WHAT IS THIS MEDICINE AND WHAT IS IT USED FOR?
Sandostatin LAR contains octreotide acetate in a long-acting release
(LAR) microsphere depot formulation. The same active ingredient as Sandostatin
short-acting ampoules (entry 172) is incorporated into biodegradable
microspheres that release octreotide slowly over 4 weeks after a single
intramuscular injection.
This allows once-monthly dosing instead of three-times-daily injections.
It is used for long-term management of:
· Carcinoid syndrome and other
neuroendocrine tumours (NETs) once symptoms are controlled on short-acting
octreotide;
· Acromegaly when short-acting
octreotide has confirmed effectiveness;
· As an antiproliferative treatment to
slow the growth of advanced midgut neuroendocrine tumours.
The 30mg vial is the highest standard maintenance dose — used in patients
who need maximum symptom and/or tumour growth control.
3. HOW TO TAKE THIS MEDICINE
The standard dose is 10mg, 20mg, or 30mg given as a deep intramuscular
injection into the gluteal muscle (buttock) every 4 weeks. The dose is
individualised — typically starting at 20mg every 4 weeks after adequate
short-acting octreotide control has been established, then adjusted to 10mg or
30mg based on symptom control and IGF-1 levels (for acromegaly).
The depot injection must be given by a healthcare professional — it
requires careful preparation and deep intramuscular technique. Do not
administer subcutaneously or intravenously.
The Sandostatin LAR suspension must be prepared carefully: the
microsphere powder and solvent must be mixed gently (not vigorously shaken) and
injected immediately after preparation. The vial should be used at room
temperature — allow to warm for 20 to 30 minutes before preparation. Always
alternate between the two gluteal muscles for alternate injections. During the
first 2 weeks after switching from short-acting octreotide to LAR, short-acting
octreotide ampoules may still be needed for breakthrough symptom control.
⚠ PATIENT TIP: The monthly injection takes a day
or two to start working as the microspheres begin releasing the medicine. If
you have breakthrough symptoms in the first few days after your injection,
short-acting octreotide ampoules may be prescribed for immediate relief. Report
any severe flushing, diarrhoea, or carcinoid crisis symptoms to your specialist
team promptly.
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects |
|
Common |
Injection site
reactions (pain, induration — firmness — at the gluteal injection site),
gastrointestinal symptoms (nausea, diarrhoea, abdominal discomfort),
hyperglycaemia, gallstones (with long-term use), bradycardia, hypothyroidism
with prolonged use |
|
Specific to Depot
Formulation |
Injection site
induration and pain — the gluteal injection site may be firm and tender for
several days after the injection. A firm lump at the injection site is normal
and expected — it represents the depot microspheres and resolves over 4
weeks. |
|
Serious |
Gallstones, blood
sugar disturbances, bradyarrhythmia, pancreatitis (rare) |
5. 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.