients are well controlled and tolerability
is excellent, some may be reduced to 10mg.
3. HOW TO TAKE THIS MEDICINE
20mg given as a deep intramuscular gluteal injection every 4 weeks by a
healthcare professional. Do not self-administer. Allow to reach room
temperature (20–30 minutes) before preparation. Prepare gently (rotation, not
shaking) and administer immediately.
Alternate gluteal sides at each injection. Continue short-acting
octreotide ampoules for the first 2 weeks after the first LAR injection.
⚠ PATIENT TIP: If your dose has recently been
reduced from 30mg to 20mg, you may notice some increase in symptoms (flushing,
diarrhoea) in the first week of the new lower dose as octreotide levels adjust.
Contact your specialist team if symptom control deteriorates significantly.
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects |
|
Common |
Injection site
induration, gastrointestinal symptoms, hyperglycaemia, gallstones,
bradycardia, hypothyroidism with prolonged use. |
WHO SHOULD NOT TAKE THIS MEDICINE
Do not administer by subcutaneous or intravenous route — LAR is
exclusively deep intramuscular. Do not administer if the patient has not first
been assessed on short-acting octreotide to confirm tolerability and
effectiveness.
⚠ DEEP INTRAMUSCULAR ADMINISTRATION ONLY:
Sandostatin LAR must be injected deep into the gluteal (buttock) muscle.
Subcutaneous or intravenous injection of this formulation would be harmful and
ineffective. Administration must be by trained healthcare staff.
⚠ GALLSTONE MONITORING: As with short-acting
octreotide, long-term LAR use increases gallstone risk. Periodic abdominal
ultrasound monitoring is required.
⚠ BREAKTHROUGH COVERAGE: Some patients,
particularly when transitioning from short-acting to LAR or after dose changes,
may need short-acting octreotide ampoules for breakthrough symptoms. Ensure a
supply is available in the first weeks after any dose change.
6. MEDICINES THAT INTERACT WITH THIS TREATMENT
Cyclosporin levels reduced; blood glucose-lowering medicine adjustments
may be needed; QT monitoring with concurrent QT-prolonging drugs.
7. HOW TO STORE THIS MEDICINE
Store in a refrigerator at 2–8°C. Do not freeze. Protect from light.
Allow to reach room temperature before preparation (20–30 minutes). Once
prepared, use immediately — do not store the prepared suspension.
8. PRESCRIPTION REQUIREMENT
|
Field |
Details |
|
Status |
Prescription Only
Medicine (POM) — Specialist (endocrinology, oncology, gastroenterology)
prescription required; hospital or specialist clinic administration |
9. GUIDANCE FOR PATIENTS & CAREGIVERS
You will receive a deep injection into your buttock (gluteus) muscle from
a nurse or doctor in a clinic, every 4 weeks. A firm lump at the injection site
is normal and expected — it represents the depot microspheres slowly releasing
the medicine and will resolve over 4 weeks.
Alternate sides of the buttock with each injection. Report severe
flushing, diarrhoea, or tummy pain in the days following your injection. Attend
gallbladder ultrasound checks as recommended. If you have diabetics, continue
monitoring your blood sugar regularly.
10. PHARMACIST & PRESCRIBER NOTES
|
Field |
Details |
|
Clinical Dispensing
Notes |
Sandostatin LAR 30mg —
monthly depot IM injection of octreotide microspheres. Must be prepared and
administered by trained healthcare personnel using the supplied mixing
technique (gentle rotation, not vigorous shaking). Room temperature before
preparation (20–30 min). Administer immediately
after preparation. Deep IM gluteal injection only — never SC or IV. Alternate
gluteal sites. Transition from short-acting: maintain short-acting octreotide
for first 2 weeks after first LAR injection to prevent symptom breakthrough
as depot builds to therapeutic levels. Gallstone monitoring:
ultrasound before starting and at 6–12-month intervals. Blood glucose
monitoring — adjustments may be needed for diabetic patients. Cyclosporin
interaction: monitor levels. IGF-1 monitoring for acromegaly dose titration.
The 10mg and 20mg vials are managed identically — see entry 174 for 20mg. |
11. FREQUENTLY ASKED QUESTIONS
Q: Do I still need the short-acting injections?
When first switching from short-acting to LAR, short-acting octreotide
ampoules are usually continued for 2 weeks to prevent a gap in coverage as the
depot builds to therapeutic levels. Some patients also keep short-acting
ampoules for breakthrough symptoms. Your specialist will advise whether you
need them.
Q: Can I have my injection at home?
No — Sandostatin LAR requires a deep intramuscular injection into the
gluteal muscle, which needs to be performed by a trained healthcare
professional. It cannot be self-administered. Most patients receive their
monthly injection at a hospital outpatient clinic or specialist nurse
appointment.
Q: All other questions about octreotide?
Please see entry 172 (Sandostatin 100mcg ampoules) for full information
about how octreotide works, what conditions it treats, gallstone risk, blood
sugar effects, and general side effect guidance.
Q: Is one side of the buttock used every time?
No — alternate sides at each injection. If last month's injection was in
the left buttock, this month's should be in the right. This reduces cumulative
local tissue reactions and allows each site to fully recover between
injections.