Octreotide (Sandostatin, Sandostatin LAR)

At a glance

Octreotide is a medicine used in specialist cancer care. Brand names include Sandostatin, Sandostatin LAR. The practical instructions depend on the exact prescription and product supplied.

Your prescription and the instructions for your own product take priority over a general guide. Keep the medicine leaflet as well as your treatment plan, especially if the brand or formulation changes.

You do not need to remember every possible side effect. Start with the administration instructions and the section on urgent help. Most people experience only some of the effects described here. Tell your team about difficulties early: supportive treatment, a planned pause or a different medicine may make treatment easier to continue.

How it works

Octreotide is a somatostatin analogue that reduces secretion of several hormones. It is available as short-acting injection and a long-acting depot. In oncology, short-acting and depot injections can control hormone-related symptoms such as flushing and diarrhoea. The depot is also used to control growth in selected neuroendocrine tumours; this benefit should not be assumed for every tumour or preparation.

Is this treatment suitable for me?

The team selects the preparation according to the purpose, tumour features and symptoms. Short-acting rescue treatment and long-acting maintenance have different jobs. Oral octreotide products used in other conditions must not be treated as a direct substitute for an oncology injection.

Your oncologist considers the biology of the cancer, treatments already received, other illnesses and your preferences. For octreotide, the aim may be to control hormone-related symptoms or, in selected neuroendocrine tumours, control tumour growth. Ask which aim applies to you and how benefit will be assessed. The same medicine can be used for different lengths of time in different treatment plans.

A brand name alone does not tell you whether a medicine is suitable. The dose, formulation and other medicines in the plan also matter. Discuss the possible benefits and risks with your care team.

Before treatment

Mention gallstones, diabetes, low blood sugar, an insulin-secreting tumour (insulinoma), heart rhythm problems, liver or kidney disease, dialysis, thyroid disease and persistent bowel symptoms. Ask whether home injections are planned and obtain training before using them. Keep a symptom record if flushing or diarrhoea is part of your illness.

Bring an up-to-date list of prescription medicines, pharmacy medicines, supplements and traditional or herbal remedies. Include medicines used only occasionally, creams containing hormones, and anything recently stopped. Mention previous allergies and describe what happened, rather than only naming the drug. Your pharmacist can check the whole list together.

Tell the team about any planned operation, dental procedure, travel or difficulty attending appointments. Discuss costs and supply before the first dose if obtaining regular refills may be difficult. Agree who will arrange repeat prescriptions and tests. Keep your own hospital's daytime and out-of-hours contact details where you and a caregiver can find them quickly.

How to take or receive treatment

Short-acting octreotide is usually injected under the skin several times daily, with an individual dose and schedule. Intravenous use is reserved for specific supervised situations. Sandostatin LAR is a deep intramuscular injection into the buttock, given by a trained healthcare professional, commonly every four weeks. It must not be injected under the skin or into a vein. The team selects the dose for your condition and formulation.

For hormone-related symptom treatment, the team first checks that short-acting octreotide works and is tolerated. When starting LAR, short-acting treatment is commonly continued for at least two weeks while depot levels build. Some patients also need prescribed rescue injections later. Do not stop short-acting treatment merely because the first depot has been given.

If prescribed and trained to give short-acting injections under the skin at home, follow the exact preparation, site rotation, refrigeration and sharps instructions. Do not inject a cold product or warm it by an improvised heating method. A missed short-acting dose and a missed depot appointment require different advice; never double either without instruction.

Check the date of the next appointment before leaving the clinic. An injection described as monthly may have a specific number of weeks or calendar-month interval; use the date your team gives you. Contact the clinic promptly if an appointment is missed or needs changing. Do not arrange an extra dose, substitute another depot strength or change the interval yourself.

Tell the nurse about blood thinners, unusual bruising, an infection near the planned injection site or a previous injection reaction. The preparation and route are specific to the product. Only prescribed short-acting injections under the skin may be given at home after training; LAR depot injections are given by a healthcare professional.

Usually the clinic stores and prepares the medicine. If you must collect or transport it, ask the dispensing pharmacy how to store and transport it, and keep their instructions handy. Do not assume all injections need the same refrigeration. If home injections are prescribed, use the provided sharps container and disposal service; never put loose needles into household waste.

