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Consensus statement: Octreotide dose titration in secretory diarrhea

Diarrhea management consensus development panel

  • Intestinal Disorders, Inflammatory Bowel Disease, Immunology, and Microbiology
  • Review Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Octreotide is an effective therapeutic option in controlling secretory diarrhea of varied etiology. However, marked patient-to-patient differences in the antidiarrheal effects necessitate titration of octreotide dose in individual patients to achieve optimal symptom control. A consensus development panel established guidelines for octreotide dose titration in patients with secretory diarrhea. Overall, the panel recommended an aggressive approach in selecting the initial octreotide dose and in making subsequent dose escalations in patients with secretory diarrhea due to gastrointestinal tumors (eg, carcinoids, VIPomas), AIDS, dumping syndrome, short bowel syndrome, radiotherapy, or chemotherapy. To avoid hypoglycemia in patients with diabetes mellitus-associated secretory diarrhea, the panel recommended a low initial octreotide dose and a conservative titration regimen with close monitoring of blood glucose levels. The end point of therapy should focus on a reduction in diarrhea (frequency of bowel movements or stool volume) rather than normalization of hormonal profile. Overall, octreotide is well tolerated; principal side effects are transient injection site pain and gastrointestinal discomfort. For many patients with secretory diarrhea, octreotide therapy is expected to improve the overall health and quality of life and in the long run will lessen health care costs.

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References

  1. Cascinu S, Fedeli A, Fedeli SL, Catalano G: Octreotide versus loperamide in the treatment of fluorouracil-induced diarrhea: A randomized trial. J Clin Oncol 11:148–151, 1993

    Google Scholar 

  2. Cascinu S, Fedeli A, Fedeli SL, Catalano G: Control of chemotherapy-induced diarrhoea with octreotide in patients receiving 5-fluorouracil. Eur J Cancer 28:482–483, 1992

    Google Scholar 

  3. Petrelli NJ, Rodriguez-Bigas M, Rustum Y, Herrera L, Creaven P: Bowel rest, intravenous hydration, and continuous high-dose infusion of octreotide acetate for the treatment of chemotherapy-induced diarrhea in patients with colorectal carcinoma. Cancer 72:1543–1546, 1993

    Google Scholar 

  4. Gebbia V, Carreca I, Testa A, Valenza R, Curto G, Carrata G, Borsellino N, Latteri MA, Cipolla C, Florenza M, Gebbia N: Subcutaneous octreotide versus oral loperamide in the treatment of diarrhea following chemotherapy. Anticancer Drugs 4:443–445, 1993

    Google Scholar 

  5. Battershill PE, Clissold SP: Octreotide. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in conditions associated with excessive peptide secretion. Drugs 38:658–702, 1989

    Google Scholar 

  6. Dunne MJ, Elton R, Fletcher T, Hofker P, Shui J: Somatostatin and gastroenteropancreatic endocrine tumors—therapeutic characteristics.In Somatostatin in the Treatment of GEP Endocrine Tumors. TM O'Dorisio (ed). Berlin, Springer-Verlag, 1989, pp 93–115

    Google Scholar 

  7. Maton PN, Gardner JD, Jensen RT: Use of long-acting somatostatin analog SMS 201-995 in patients with pancreatic islet cell tumors. Dig Dis Sci 34:28S-39S, 1989

    Google Scholar 

  8. Vinik A, Moattari AR: Use of somatostatin analog in management of carcinoid syndrome. Dig Dis Sci 34(suppl):14S-27S, 1989

    Google Scholar 

  9. Gorden P, Comi RJ, Maton PN, Go VLW: NIH Conference: Somatostatin and somatostatin analogue (SMS 201-995) in treatment of hormone-secreting tumors of the pituitary and gastrointestinal tract and non-neoplastic diseases of the gut. Ann Intern Med 110(1):35–50, 1989

    Google Scholar 

  10. Bianco JA, Higano C, Singer J, Appelbaum FR, McDonald GB: The somatostatin analog octreotide in the management of the secretory diarrhea of the acute intestinal graft-versus-host disease in a patient after bone marrow transplantation. Transplantation 49:1194–1195, 1990

