Sandostatin

Sandostatin is the brand name for octreotide, a synthetic analogue of the natural hormone somatostatin. It binds somatostatin receptors and inhibits the release of several hormones, including growth hormone, insulin, glucagon, gastrin, and vasoactive intestinal peptide. Through these effects, it reduces gastrointestinal secretions and slows intestinal motility and splanchnic blood flow, which can alleviate hormone-related symptoms in several disorders.

Indications include acromegaly; certain neuroendocrine tumors such as carcinoid tumors and pancreatic neuroendocrine tumors; vasoactive intestinal peptide–secreting tumors (VIPoma); and bleeding from esophageal varices. It is used to control symptoms of carcinoid syndrome and VIPoma and to reduce hormonal surges in some tumor-related emergencies.

Administration: Short-acting octreotide is given by subcutaneous injection, typically 50–100 micrograms every 8 hours, titrating to response. Sandostatin LAR is a long-acting formulation given by intramuscular injection every 4 weeks, with starting doses around 20 mg and adjustment as needed based on clinical response and tolerability.

Common adverse effects include gastrointestinal symptoms (nausea, abdominal pain, diarrhea or constipation), gallbladder sludge or gallstones with long-term use, injection-site reactions, bradycardia, and glucose metabolism changes. It can interact with diabetes therapies, requiring monitoring of blood glucose and dose adjustments; use in pregnancy only if clearly indicated. Generics of octreotide are available in addition to the Sandostatin brand.