Use a calendar or a phone reminder that records what was actually taken or given. A tick made after a dose is more useful than one made in advance. If someone helps with medicines, agree who records each dose so it is not accidentally repeated. Keep the drug name, strength and current instructions together; an old prescription may no longer describe your current dose.

Contact the treating team if a supply problem or illness is likely to interrupt treatment. Do not stretch the supply by taking smaller doses or lengthening intervals yourself. If you receive too much medicine, seek urgent advice and have the packaging and dose times available. Do not induce vomiting.

Monitoring your treatment

Monitoring includes symptom diaries, glucose and nutritional status. Glucose needs checking when treatment starts or the dose changes; insulinoma can increase the risk of prolonged low glucose. Thyroid tests before and periodically during longer treatment, vitamin B12 and liver tests are part of the monitoring plan. Gallbladder assessment may include ultrasound before treatment and at intervals during long-term LAR treatment, often about every six months according to the product instructions. Persistent oily stools or weight loss should prompt evaluation for pancreatic enzyme insufficiency. Scans assess tumour control separately from symptom relief.

Monitoring has two purposes: checking whether treatment is helping and detecting problems that may be silent at first. Your schedule depends on the medicine, any partner treatment and your general health. Ask which results need to be reviewed before the next prescription or injection, and who will contact you if a result is abnormal.

Record symptoms that affect eating, walking, sleep or daily activities, along with when they began. Bring this record to appointments. A single symptom or blood result rarely explains the whole picture; the team may compare trends, examination findings and scans. Feeling well is welcome, but it does not remove the need for planned monitoring.

Common side effects

Effects to discuss with your team

Nausea, abdominal discomfort, wind, loose stools and local injection discomfort can occur. Some bowel symptoms may improve because hormone release is reduced; new or different symptoms can indicate a treatment effect or another problem. Report the pattern clearly.

Somatostatin analogues act on hormone signalling in a different way from treatments that lower oestrogen or testosterone. They can reduce hormone-related symptoms and, in suitable circumstances, help control tumour growth. Symptom control and tumour control are separate outcomes: fewer flushing episodes or less diarrhoea does not remove the need for planned scans and review.

Keep a record of bowel frequency, flushing, abdominal discomfort, weight and any rescue medicine used. Persistent or worsening diarrhoea can have several causes. In particular, pale, oily, floating or difficult-to-flush stools with bloating or weight loss may reflect reduced pancreatic enzyme activity. Tell the team rather than repeatedly increasing anti-diarrhoeal medicine; testing and pancreatic enzyme replacement may be appropriate.

These medicines can change both insulin and glucagon secretion, so blood sugar can rise or fall. If you have diabetes, ask how often to check glucose when treatment starts or changes. Sweating, trembling, confusion or faintness may suggest low glucose. Use your established diabetes emergency plan and obtain help if symptoms are severe or do not resolve.

Gallstones and slow heart rate are other concerns. Severe upper abdominal pain, fever, jaundice or persistent vomiting needs urgent assessment. Tell the team about heart-rate medicines and any fainting episodes. If surgery, anaesthesia, a specialist scan or radionuclide treatment is planned, the relevant team must coordinate injection timing and any rescue treatment; do not pause a depot or short-acting dose without instructions.

Making symptoms easier to manage

Tell the team which symptom is causing the most difficulty. Describe its effect on ordinary tasks: for example, whether pain prevents dressing or tiredness stops you preparing food. This helps the team choose practical support and judge whether treatment needs adjustment. Avoid waiting until the next routine visit if symptoms are worsening.

For mild nausea, try smaller meals and regular sips of fluid, following any food rule for the medicine. Ask about an anti-sickness medicine if needed. Repeated vomiting, inability to keep fluids down or very little urine needs prompt advice. If you have been told to restrict fluids for another illness, use that plan rather than forcing extra drinks.

Energy and emotional wellbeing

Pace demanding activities and allow rest, but keep some gentle movement in your day if you can. Persistent exhaustion deserves assessment; poor sleep, anaemia, low mood and other illnesses may contribute. Tell the team about persistent anxiety, sadness or loss of interest. If you feel at risk of harming yourself, seek emergency help and ask someone to stay with you.

Important side effects

The effects below are important because they may require tests or a change in treatment. They are not a prediction that you will develop them. New symptoms can also come from the cancer or an unrelated illness. Reporting them promptly allows the team to work out the cause; do not assume that everything is a routine treatment effect.

