Sandostatin, Sandostatin LAR
Pharmacologic class: Somatostatin analog
Therapeutic class: Antidiarrheal
Pregnancy risk category B
Suppresses secretion of serotonin, serotonin metabolites, and gastrohepatic peptides, increasing fluid and electrolyte absorption from GI tract. Also suppresses growth hormone, insulin, and glucagon.
Depot injection: 10 mg, 20 mg, 30 mg
Injection: 0.05 mg/ml, 0.1 mg/ml, and 0.5 mg/ml in 1-ml ampules; 0.2 mg/ml and 1 mg/ml in 5-ml vials
⊘Indications and dosages
➣ Diarrhea and flushing associated with carcinoid tumors
Adults: 100 to 600 mcg (Sandostatin) subcutaneously or I.V. daily in two to four divided doses for 2 weeks. Then, depending on response, 20 mg (LAR Depot) I.M. q 4 weeks for 2 months.
➣ Diarrhea caused by vasoactive intestinal peptide tumors (VIPomas)
Adults: 200 to 300 mcg (Sandostatin) subcutaneously or I.V. daily in two to four divided doses for 2 weeks. Then, depending on response, 20 mg (LAR Depot) I.M. q 2 weeks for 2 months.
Adults: 50 to 100 mcg (Sandostatin) subcutaneously or I.V. two or three times daily. Then, depending on response, 20 mg (LAR Depot) I.M. q 4 weeks for 3 months. Then adjust based on growth hormone levels.
• Renal impairment
• Dumping syndrome (postprandial hypotension)
• GI and pancreatic fistulas
• Variceal bleeding
• Hypersensitivity to drug or its components
Use cautiously in:
• gallbladder disease, renal impairment, hyperglycemia or hypoglycemia, fat malabsorption
• pregnant or breastfeeding patients
• When giving subcutaneously, rotate administration site with each injection.
☞ Don't give LAR Depot I.V.
• Mix I.M. solution and inject deep into gluteal muscle over 3 minutes. Don't use deltoid.
• For I.V. administration, dilute in 50 to 200 ml of dextrose 5% in water or normal saline solution. Infuse over 15 to 30 minutes.
• Know that octreotide suppression test and octreotide scintigraphy may be done to determine if drug will aid carcinoid tumor treatment.
• Drug may be kept at room temperature for 2 weeks. Refrigerate ampules.
CNS: dizziness, drowsiness, fatigue, headache, weakness
CV: edema, bradycardia, conduction abnormalities, arrhythmias
EENT: vision disturbances
GI: nausea, vomiting, diarrhea, abdominal pain, cholelithiasis, fat malabsorption
Metabolic: hypothyroidism, hyperglycemia, hypoglycemia
Other: injection site pain
Drug-drug.Cyclosporine: reduced cyclosporine blood level
Insulin, oral hypoglycemics: altered requirements for these drugs
Orally administered drugs: altered absorption of these drugs
Drug-diagnostic tests.Glucose: increased or decreased level
Hepatic enzymes: slightly increased levels
Schilling's test: abnormal results
Thyroxine, vitamin B12: decreased levels
Drug-food.Fats: altered octreotide absorption
• Assess bowel sounds and stool frequency and consistency.
• Monitor vital signs and fluid intake and output. Stay alert for dehydration or edema.
• Evaluate diabetic patient for hypoglycemia or hyperglycemia.
• Know that in women with active acromegaly, normalization of growth hormone and insulin-like growth factor-1 may restore fertility.
• Tell patient being treated for carcinoid tumor to keep track of number of daily stools or flushing episodes.
• Instruct patient to weigh himself daily and report significant changes.
• Advise female with childbearing potential to use adequate contraception while taking drug.
• If patient will use drug at home, teach correct methods for injection, storage, and needle disposal.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.