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Poisoning Information for the Public & Health Care Professionals

Atlantic Canada Poison Centre
Antidote Kit Manual

1-800-565-8161 or 902-470-8161 | atlanticcanadapoisoncentre.ca
Last updated: 02/2020
Pediatric Adult
Last updated: 02/2020
Antidote
Pediatric

Octreotide

Sandostatin®

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Antidote
Pediatric

Octreotide

Sandostatin®

ALERT: This item is found in the refrigerator antidote kit.

Indications

  • Hypoglycemia due to acute or chronic sulfonylurea toxicity.
    Use in combination with dextrose to maintain normal blood glucose levels.

Dosage

  • 1 microgram/kg (not to exceed 50 microgram) subcutaneous or IV every 6 - 12 hours.
    For refractory hypoglycemia, consider continuous infusion of 1 microgram/kg/hour.
     
  • Treatment duration: Dependent on the sulfonylurea dose and its half-life. Monitoring must continue for at least 8 hours after discontinuation of dextrose and 24 hours after last dose of octreotide.
    -Limited pediatric data are available (case reports only).
    -Maximum doses in pediatrics are unavailable.

Administration

  • Subcutaneous (preferred): Administer undiluted.
  • IV Direct: Administer undiluted (100 microgram/mL) over 3 minutes.
  • Continuous Infusion: For a final concentration of 5 microgram/mL: add 200 microgram (2 mL of 100 microgram/mL solution) to 38 mL of sodium chloride 0.9%.  Total volume 40 mL.  An infusion device is required. Allow solution to come to room temperature before administration if possible.

Compatibility, Stability

  • Compatible with sodium chloride 0.9% or dextrose 5% in water.
  • Stable in sodium chloride 0.9% for 24 hours.
  • Store in the refrigerator. Protect ampoules from light.

Potential Hazards of Administration

  • Headache, dizziness.
  • Nausea, abdominal discomfort or distension, diarrhea (more common) or constipation, gallstones.
  • Hyperglycemia (more common) or hypoglycemia.
  • Irritation at injection site.

Miscellaneous

  • Octreotide is administered subcutaneously for most indications.
  • Octreotide reduces the frequency of hypoglycemic episodes and the need to administer supplemental glucose in sulfonylurea overdose.

Bailey, B., Blais, R., Gaudreault, P., Gosselin, S., & Laliberte, M. (2009). Antidotes en toxicologie d'urgence (3rd ed.). Quebec, Canada: Centre antipoison du Quebec.

Glatstein, M., Garcia-Bournissen, F., Scolnik, D., & Koren, G. (2010). Sulfonylurea intoxication at a tertiary care paediatric hospital. Canadian Journal of Clinical Pharmacolgy, 17(1), 51-56.

Goldfrank, L. R., Nelson, L. S., Lewin, N. A., Howland, M. A., Hoffman, R. S., (2015). Goldfrank's toxicologic emergencies(Tenth ed.). New York: McGraw Hill.

Liamado, R., Czaja, A., Stence, N., & Davidson, J. (2013). Clinical communications: Pediatrics: Continuous octreotide for sulfonylurea-induced hypoglycemia in a toddler. The Journal of Emergency Medicine, 45, e209-e213.

Micromedex, T. H. A. (2014). Micromedex health care systems. Retrieved from http://www.micromedexsolutions.com

Olson, K. R. (2007). Poisoning & drug overdose (Sixth ed.). New York: McGraw Hill.

Phelps SJ, C. C. (2013).  Teddy bear, pediatric injectable drugs. Retrieved from http://www.pharmpress.com/product/MC_PED/pediatric-injectable-drugs

Shannon, M. W., Borron, S. W., & Burns, M. J. (2007). Haddad and Winchester's clinical management of poisoning and drug overdose (Fourth ed.). Philadelphia: Saunders Elsevier.

Trissel, Lawrence, A,. (2013). Handbook on injectable drugs (17th ed.). Bethesda, Maryland: American Society of Health-System Pharmacists

Vallurupalli, S. (2010). Safety of subcutaneous octreotide with sulfonylurea-induced hypoglycemia and congestive heart failure. The Annals of Pharmacotherapy, 44, 387-390.