What is Sandostatin used for?
- Relieving symptoms caused by hormone-producing tumours of the gut, liver and pancreas (gastroenteropancreatic or GEP tumours).
- Controlling or reducing growth hormone levels in people with a condition called acromegaly.
- Controlling or reducing thyroid stimulating hormone (TSH) levels in people with TSH-secreting pituitary adenomas.
- Preventing complications following surgery on the pancreas.
- Emergency treatment to stop bleeding and prevent re-bleeding from varicose veins in the oesophagus (gastro-oesophageal varices) in people with liver cirrhosis.
How does Sandostatin work?
Sandostatin injection contains the active ingredient octreotide, which is a type of medicine called a somatostatin analogue. It is similar to a naturally-occurring hormone in the body called somatostatin. Somatostatin is produced in various parts of the body, including the brain, gut and pancreas. Its function is to stop the release of certain other hormones, such as growth hormone and insulin.
Octreotide mimics the action of natural sandostatin and so decreases the production of these types of hormones. It is used to relieve the symptoms of gastroenteropancreatic (GEP) tumours. Most tumours of this type develop in the organs of the digestive system. They usually start in the cells of the stomach (gastro), intestines (entero) and the pancreas. These areas of the body produce various hormones, and tumours that grow in these areas often cause too much of a certain hormone to be produced. The type of hormone overproduced depends on the type of gland that is affected by the tumour.
The different types of GEP tumours are named after the cells where they develop. Insulinomas occur in the pancreas, causing excessive amounts of insulin to be produced. This can cause a fall in blood sugar level (hypoglycaemia). Glucagonomas also occur in the pancreas, but these cause excessive amounts of glucagon to be produced. Glucagon increases blood sugar and tumours of this type can cause symptoms of diabetes.
Gastrinomas occur in the stomach, causing excessive amounts of gastrin to be produced. Gastrin causes the production of stomach acid. If too much gastric acid is produced this can lead to ulcers in the stomach, oesophagus and small intestine. VIPomas usually occur in the pancreas and produce too much of a substance called vasoactive intestinal peptide (VIP). This can cause watery diarrhoea.
Carcinoid tumours are usually found in the intestines. They can produce excessive amounts of the hormone serotonin. The serotonin causes various symptoms, including diarrhoea, that together are known as carcinoid syndrome.
Octreotide only relieves the symptoms of these hormone-producing tumours, it does not cure the tumour.
Octreotide is also used to treat acromegaly, which is a condition characterised by enlarged facial features, hands and feet. It results from excessive production of growth hormone by a tumour in the pituitary gland. Octreotide decreases the production of the growth hormone and so treats the symptoms of the condition, however, again it does not cure the tumour.
For acromegaly, this medicine is used for short-term treatment prior to pituitary surgery. It can also be used for long-term treatment in those who are inadequately controlled by pituitary surgery or radiotherapy, in the interim period until radiotherapy becomes effective, or in people for whom surgery is inappropriate.
Octreotide is also used to treat thyrotrophic adenomas, which are a different type of tumour affecting the pituitary gland. This rare type of tumour affects the cells that produce thyroid stimulating hormone (TSH) and causes overproduction of TSH. TSH stimulates the production of thyroid hormones from the thyroid gland, so this type of tumour can disrupt the body�s normal metabolism. Octreotide is used when levels of TSH still remain too high following surgery or radiotherapy to treat the pituitary tumour, in the interim period until radiotherapy becomes effective, or in people for whom surgery is inappropriate.
How is Sandostatin given?
- Sandostatin is a short-acting injection of octreotide that is usually given under the skin (subcutaneously) up to three times a day, depending on the condition being treated.
- Either you or a family member can be taught to give subcutaneous injections. It is important that you always follow the instructions given by your doctor, as well as those in the information leaflet provided with the injections.
- Sandostatin may also be given via a drip into a vein in hospital.
