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Intravenous Dilution Guidelines

Octreotide Acetate (Sandostatin ®)

The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

NS, D5W

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]

[0 to 200 mcg] [50 ml] [15-30 min]
[600 mcg] [250 ml] [25 mcg/hr]
[1250 mcg] [250 ml] [50 mcg/hr]

Stability / Miscellaneous

Synthetic octapeptide. Mimics the action of naturally occuring somatostatin and decreases the secretion of gastroenterohepatic peptides that may contribute to adverse symptoms in patients with metastatic tumors, VIPomas.

Octreotide-potent inhibitor of GH, insulin, and glucagon secretion. Also decreases splanchnic blood flow and inhibits release of serotonin, gastrin, vasoactive intestinal peptide.

Half-life= 1.5hr (30 times greater than natural somatostatin).

---Dosing--
Reduce output of GI fistulas: 50 to 200 mcg q8h
Variceal bleeding: 50 mcg bolus f/b 25 to 50 mcg/hr (up to 5 days).
Aids related diarrhea: (prolongs intestinal transit time): 100 to 500 mcg SC tid
Short bowel (ileostomy) syndrome: 25 mcg/hr infusion or 50 mcg SC bid.
Diarrhea due to chemotherapy: 50 to 100 mcg SC tid
Irritable bowel syndrome: 100 mcg qd to 125 mcg SC bid
Acromegaly: 50 to 100 mcg SC tid Carcinoid tumors:100-600 mcg in 2-4 divided doses.
VIPomas: 200-300 mcg/day in 2-4 divided doses.


DOSAGE AND ADMINISTRATION
Sandostatin® (octreotide acetate) may be administered subcutaneously or intravenously. Subcutaneous injection is the usual route of administration of Sandostatin for control of symptoms. Pain with subcutaneous administration may be reduced by using the smallest volume that will deliver the desired dose. Multiple subcutaneous injections at the same site within short periods of time should be avoided. Sites should be rotated in a systematic manner.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. Do not use if particulates and/or discoloration are observed. Proper sterile technique should be used in the preparation of parenteral admixtures to minimize the possibility of microbial contamination. Sandostatin is not compatible in Total Parenteral Nutrition (TPN) solutions because of the formation of a glycosyl octreotide conjugate which may decrease the efficacy of the product.

Sandostatin is stable in sterile isotonic saline solutions or sterile solutions of dextrose 5% in water for 24 hours. It may be diluted in volumes of 50 - 200 mL and infused intravenously over 15-30 minutes or administered by IV push over 3 minutes. In emergency situations (e.g., carcinoid crisis) it may be given by rapid bolus.

The initial dosage is usually 50 mcg administered twice or three times daily. Upward dose titration is frequently required. Dosage information for patients with specific tumors follows.

Acromegaly
Dosage may be initiated at 50 mcg t.i.d. Beginning with this low dose may permit adaptation to adverse gastrointestinal effects for patients who will require higher doses. IGF-I (somatomedin C) levels every 2 weeks can be used to guide titration. Alternatively, multiple growth hormone levels at 0-8 hours after Sandostatin administration permit more rapid titration of dose. The goal is to achieve growth hormone levels less than 5 ng/mL or IGF-I (somatomedin C) levels less than 1.9 U/mL in males and less than 2.2 U/mL in females. The dose most commonly found to be effective is 100 mcg t.i.d., but some patients require up to 500 mcg t.i.d. for maximum effectiveness. Doses greater than 300 mcg/day seldom result in additional biochemical benefit, and if an increase in dose fails to provide additional benefit, the dose should be reduced. IGF-I (somatomedin C) or growth hormone levels should be re-evaluated at 6-month intervals.

Sandostatin should be withdrawn yearly for approximately 4 weeks from patients who have received irradiation to assess disease activity. If growth hormone or IGF-I (somatomedin C) levels increase and signs and symptoms recur, Sandostatin therapy may be resumed.

Carcinoid Tumors
The suggested daily dosage of Sandostatin during the first 2 weeks of therapy ranges from 100-600 mcg/day in 2-4 divided doses (mean daily dosage is 300 mcg). In the clinical studies, the median daily maintenance dosage was approximately 450 mcg, but clinical and biochemical benefits were obtained in some patients with as little as 50 mcg, while others required doses up to 1500 mcg/day. However, experience with doses above 750 mcg/day is limited.

VIPomas
Daily dosages of 200-300 mcg in 2-4 divided doses are recommended during the initial 2 weeks of therapy (range 150-750 mcg) to control symptoms of the disease. On an individual basis, dosage may be adjusted to achieve a therapeutic response, but usually doses above 450 mcg/day are not required.

HOW SUPPLIED
Sandostatin® (octreotide acetate) Injection is available in 1-mL ampuls and 5-mL multi-dose vials as follows:

Ampuls
50 mcg/mL octreotide (as acetate)

Package of 10 ampuls……………………………………………………..NDC 0078-0180-01
100 mcg/mL octreotide (as acetate)

Package of 10 ampuls……………………………………………………..NDC 0078-0181-01
500 mcg/mL octreotide (as acetate)

Package of 10 ampuls……………………………………………………..NDC 0078-0182-01

Multi-Dose Vials
200 mcg/mL octreotide (as acetate)
Box of one…………………………………………………………………NDC 0078-0183-25

1000 mcg/mL octreotide (as acetate)
Box of one…………………………………………………………………NDC 0078-0184-25

Storage
For prolonged storage, Sandostatin ampuls and multi-dose vials should be stored at refrigerated temperatures 2-8°C (36-46°F) and protected from light. At room temperature, (20-30°C or 70-86°F), Sandostatin is stable for 14 days if protected from light. The solution can be allowed to come to room temperature prior to administration. Do not warm artificially. After initial use, multiple-dose vials should be discarded within 14 days. Ampuls should be opened just prior to administration and the unused portion discarded.

REV: SEPTEMBER 2005 2030581
Manufactured by:
Novartis Pharma Stein AG
Stein, Switzerland
Distributed by:
Novartis Pharmaceuticals Corporation
East Hanover, New Jersey 07936
©Novartis

Source: [package insert]
Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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