Canadian antidote guide

Octreotide

• Octreotide acetate
• Sandostatin^®
• WARNING: Not to be confused with the long-acting formulation Sandostatin LAR!

• Recurrent hypoglycemia induced by sulfonylureas, meglitinides or quinine.

• Nausea
• Burning sensation at SC injection site (short-term)
• Cardiovascular effects: 
  • Bradycardia, conduction abnormalities (AV block) 
  • Cardiovascular effects are rare and seems to be dose and route related. Intravenous route being associated with a higher incidence.

• Capillary blood glucose hours during antidote treatment and for 16-24 hrs after discontinuation of treatment
• Serum potassium

• Symptomatic patients should be observed and blood glucose monitored for 24 hours after ingestion, or at least 8 hours after discontinuation of IV dextrose, or 24 hours after last octreotide dose, whichever is longer.

Subcutaneous Route (SC)

• Preferred administration route.
• To reduce local discomfort, use the solution at room temperature (warm up the bottle by holding it in the hand), and then slowly inject the solution.

Intravenous Route (IV)

• Possible alternative to SC route.
• Dilute dose in 50 or 100 mL of NS or D5W and infuse over 15 – 30 minutes.
• Administration of the undiluted solution by direct IV push over 3 minutes can also be considered, however cardiovascular side effects may be more pronounced after bolus administration. 

Intramuscular Route (IM)

• No data available

Intraosseous Route (IO)

• No data available

Compatibility

Partial list only. Consult the pharmacist on duty at your health care facility.

• Compatible solutions: D5W, NS.
• Y-site compatibility: amiodarone, calcium (chloride and gluconate), digoxin, diltiazem, diphenhydramine, dobutamine, dopamine, esmolol, famotidine, fentanyl, furosemide, haloperidol, heparin, hydromorphone, regular insulin, isoproterenol, labetalol, lorazepam, magnesium (sulfate), mannitol, meperidine , metoprolol, midazolam, milrinone, morphine, naloxone, nitroglycerin, sodium nitroprusside, norepinephrine, ondansetron, pancuronium, phenylephrine, potassium (acetate, chloride, phosphate), propranolol, ranitidine, rocuronium, sodium (bicarbonate, phosphate), vasopressin, verapamil .
• Y-site incompatibility: dantrolene, diazepam, pantoprazole (variable), phenytoin.

Stability

• Store unopened vials in refrigerator at temperatures between 2°C and 8°C, protected from light.
• Unopened vials are stable for up to two weeks when stored at room temperature and protected from light.

• Octreotide acetate, 50 mcg/ml (1 ml) Inj. Sol., Omega/ Hospira, DIN 02248639, 
• Octreotide acetate, 100 mcg/ml (1 ml) Inj. Sol., Omega/ Hospira, DIN 02248600, 
• Octreotide acetate, 200 mcg/ml (5 ml; multidose) Inj. Sol., Omega/ Hospira, DIN 02248642, 
• Octreotide acetate, 500 mcg/ml (1 ml) Inj. Sol., Omega/ Hospira, DIN 02248641, 
• Octreotide injection, 50 mcg/ml (1ml) Inj. Sol., Teva DIN02299429, 
• Octreotide injection, 100 mcg/ml (1 ml) Inj. Sol., Teva DIN 02299437, 
• Octreotide injection, 200 mcg/ml (5 ml; multidose) Inj. Sol.,Teva DIN 02299445, 
• Octreotide injection, 500 mcg/ml (1 ml) Inj. Sol., Teva DN 02299453, 
• Sandostatin, 50 mcg/ml (1 ml) Inj. Sol., Novartis DIN 00839191, 
• Sandostatin, 100 mcg/ml (1 ml) Inj. Sol., Novartis DIN 00839205, 
• Sandostatin, 200 mcg/ml (5 ml; multidose) Inj. Sol., Novartis DIN 02049392, 
• Sandostatin, 500 mcg/ml (1 ml) Inj. Sol., Novartis DIN 00839213, 

• At least 200 mcg.

Carr, Roxane, and Peter J. Zed. 2002. “Octreotide for Sulfonylurea-Induced Hypoglycemia Following Overdose.” The Annals of Pharmacotherapy 36 (11):1727–32.

Dougherty, Patrick P., and Wendy Klein-Schwartz. 2010. “Octreotide’s Role in the Management of Sulfonylurea-Induced Hypoglycemia.” Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology 6 (2):199–206.

Dougherty, Patrick P., Samantha C. Lee, Derrick Lung, and Wendy Klein-Schwartz. 2013. “Evaluation of the Use and Safety of Octreotide as Antidotal Therapy for Sulfonylurea Overdose in Children.” Pediatric Emergency Care 29 (3):292–95.

Francino, Marie-Catherine, Marie Bretaudeau Deguigne, Julie Badin, Alain Turcant, and Dominique Perrotin. 2012. “Hypoglycaemia: A Little Known Effect of Venlafaxine Overdose.” Clinical Toxicology 50 (3):215–17.

Glatstein, Miguel, Dennis Scolnik, and Yedidia Bentur. 2012a. “Octreotide for the Treatment of Sulfonylurea Poisoning.” Clinical Toxicology 50 (9):795–804.

Hayes, Bryan D. 2016. “Octreotide.” In Critical Care Toxicology, edited by Jeffrey Brent, Keith Burkhart, Paul Dargan, Benjamin Hatten, Bruno Megarbane, and Robert Palmer, 309:1–9. Cham: Springer International Publishing.

Klein-Schwartz, Wendy, Gina L. Stassinos, and Geoffrey K. Isbister. 2016. “Treatment of Sulfonylurea and Insulin Overdose.” British Journal of Clinical Pharmacology 81 (3):496–504.

Llamado, Rebecca, Angela Czaja, Nicholas Stence, and Jesse Davidson. 2013. “Continuous Octreotide Infusion for Sulfonylurea-Induced Hypoglycemia in a Toddler.” The Journal of Emergency Medicine 45 (6):e209–13.

Schier, J. G., O. N. Hirsch, and J. Chu. 2001. “Octreotide as Antidote for Sulfonylurea-Induced Hypoglycemia.” Annals of Emergency Medicine 37 (4):417–18.

Vallurupalli, Srikanth. 2010. “Safety of Subcutaneous Octreotide in Patients with Sulfonylurea-Induced Hypoglycemia and Congestive Heart Failure.” The Annals of Pharmacotherapy 44 (2):387–90.

Hasan Ali, A case of complete heart block induced by octreotide, Turk J Gastroenterol 2010;21:72-73

Luke Simon Olivera Yuhico, Octreotide-induced asystolic events in an intensive care unit patient with gastrointestinal bleeding, Heart and Lung, 2012; 41, E18-E20

Taketomo, Octreotide Acetata in Pediatric Dosage Handbook, 13ed, 1036-1038
 

Ottawa Parenteral Drug Therapy Manual 2021, Octreotide