Important information about Sandostatin
- For prolonged storage, Sandostatin ampoules and multidose vials should be stored in a fridge between 2oC and 8oC. Do not freeze. For day-to-day use they may be stored at room temperature for up to two weeks. Protect from light. If you store the medicine in the fridge, it is recommended that you allow it to reach room temperature before using it. This will reduce the risk of pain at the site of injection. You can warm it up in your hand but do not heat it.
- People receiving long-term treatment with this medicine should have their thyroid function and liver function regularly monitored.
- This medicine can sometimes cause gallstones. An ultrasound examination of the gall bladder is recommended before treatment is started and at regular 6 to 12 month intervals during treatment.
- Women who need treatment with this medicine should use an effective method of contraception to prevent pregnancy. This is important for women with acromegaly, as this medicine can restore your fertility as it restores your hormone levels.
Sandostatin should be used with caution by
- People with liver cirrhosis.
- People with a slow heartbeat.
- People with diabetes mellitus.
- People with insulin producing tumours (insulinomas).
- People with a history of vitamin B12 deficiency.
Sandostatin should not be used by
- People who are allergic to any ingredient.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- Experience with this medicine during pregnancy is very limited. It is not recommended for use during pregnancy unless considered essential by your doctor. Seek further medical advice from your doctor.
- Women who need treatment with this medicine should use an effective method of contraception to prevent pregnancy. This is also important for women with acromegaly, as this medicine can restore your fertility as it restores your hormone levels.
- It is not known if this medicine passes into breast milk. Mothers who need treatment with this medicine should not breastfeed their infants. Discuss this with your doctor.
Possible side effects of Sandostatin
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Very common (affect more than 1 in 10 people)
- Gut disturbances such as diarrhoea, constipation, nausea, abdominal pain, wind (flatulence). These become less frequent over time with continued treatment and can be reduced by avoiding meals around the time of injection, ie timing the injections between meals or on going to bed. Ask your doctor or pharmacist for further advice.
- Gallstones (cholelithiasis).
- High blood sugar level (hyperglycaemia).
- Short-term pain, stinging, tingling, burning sensation, swelling or redness at the injection site.
Common (affect between 1 in 10 and 1 in 100 people)
- Fatty or discoloured stools.
- Loss of appetite.
- Thyroid gland dysfunction.
- Low blood sugar level (hypoglycaemia).
- Inflammation of the gall bladder (cholecystitis).
- Rash or itching.
- Hair loss (alopecia).
- Feeling weak.
- Shortness of breath.
- Slow heartbeat (bradycardia).
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Increased heart rate (tachycardia).
- Inflammation of the liver (hepatitis).
- Acute inflammation of the pancreas (pancreatitis).
- Irregular heartbeats (arrhythmias).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
If you think you have experienced a side effect from a medicine or vaccine you should check the patient information leaflet. This lists the known side effects and what to do if you get them. You can also get advice from your doctor, nurse or pharmacist. If they think it''s necessary they'll report it for you.
You can also report side effects yourself using the yellow card website: www.mhra.gov.uk/yellowcard.
How can Sandostatin affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while having treatment with this one, to make sure that the combination is safe.
Your heart beat may slow down too much if this medicine is used in combination with other medicines that can slow down your heart rate, for example diltiazem, verapamil, ivabradine or beta-blockers such as atenolol. Your doctor will monitor your heart rate and may need to adjust your doses of these medicines if you are taking them in combination with octreotide.
Octreotide can decrease the absorption of the immunosuppressant ciclosporin from the gut and so can make it less effective. The dose of ciclosporin may need to be increased.
If you have diabetes you may need changes in your dose of insulin or antidiabetic tablets while you are having treatment with octreotide. Your doctor may ask you to monitor your blood sugar more frequently and will adjust your doses as necessary.
Other medicines containing octreotide
- Sandostatin LAR (depot injection).
Octreotide injection is also available without a brand name, ie as the generic medicine.
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