Peptide

Octreotide

Synthetic and longer-lasting version of somatostatin, a hormone that slows the secretion of other hormones. Used in acromegaly, in neuroendocrine tumors, and for their symptoms (diarrhea, flushing).

Regulatory status

Approved (FDA / EMA)

Family

Somatostatin analog

Scientific evidence

High

Number of findings

Where it acts

Hormones and metabolism · Digestive and weight

Also known as

octreotide, Sandostatin, Sandostatin LAR, Mycapssa, SMS 201-995

Regulatory status

FDA (US): Approved (1988, Sandostatin; 1998, long-acting Sandostatin LAR) for acromegaly and for the diarrhea and flushing of carcinoid tumors and VIPomas. Approved (2020, Mycapssa, oral capsules) for acromegaly

EMA (EU): Injectable forms authorized through national procedures in the EU (in Spain, Sandostatin and generics). Approved through the centralized route (2022, oral Mycapssa) for maintenance treatment of acromegaly

Dose

Acromegaly: start with 50 µg subcutaneously three times a day; usual dose 100 µg three times a day. Long-acting formulation: 20 mg intramuscularly every 4 weeks, adjusting according to GH and IGF-1 (FDA label Sandostatin / Sandostatin LAR). In the PROMID trial, 30 mg of the LAR form was used every 28 days.

Safety

Diarrhea, abdominal pain, nausea, and gas; gallstones with prolonged use; glucose disturbances (hypoglycemia or hyperglycemia); bradycardia; decreased thyroid function. Use under medical supervision.

Interactions

Reduces cyclosporine absorption. May require adjusting insulin, antidiabetic drugs, and drugs that lower heart rate (beta-blockers, calcium channel blockers). Proton pump inhibitors and antacids reduce absorption of the oral form.

Differences between women and men

According to the label, when GH and IGF-1 normalize in women with acromegaly, fertility may be restored, so contraception is recommended if pregnancy is not desired. Limited data in pregnancy.

Effect by goal · level of evidence

Growth control of midgut neuroendocrine tumors

improves Moderate RCT (AA) in people

14.3 vs 6 months to progression

PROMID trial with 85 patients with metastatic midgut tumors. Time to progression was 14.3 months with octreotide LAR vs 6 months with placebo (HR 0.34). No overall survival benefit was shown.

View the study (RCT) →

In depth

Where it acts

Hormones and metabolism, Digestion and weight

How it works

It binds to somatostatin receptors (mainly SSTR2 and SSTR5). In doing so it reduces the release of growth hormone, IGF-1, insulin, glucagon, and several digestive hormones. In neuroendocrine tumors it slows the secretion of substances that cause symptoms and may slow tumor growth.

What the evidence says

In people

Control of midgut neuroendocrine tumor growth. PROMID trial with 85 patients with metastatic midgut tumors. Time to progression was 14.3 months with octreotide LAR versus 6 months with placebo (HR 0.34). No overall survival benefit was demonstrated. PubMed 19704057

References

PubMed 19704057

Information, not medical advice. Prescription or unapproved peptides should only be used under medical supervision.