Octreotide (Sandostatin®, Sandostatin LAR®)

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 make too much of certain hormones. These extra hormones can lead to symptoms known as "carcinoid syndrome.” Common symptoms are flushing (90% of patients), diarrhea (75%), abdominal (belly) cramping (51%), and changes to the heart valves (53%), possibly leading to right heart failure. Octreotide works to reduce the production of these hormones and decrease these symptoms.

How to Take Octreotide

The short-acting form of octreotide is given as a subcutaneous injection (SubQ, injection under the skin) or in an intravenous (IV, into a vein) form. Your dose depends on how your body responds and is given several times a day. For chronic (long-term) treatment, you will often receive the short-acting form at first, and if this leads to a decrease in symptoms, you may 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 your body over a 4-week period. This allows you to receive only one injection a month at your provider’s office. This injection is given into the muscle (intramuscular, 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 every so often while on the LAR form).

This medication can interact with other medications, including cyclosporine, insulin, oral diabetic medications, and many cardiac mediations. Be sure to tell your healthcare provider about all medications and supplements you take.

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:

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 after the LAR form. To reduce this side effect, the medication will be removed from the refrigerator ahead of time and allowed it to reach room temperature. Also, rotating the site of the injections is helpful.

Abdominal (Belly) Side Effects

Side effects such as diarrhea, bloating, gas, and abdominal pain were reported in studies. It is hard to tell if these are related to the medication or the disease, so talk about them with your care team. 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, and they often stop within 1-4 days of the injection and decrease with long-term treatment.

Nausea and/or Vomiting

Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. 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 saltines, or ginger ale to lessen symptoms.

Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Gallstones

This medication can affect your gall bladder and can cause gallstones or biliary changes (including jaundice) in patients who use it over a long period of time. Report any symptoms of sudden abdominal pain, fever, nausea/vomiting, tea-colored urine, light-colored stools, or yellowing of the eyes or skin to your health care provider.

Heart Problems

This medication may cause slow or abnormal heartbeats or sinus bradycardia. Notify your oncology care team right away if you feel abnormal heartbeats or if you feel dizzy or faint.

Blood Sugar Changes (Hypo/Hyperglycemia)

This medication can cause low or high blood sugar levels in patients with and without diabetes. Your healthcare team will monitor your blood sugar. If you develop shakiness, nervousness, anxiety, sweating, chills, clamminess, rapid/fast heartbeat, or headaches (symptoms of low blood sugar) or have increased thirst, urination or hunger, blurry vision, headaches, or your breath smells like fruit (symptoms of high blood sugar), tell your healthcare team. Diabetics should monitor their blood sugar closely and report elevations to the healthcare team.

Less common but important side effects can include:

• Thyroid Problems: This medication can cause hypothyroidism (underactive thyroid). Your healthcare provider will perform blood tests to check your thyroid and treat this side effect if it develops. Symptoms of thyroid problems can be: tiredness, feeling hot or cold, change in your voice, weight gain or loss, hair loss, and muscle cramps. Report any of these symptoms to your oncology care team.
• Nutrition Problems: This medication can change how your body absorbs fats from food. Your B12 levels (a vitamin in your blood) may be checked during treatment with octreotide.

Reproductive Concerns

Women who have not gone through menopause yet may have a higher chance of becoming pregnant while on this medication. Talk with your care team about safe contraceptive use and which method is best for you and your partner. Talk with your care team about any risks of breastfeeding while on this medication.