Octreotide variceal bleeding

Dizziness occurred in 7.4% of 68 patients randomized to somatostatin and 8.2% of 73 randomized to octreotide, both by rapid infusion, to control variceal bleeding, in which the effectiveness of somatostatin and its analogues is probably via a transient reduction in heart rate and cardiac output (13). 

In a meta-analysis of trials for variceal bleeding, hyperglycemia occurred in 41 of 310 patients who received somatostatin, octreotide, or vapreotide, compared with 26 of 318 patients who received placebo (19). 

Hadengue A. Somatostatin or octreotide in acute variceal bleeding. Digestion 1999 60(Suppl 2) 31—41. 

Zhang HB, Wong BC, Zhou XM, Guo XG, Zhao SJ, Wang JH, Wu KC, Ding J, Lam SK, Fan DM. Effects of somatostatin, octreotide and pitressin plus nitroglycerine on systemic and portal haemodynamics in the control of acute variceal bleeding. Int J Clin Pract 2002 56(6) 447-51. 

Corley DA, Cello JP, Adkisson W, Ko WF, Kerhkowske K. Octreotide for acute esophageal variceal bleeding a metaanalysis. Gastroenterology 2001 120(4) 946-54. 

Erstad BL. Octreotide for acute variceal bleeding. Ann Pharmacother 2001 35(5) 618-26. 

There has been one report of acute pulmonary edema during octreotide and intravenous fluid therapy for variceal bleeding (7). 

Octreotide is the preferred vasoactive agent employed in the medical management of variceal bleeding. Vasopressin... 

Variceal bleeding Pharmacologic prophylaxis Endoscopy, vasoactive drug therapy (octreotide), sclerotherapy, volume resuscitation, pharmacologic prophylaxis Child-Pugh score, endoscopy, CBC CBC, evidence of overt bleeding Appropriate reduction in heart rate and portal pressure Acute control acute bleed Chronic variceal obliteration, reduce portal pressures... 

Octreotide (Sandostatin) injection is commercially available in the United States for subcutaneous or intravenous administration. A long-acting intramuscular formulation of octreotide (Sandostatin EAR) is also available for monthly administration. In addition to the treatment of acromegaly, octreotide has many other therapeutic uses, including the treatment of carcinoid tumors, vasoactive intestinal peptide tumors (VIPomas), gastrointestinal fistulas, variceal bleeding, diarrheal states, and irritable bowel syndrome. 

Octreotide for IV injection is used in the treatment of acute bleeding from esophageal varices. Variceal bleeding occurs in about half the patients with cirrhosis of the liver and is responsible for about one-third of deaths in these patients. Octreotide is a potent vasoconstrictor that reduces portal and collateral blood flow by constricting visceral vessels, which leads to reduced portal blood pressure and decreases the bleeding. 

Vasoactive drug therapy (somatostatin, octreotide, or terlipressin) to stop or slow bleeding is routinely employed early in patient management to allow stabilization of the patient and to permit endoscopy to proceed under more favorable conditions. These agents decrease splanchnic blood flow and reduce portal and variceal pressures, without significant adverse effects. 

Active bleeding. Acutely bleeding varices can be treated by injection sclerotherapy, by tamponade and by infusion systemically of vasopressin analogues or octreotide (which reduce variceal pressure). Results of controlled trials generally reflect efficacy in oesophageal rather than gastric variceal disease, which form a minority of cases, and can be more difficult to manage. 

Octreotide Sandostatin) is a synthetic somatostatin analogue. It is used in a variety of situations and must be given subcutaneously or intravenously. Most commonly, it is used as a continuous intravenous infusion in patients hospitalized with bleeding varices, because it de-... 

G. Other applications Octreotide has been reported to be effective in treating noninfectious diarrhea and diarrhea in patients with AIDS, and as an adjunct to endoscopic variceal ligation, to reduce recurrent bleeding from esophageal varices. Micromedex lists many other potential uses. 

Octreotide Somatostatin analog mechanism not certain May alter portal blood flow and variceal pressures Patients with bleeding varices or at high risk of repeat bleeding Reduced endocrine and exocrine pancreatic activity other endocrine abnormalities GI upset... 

Although vasopressin and its analogues have been used in the acute management of bleeding esophageal varices, they do not reduce mortality (2,3) and the rate of adverse effects is higher than with octreotide (3). 

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