Octreotide Insulin

Octreotide -synthetic peptide analogue of somatostatin -abdominal pain, nausea, vomiting, diarrhea -local injection site reactions -cholelithiasis -sweating, flushing -hyperglycemia (many patients will require insulin therapy)... 

Octreotide acetate (Sandostatin) is a synthetic peptide analogue of the hormone somatostatin. Its actions include inhibition of the pituitary secretion of growth hormone and an inhibition of pancreatic islet cell secretion of insulin and glucagon. Unlike somatostatin, which has a plasma half-life of a few minutes, octreotide has a plasma elimination half-Hfe of 1 to 2 hours. Excretion of the drug is primarily renal. 

Treatment of sulfonylurea-induced hypoglycemia and of overdose with sulfonylureas has been reviewed (69). If intravenous dextrose is insufficient, octreotide is recommended (70) but not diazoxide. In patients with insulin reserve, dextrose can stimulate insulin secretion and paradoxically worsen the condition. Patients with drug-induced hypoglycemia should not be given glucagon, since it will stimulate insulin secretion. Hypoglycemia can last for up to 5 days. Continued observation is important, because recurrence after temporary recovery is common. 

In 24 patients with acromegaly, glucose homeostasis was assessed before and after 6 months of either 2-weekly lanreotide (n = 14) or monthly octreotide (n = 10) (21). Insulin resistance and triglyceride concentrations improved. Glucose homeostasis, measured by HbAic, deteriorated. This was probably due to impaired insulin secretion. There were no distinct differences between the analogues, but the numbers were small. 

With the advent of new biotechnological techniques endogenous compounds like insulin, buserelin or octreotide have become available at affordable prices. All of these substances still have to undergo needle application. Until today the development of alternative delivery systems for the nasal, buccal, peroral, rectal and pulmonary routes for the administration of those class III drugs according to the biopharmaceutics classification system (BCS) (Amidon et al. 1995) could not keep pace with this development of endogenous compounds or is not economic enough for the health care payers (e.g. insulin application via the pulmonary route). 

Octreotide is a long-acting somatostatin analog that inhibits the secretion of serotonin, vasoactive intestinal peptide, gastrin, motilin, insulin, glucagons, secretin, and pancreatic polypeptide. It is used for the control of symptoms in patients with carcinoid and vasoactive intestinal peptide-secreting tumors (VIPomas). Its major toxicity is nausea and vomiting. 

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