Understanding Octreotide and Its Formulations
Octreotide is a man-made (synthetic) version of the natural hormone somatostatin [1.10.1]. It is primarily used to treat acromegaly, a condition caused by excess growth hormone, and to manage symptoms like severe diarrhea and flushing associated with certain neuroendocrine tumors (NETs), such as carcinoid tumors and VIPomas [1.10.2, 1.10.4]. The medication works by decreasing the body's production of certain hormones and other natural substances [1.10.2].
Octreotide is administered via injection and comes in two main forms [1.5.4]:
- Short-Acting (Immediate-Release): This form is typically given as a subcutaneous (under the skin) injection multiple times a day, usually 2 to 4 times daily [1.3.4, 1.5.4]. It begins to work quickly but also leaves the body relatively fast.
- Long-Acting (LAR Depot): This form is a depot formulation given as an intramuscular (into the muscle) injection, usually once every 4 weeks by a healthcare professional [1.4.5, 1.5.4]. It releases the medication slowly over time.
Patients often start with the short-acting form to ensure the medication is effective and well-tolerated before switching to the long-acting version for maintenance [1.10.2].
Comparison: Subcutaneous vs. Intramuscular Octreotide
| Feature | Short-Acting (Subcutaneous) | Long-Acting LAR (Intramuscular) |
|---|---|---|
| Administration Route | Injected into the fatty tissue under the skin (subcutaneous) [1.3.5] | Injected deep into the gluteal muscle (intramuscular) [1.4.1] |
| Frequency | 2 to 4 times per day [1.3.4] | Once every 4 weeks [1.4.5] |
| Onset of Action | Rapid [1.5.4] | Slow release over a month; may require short-acting coverage initially [1.4.4, 1.10.2] |
| Who Administers? | Patient or caregiver can be taught to self-administer at home [1.3.1] | Typically administered by a doctor or nurse [1.5.3] |
| Common Use | Initial treatment, managing breakthrough symptoms [1.10.2] | Long-term maintenance therapy [1.4.5] |
How Do You Give an Octreotide Injection? (Short-Acting, Subcutaneous)
Self-administering a subcutaneous octreotide injection requires careful preparation and technique. Always follow the specific instructions from your healthcare provider.
Step 1: Preparation
- Gather Supplies: You will need the octreotide vial or ampule, a sterile syringe (often an insulin syringe), alcohol wipes, and a sharps disposal container [1.3.2].
- Wash Hands: Thoroughly wash your hands with soap and water [1.3.1].
- Warm the Medication: Remove the vial from the refrigerator and let it come to room temperature for about 30 minutes. Do not use artificial heat [1.3.1, 1.8.1]. This can reduce injection site discomfort [1.4.5].
- Inspect the Vial: Check the medication to ensure it is clear, colorless, and free of particles. Do not use it if it appears cloudy or discolored or if the expiration date has passed [1.3.4, 1.8.2].
- Prepare the Dose: Clean the rubber stopper on the vial with an alcohol wipe. Draw air into the syringe equal to your prescribed dose. Inject the air into the vial, then turn the vial upside down and withdraw the correct amount of medication. Tap the syringe to make air bubbles rise to the top and gently push the plunger to expel them [1.2.1].
Step 2: Injection
- Select and Clean the Site: Choose an injection site on the upper arms, thighs, or abdomen (avoiding the 2-inch area around the navel) [1.3.1, 1.3.2]. It's crucial to rotate injection sites with each dose to prevent skin problems [1.3.1]. Clean the chosen area with a new alcohol wipe and let it air dry.
- Pinch the Skin: Gently pinch about an inch of the cleaned skin [1.3.2].
- Inject the Medication: Hold the syringe like a pen and insert the needle at a 90-degree angle into the pinched skin with a quick, smooth motion [1.3.2].
- Administer and Withdraw: Push the plunger down steadily to inject all the medication. Release the pinched skin, then quickly withdraw the needle [1.2.1].
- Post-Injection: You can gently blot the site with a cotton ball if needed, but do not rub the area, as this can cause bruising [1.3.4]. A small drop of blood or medication at the site is normal [1.3.2].
Step 3: Disposal
Immediately place the used syringe and needle into a puncture-resistant sharps container. Do not reuse needles or syringes. Follow local guidelines for disposing of the full container [1.8.1].
Administering Octreotide LAR (Long-Acting, Intramuscular)
This procedure is typically performed by a healthcare professional due to the complexity and need for a deep intragluteal (buttocks) injection [1.4.1].
Preparation and Reconstitution
- Bring to Room Temperature: The injection kit must be removed from the refrigerator and allowed to stand at room temperature for at least 30 minutes, but no more than 24 hours, before mixing [1.4.1].
- Reconstitute the Medication: The kit contains a vial with powder and a syringe with a diluent. The healthcare provider will attach the syringe to the vial adapter, inject the diluent into the powder, and allow it to saturate for 2 to 5 minutes [1.4.1, 1.2.2].
- Mix Thoroughly: After saturation, the vial is shaken moderately in a horizontal direction for at least 30 seconds until a uniform, milky suspension is formed [1.4.1]. The contents are then drawn back into the syringe.
Administration
- Site Selection: The injection is given only into the left or right gluteal muscle. The site should be rotated between injections [1.4.1, 1.4.2].
- Injection: The needle is inserted fully into the muscle at a 90-degree angle. The provider will pull back the plunger slightly (aspirate) to ensure a blood vessel has not been hit [1.4.1].
- Administration: The plunger is depressed with steady pressure until all the medication is delivered. The needle is then withdrawn, and the safety guard is activated [1.4.1, 1.2.2]. Administration must happen immediately after mixing to prevent the suspension from settling [1.4.1].
Important Safety Information and Side Effects
Common side effects of octreotide include pain at the injection site, nausea, diarrhea, constipation, stomach pain, gas, and headache [1.3.4, 1.5.4]. It can also affect blood sugar levels, causing either high (hyperglycemia) or low (hypoglycemia) blood sugar [1.11.1]. Long-term use can lead to gallstones or gallbladder problems [1.10.1].
It is essential to tell your doctor about all medical conditions, especially diabetes, heart, kidney, or liver disease, and all other medications you are taking [1.11.2].
Conclusion
Administering an octreotide injection requires precise steps to ensure safety and efficacy. While the long-acting intramuscular injection is performed by a healthcare provider, patients can be trained to give the short-acting subcutaneous injections at home. Following proper procedures for preparation, site rotation, and disposal is critical. Always refer to the guidance of your healthcare team for personalized instructions and to manage any side effects that may arise.
For detailed instructions with diagrams, refer to the manufacturer's patient information or a trusted medical source like the Sandostatin® LAR Depot HCP site [1.4.2].
