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Administering Sandostatin® LAR® |
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With its slow-release pharmacokinetic profile compared to Sandostatin® Injection, Sandostatin® LAR® can be administered once a month instead of 3 times a day, which may lead to enhanced patient compliance. In addition, improvements such as a new pre-filled vehicle syringe and redesigned needle size make mixing and administering Sandostatin® LAR® easier than ever.
Click on the following links for more detailed information on administering Sandostatin® LAR®.
To review frequently asked questions and answers on administering Sandostatin® LAR®, click here. |
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Dosage |
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This section offers dosage guidelines for Sandostatin® LAR®.
Dosing algorithm in acromegaly
Sandostatin® LAR® (octreotide/IM injection) is designed to be injected intramuscularly (intragluteally) once every 4 weeks. It should never be administered intravenously or subcutaneously. When beginning treatment with Sandostatin® LAR®, a specific procedure must be followed:
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Sandostatin® LAR® for acromegaly
Patients not currently receiving octreotide acetate should begin therapy with subcutaneous (SC) Sandostatin® (octreotide acetate) Injection at an initial dose of 50 mcg three times a day. Beginning with this low dose may permit adaptation to adverse gastrointestinal effects for patients who require higher doses. Dosage titration can be based on multiple GH measurements at 0-to-8 hours after administration. The goal is to attempt to normalize GH and IGF-I levels. Most patients require a dosage of 100 mcg to 200 mcg 3 times a day for the maximum effect of normalizing growth hormone and IGF-I. Some patients may require up to 500 mcg 3 times a day. Injection sites should be rotated in a systematic manner to avoid irritation. Patients should be maintained on this formulation for at least 2 weeks to determine their response and tolerability to octreotide.
Patients who tolerate the drug and are considered to be responders to therapy based on GH and IGF-I levels can be switched directly to Sandostatin® LAR®. The dosage should be 20 mg administered intragluteally at 4-week intervals for the initial 3 months, followed by dosage adjustment. |
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Patients currently receiving Sandostatin® Injection can be switched directly to Sandostatin® LAR® at a dose of 20 mg administered intragluteally at 4-week intervals for the initial 3 months. Deltoid injections should be avoided because of significant discomfort at the injection site when given in that area. Gluteal injection sites should be alternated to avoid irritation.
At the end of 3 months, the dose of Sandostatin® LAR® may be continued at the same level or adjusted based on the following regimen:
- GH greater than 1 µg/L and less than or equal to 2.5 µg/ L: IGF-I normal, and clinical symptoms controlled: Maintain the dose of Sandostatin® LAR® at 20 mg every 4 weeks.
- GH greater than 2.5 µg/L, and/or IGF-I elevated, and/or clinical symptoms uncontrolled: Increase dose of Sandostatin® LAR® to 30 mg every 4 weeks.
- GH less than or equal to 1 µg/mL, IGF-I normal, and clinical symptoms controlled: Reduce dose of Sandostatin® LAR® to 10 mg every 4 weeks.
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Sandostatin® LAR® for GEP NE tumours and carcinoid syndrome
Patients not currently receiving octreotide acetate should begin therapy with SC Sandostatin® (octreotide acetate) Injection. The suggested daily dose during the first 2 weeks of therapy ranges from 100 to 600 mcg/day in divided doses. Some patients may require higher doses of up to 1,500 mcg/day
Patients should be maintained on SC Sandostatin® Injection for at least 2 weeks. Thereafter, patients who are considered responders to octreotide acetate and who tolerate the drug may be switched to Sandostatin® LAR® in the dosing scheme described below. |
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Patients currently receiving Sandostatin® Injection can be switched directly to Sandostatin® LAR® at a dose of 20 mg administered intragluteally at 4-week intervals for the initial 3 months, followed by dosage adjustment. Deltoid injections should be avoided because of significant discomfort at the injection site. Gluteal injection sites should be alternated to avoid irritation. Because of the need for serum octreotide to reach therapeutically effective levels following the initial injection of Sandostatin® LAR®, patients should continue to receive SC Sandostatin® Injection for at least 2 weeks in the same dosage they were taking before the switch. An exacerbation of symptoms may occur if subcutaneous injections are not continued for this period. Some patients may require 3 to 4 weeks of combination SC Sandostatin®/Sandostatin® LAR® therapy.
After 3 months of receiving a 20-mg dose of Sandostatin® LAR®, the dosage may be increased to 30 mg every 4 weeks if symptoms are not adequately controlled. (Despite good overall control of symptoms, patients with carcinoid tumours and VIPomas often experience periodic exacerbation of symptoms [regardless of whether they are being maintained on Sandostatin® Injection or Sandostatin® LAR®]). During these periods, patients may be given Sandostatin® Injection SC for a few days at the dose they were receiving prior to switching to Sandostatin® LAR®. When symptoms become controlled, the Sandostatin® Injection SC can be discontinued.
Patients who achieve good control on a 20-mg dose may have their dose lowered to 10 mg for a trial period. If symptoms recur, the dose should be increased to 20 mg every 4 weeks. Many patients can be satisfactorily maintained at a 10-mg dose every 4 weeks. However, a 10 mg-dose is not recommended as a starting dose because therapeutically effective levels of octreotide are reached more rapidly with a 20-mg dose. A dose of more than 30 mg is not recommended because there is no information on its usefulness. |
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