Gallstones and their complications, high or low glucose, slow heart rate and conduction problems are important concerns. Pancreatic enzyme suppression can impair fat absorption. Thyroid and vitamin B12 changes may develop with prolonged treatment. Allergic reactions, including anaphylaxis, can happen. If a gallstone complication is suspected, the treating team should withhold further treatment while arranging assessment and any necessary symptom-control alternative.

Other medicines and vaccinations

Review insulin, other diabetes treatment, beta-blockers, ciclosporin and bromocriptine. Specialist scans, anaesthesia and radionuclide treatment may require coordinated timing of short-acting and depot doses. Do not decide your own washout interval.

Ask the oncology pharmacist to check new medicines before you start them, including antibiotics prescribed elsewhere. Do not stop essential treatment for another illness on your own. If an interaction is possible, the prescribers can choose an alternative, adjust a dose or arrange monitoring. Herbal products labelled natural can still alter drug levels or have hormone-like effects.

Vaccination advice depends on your complete treatment plan. Hormone treatment alone does not automatically mean that every vaccine is unsuitable. Ask about influenza, COVID-19 and other recommended vaccines; live vaccines need a specific check if you also receive chemotherapy, an immune-suppressing medicine or certain doses of steroid. Tell the vaccination service all the treatments you receive.

Everyday life

Food and movement

Aim for regular meals with enough protein and a varied range of foods that you can tolerate. Tell the team about unplanned weight loss, rapid weight gain or difficulty eating. A dietitian can adapt advice to diabetes, kidney problems, bowel symptoms or a restricted appetite. Do not start a restrictive diet or high-dose supplement as a substitute for treatment.

Choose activity that suits your strength and balance. Short walks or gentle exercises may be easier to sustain than occasional strenuous sessions. If cancer affects your bones, or you have osteoporosis, ask which movements and resistance exercises are safe before starting a new programme. New focal bone pain should be assessed rather than exercised through.

Work and travel

Many people continue some usual activities, but flexibility helps while you learn how treatment affects you. Discuss rest breaks, shorter hours or help with physically demanding work if needed. Avoid driving or operating machinery when dizzy, sleepy, confused or affected by visual symptoms. Follow any additional driving advice after a seizure or loss of consciousness.

Plan travel around prescriptions, injections and tests. Carry an up-to-date medicine list and enough supply for the agreed trip, with advice about storage and time-zone changes. For long journeys, discuss mobility and your individual clot risk. Do not start aspirin or a blood thinner simply because you are travelling.

Relationships and support

Changes in energy, body image or sexual function can affect relationships. You can ask for help privately, with or without a partner present. There may be practical measures or specialist support for discomfort and intimacy. A caregiver can help record symptoms and organise appointments while leaving treatment decisions and personal information under your control.

Fertility, pregnancy and breastfeeding

Octreotide is generally avoided during pregnancy unless the specialist considers it necessary. Discuss pregnancy plans and effective contraception; treatment is not a contraceptive and hormone control can change fertility in some settings. Breastfeeding should be avoided during Sandostatin LAR treatment. Ask the team about the interval after the final depot and the implications of other medicines.

Tell the team before treatment if having children in the future matters to you. Fertility preservation needs discussion before exposure where possible. Reduced fertility is not the same as reliable contraception, and an absence of periods or reduced sexual function does not prove that pregnancy is impossible.

Ask your team which contraception to use and how long to continue it, taking account of every medicine in your regimen. A partner drug may require a longer precaution period than this medicine alone. If pregnancy is suspected in you or a partner during a risk period, contact the treating team promptly for individual advice. Do not make pregnancy or breastfeeding decisions from a generic time interval without checking your own treatment plan.

After treatment

Plan stopping carefully because hormone-related symptoms may recur as the medicine wears off. Retain any prescribed rescue plan and know when to seek help. Nutritional, gallbladder or endocrine problems may need continuing review.

Before a planned stop, confirm which medicines end, which continue, and when the next review is due. Return unused medicine through the pharmacy's recommended route; do not give it to another person. Keep a record of the last dose and any side effects that still need follow-up.

Changes caused by treatment may settle gradually, and some need ongoing support. Report persistent symptoms or new problems after treatment rather than assuming they will disappear on their own. Continue the agreed follow-up and screening plan. If treatment is being changed, ask your team to help you update your treatment schedule so that old and new instructions are not accidentally combined.

Common questions