Acromegaly: Octreotide acetate injection is indicated to reduce blood levels of growth hormone and IGF-I (somatomedin C) in patients with acromegaly who are not adequately controlled by, or are not suitable for, surgery, pituitary irradiation, or maximally tolerated doses of bromocriptine mesylate. The goal is to normalize growth hormone and IGF-I levels.
It reduces growth hormone to normal levels in about 50% of patients and IGF-I levels in about 50%–60% of patients. As the full effect of pituitary irradiation may take years, it can be used as adjunct therapy in the meantime.
Clinical trials did not show clear effects on tumor size, growth rate, or symptom improvement, as they were not designed for these outcomes.

Carcinoid Tumors: Octreotide acetate injection is indicated for symptomatic treatment of metastatic carcinoid tumors, particularly for controlling severe diarrhea and flushing episodes.
These studies did not evaluate effects on tumor size, growth rate, or metastasis.

Vasoactive Intestinal Peptide Tumors (VIPomas): Octreotide acetate injection is indicated for the treatment of profuse watery diarrhea associated with VIP-secreting tumors.
These studies did not assess tumor size, growth rate, or metastasis.

Octreotide is a synthetic analogue of somatostatin that suppresses both basal and stimulated secretion of growth hormone (GH). It also inhibits the LH response to gonadotropin-releasing hormone and reduces secretion of several gastrointestinal and pancreatic hormones, including gastrin, vasoactive intestinal peptide (VIP), insulin, glucagon, secretin, motilin, and pancreatic polypeptide.

Intramuscular (IM)
Acromegaly:

• Adult: After initial control with SC therapy: As a depot preparation, initially 20 mg every 4 weeks. Adjust if required after 3 months to 10–30 mg every 4 weeks. Max: 40 mg every 4 weeks.

Intravenous (IV)
Variceal haemorrhage in patients with cirrhosis:

• Adult: As continuous IV infusion: 25 mcg/hour for 48 hours (up to 5 days in patients at high risk of re-bleeding).
• Child: ≥1 month: 1 mcg/kg/hour (up to 50 mcg/hour); given as continuous IV infusion. Higher doses may be needed initially, reduce dose gradually over 24 hours until bleeding has stopped.

Subcutaneous (SC)
Prophylaxis of complications following pancreatic surgery:

• Adult: 100 mcg three times daily (tid) of a rapid-acting preparation for 7 consecutive days, starting at least 1 hour before operation.

Subcutaneous

Acromegaly:

• Adult: Initially 50 mcg tid, increased as necessary to usual dose 100–200 mcg tid. Max: 500 mcg tid.

Subcutaneous

Secretory neoplasms:

• Adult: Initially 50 mcg 1–2 times daily, increased gradually to up to 600 mcg daily in 2–4 divided doses according to response. Continued treatment is not recommended if there is no benefit within 1 week of starting treatment for carcinoid tumour. Initial dose may be given via IV administration if a rapid response is required.

Subcutaneous

HIV-associated diarrhoea:

• Adult: Initial dose 100 mcg tid. If symptoms are not controlled after 1 week, increase dose to 250 mcg tid; if still not effective after 1 week, stop therapy.

Dosage adjustment of concurrent therapy may be required with calcium channel blockers, oral hypoglycaemic agents, β-blockers, and diuretics. Octreotide may increase the concentration of bromocriptine.

Hypersensitivity to the drug or any of its components.

Local pain, stinging, or tingling at the injection site; anorexia, nausea, vomiting, abdominal pain, bloating, flatulence, loose stools, steatorrhoea; biliary tract abnormalities. Hypoglycaemia or hyperglycaemia, hypothyroidism, cardiac conduction abnormalities, pancreatitis.

Category B: Animal studies have not shown fetal risk, but there are no adequate and well-controlled studies in pregnant women. Some animal studies have shown adverse effects that were not confirmed in human studies during the first trimester, and there is no evidence of risk in later trimesters.

Use with caution in renal disease, gallbladder disease risk, diabetes mellitus, hypothyroidism, pregnancy, lactation, children, and elderly patients. Vitamin B12 levels should be monitored during long-term therapy.

Renal Impairment: Dosage may need to be reduced in patients with severe renal impairment requiring dialysis.

Growth hormone antagonist

Store at 2–8°C. Stable at room temperature for up to 14 days.