Octreotide

Octreotide is a type of somatostatin analogue. Somatostatin is a protein made naturally in the body. Octreotide is a man made (synthetic) version of somatostatin. It is also known as Sandostatin or Olatuton.

It is a treatment:

• for carcinoid syndrome

• to control the growth of some advanced neuroendocrine tumours (NETs)

Carcinoid syndrome is a group of symptoms that some people get when they have a neuroendocrine tumour (NET) . The symptoms happen when the NET makes large amounts of hormones. Some of the symptoms you may have with carcinoid syndrome include flushing of the skin, diarrhoea and tummy (abdominal) pain.

How does octreotide work?

Octreotide works in the same way as somatostatin.

It slows down or stops the body producing a number of hormones and chemicals. These include gut hormones which control the emptying of the stomach and bowel. And chemicals that cause flushing of the skin. So, you might have it to control the symptoms of carcinoid syndrome.

Octreotide also causes cancer cells to die or stop dividing. This helps slow down the growth of some types of NETs.

How do you have octreotide?

You might have octreotide as an injection under the skin (subcutaneous) or into the muscle (intramuscular).

As an injection under your skin

You have these under the skin into your:

• upper arms

• thighs

• tummy (abdomen)

Your nurse will give you the injection. Or they might show you, or one of your friends or relatives how to do it. Tell your nurse if you don’t have anyone to help give you the injection and you can’t do it yourself.

It’s important that you vary where you have the injection. For example, you may have one injection in your abdomen and the next in your thigh.

You may get some pain where you’ve had the injection. But this normally only lasts a short while. It can help if you gently rub the area afterwards.

The video below shows you how to give an injection under the skin. 

As an injection into the muscle

Your nurse gives you the injection in your bottom. They vary the site of the injection. So you might have one injection on the right side and the next injection on the left.

You usually have a stinging or dull ache for a short time, but it don’t usually hurt much. 

How often do you have octreotide?

Your doctor or nurse will tell you how often you need to have octreotide and how long for. This is because it depends on your individual needs.

There are 2 types of octreotide:

• short acting
• long acting (also called Sandostatin LAR or Olatutan)

Short acting octreotide

Short acting octreotide starts to work straight away. But the drug only stays in your body for a short period of time. This means that you need to have the injections more often. 

You usually have short acting octreotide as injections under the skin 1 to 3 times a day.

Long acting octreotide

Long acting octreotide is slowly absorbed by the body. This means that the drug stays in your body for longer.

You usually have long acting octreotide as an injection into the muscle in your bottom once every 4 weeks.

Long and short acting together

Sometimes you might have long acting octreotide every 4 weeks but also have short acting octreotide each day. This may be when:

• you are changing from short acting to long acting octreotide
• the long acting octreotide doesn’t completely control your symptoms

Tests

Octreotide can affect hormones in your body such as insulin and thyroid hormones. Your doctor will ask you to have blood tests before and during treatment to check sugar and hormone levels.

You also have blood tests to check how well your liver is working. And to check your level of vitamin B12 if you’ve had low levels in the past.

Your doctor may also check your gallbladder with ultrasound scans. This is to look for gallstones which are a side effect of octreotide.

What are the side effects of octreotide?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, nurse, or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Diarrhoea or constipation

Even though you might have octreotide for diarrhoea, it can also be a side effect of taking it.

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. Or they might change the amount of octreotide you’re having.

Feeling sick (nausea) or being sick (vomiting)

Octreotide might make you feel sick. Less often it might make you be sick.

Feeling sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as directed by your doctor or pharmacist, even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Having Octreotide subcutaneous injections between meals or when you go to bed may help to reduce this.

Tummy (abdominal) pain and bloating

Octreotide might cause abdominal pain, or less often can make you feel bloated. Tell your healthcare team if you have this. They can check the cause and give you medicine to help.

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Side effects like headache may affect your ability to drive or use machines safely.

Gallstones and gallbladder problems

Gallstones are hard lumps, like little rocks that form in the gallbladder . In most cases, they don’t cause symptoms and you don’t need to have treatment unless you have:

• a high temperature

• severe and sudden tummy (abdominal) pain

• yellowing of the skin and the whites of your eyes (jaundice)

Less often you may get inflammation of the gallbladder (cholecystitis). This might make you feel or be sick, have abdominal pain, and a high temperature - call your health care team if you have these symptoms.

Or you might get a build up of substances in the gallbladder (biliary sludge). Symptoms might include abdominal pain, feeling sick, or being sick, especially after a fatty meal.

Changes in blood sugar levels

Octreotide can cause high blood sugar levels (hyperglycaemia). This can make you feel very thirsty, have a dry mouth, pass urine very often, feel tired, have blurred vision, lose weight, feel or be sick and have fruity smelling breath.

Less commonly you might get a low blood sugar level (hypoglycaemia). This can make you feel hungry, shaky, like your heart is beating really fast, dizzy and tired.

You have regular tests to check your blood sugar levels. You may need to check your levels more often if you are diabetic.

Pain and inflammation at the injection site

You may get some redness, swelling or pain at the injection site. This normally goes away after 15 minutes. But tell your nurse if you notice any of these symptoms.

Wind (flatulence)

You may pass more wind than usual. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• indigestion - symptoms can include heartburn, feeling full and burping

• dizziness, tiredness or general weakness - these side effects may affect your ability to drive safely

• low levels of thyroid hormones that can make you feel tired or cold and can make you feel depressed

• liver changes that can be picked up on a blood test – tell your doctor if you have yellowing of the skin or whites of your eyes (jaundice), or your wee may look darker

• skin problems such as a rash and itchy skin

• hair loss (alopecia)

• shortness of breath

• poo (stool) that floats, looks pale or has a bad smell - this can be caused by undigested fat. Your poo may also change colour

• loss of appetite

• a slow heartbeat - symptoms can include feeling your heart is beating very slowly, feeling lightheaded or faint

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• a lack of fluid in the body (dehydration)

• a fast heartbeat - you might have symptoms such as feeling that your heart is beating very fast or shortness of breath

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Let your team know straight away if you or your partner become pregnant while having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.