    Google Scholar 

  11. Farthing MJG: Octreotide in dumping and short bowel syndromes. Digestion 54(suppl 1):47–52, 1993

    Google Scholar 

  12. Tsai S-T, Vinik AI, Brunner JF: Diabetic diarrhea and somatostatin. Ann Intern Med 104:894, 1986, (abstract)

    Google Scholar 

  13. Mourad FH, Gorard D, Thillainayagam AV, Colin-Jones D, Farthing MJ: Effective treatment of diabetic diarrhoea with somatostatin analogue, octreotide. Gut 33:1578–1580, 1992

    Google Scholar 

  14. Walker JJ, Kaplan DS: Efficacy of the somatostatin analog octreotide in the treatment of two patients with refractory diabetic diarrhea. Am J Gastroenterol 88:765–767, 1993

    Google Scholar 

  15. Harris AG: Octreotide in the treatment of disorders of the gastrointestinal tract. Drug Invest 4 (suppl 3):1–54, 1992

    Google Scholar 

  16. Miskovitz PF, Rochwarger AM: Diarrhea due to hormones, regulatory peptides, and circulating humoral messengers.In The Evaluation and Treatment of the Patient with Diarrhea. PF Miskovitz, AM Rochwarger (eds): Boston, Andover Medical Publishers, 1993, pp 135–146

    Google Scholar 

  17. Davis GR, Camp RC, Raskin P, Krejs GJ: Effect of somatostatin infusion on jejunal water and electrolyte transport in a patient with secretory diarrhea due to malignant carcinoid syndrome. Gastroenterology 78:346–349, 1980

    Google Scholar 

  18. Ruskone A, Rene E, Choyvialle J, Bonin H, Pignal F, Kremer M: Effect of somatostatin on diarrhea and on small intestinal water and electrolyte transport in a patient with pancreatic cholera. Dig Dis Sci 27:459–466, 1982

    Google Scholar 

  19. Dharmsathaphorn K, Sherwin RS, Cataland S: Somatostatin inhibits diarrhea in the carcinoid syndrome. Ann Intern Med 92:68–69, 1980

    Google Scholar 

  20. Mulvihill S, Passaro EJ, Debas H, Yamada T: Severe diarrhea after colonic pseudo-obstruction: Treatment with somatostatin. N Engl J Med 310(7):467–468, 1984

    Google Scholar 

  21. Quatrini M, Basilisco G, Conte D, Bozzani A, Bardella MT, Bianchi PA: Effects of somatostatin infusion in four patients with malignant carcinoid syndrome. Am J Gastroenterol 78:149–151, 1983

    Google Scholar 

  22. Katz MD, Erstad BL: Octreotide, a new somatostatin analogue. Clin Pharmacol 8:255–273, 1989

    Google Scholar 

  23. Liberti A, Bisogno A, Izzo E: Octreotide treatment in secretory and cryptosporidial diarrhea in patients with acquired immunodeficiency syndrome (AIDS): Clinical evaluation. J Chemother 4:303–305, 1992

    Google Scholar 

  24. Fassler JE, O'Dorisio TM, Mekhjian HS, Gaginella TS: Octreotide inhibits increases in short-circuit current induced in rat colon by VIP, substance P, serotonin, and aminophylline. Regul Pept 29:189–197, 1990

    Google Scholar 

  25. Fassler JE, O'Dorisio TM, Goddard CG, Gaginella TS: Peptides of human immunodeficiency virus (HIV) evoke rat colonic electrolyte secretion inhibitable by the somatostatin analog octreotide. Life Sci 48:13–17, 1991

    Google Scholar 

  26. Lamberts SWJ, Hofland LJ, van Koetsveld PM, Reubi JC, Bruining HA, Bakker WH, Krenning EP: Parallelin vivo andin vitro detection of functional somatostatin receptors in human endocrine pancreatic tumors: Consequences with regard to diagnosis, localization, and therapy. J Clin Endocrinol Metab 71:566–574, 1990

    Google Scholar 

  27. Reubi JC, Landolt AM: The growth hormone responses to octreotide in acromegaly correlate with adenoma somatostatin receptor status. J Clin Endocrinol Metab 68:844–850, 1989

    Google Scholar 

  28. Reubi JC, Laissue J, Krenning E, Lamberts SWJ: Somatostatin receptors in human cancer: Incidence, characteristics, functional correlates and clinical implications. J Steroid Biochem Mol Biol 43:27–35, 1992

    Google Scholar 

  29. Plockinger U, Dienemann D, Quabbe HJ: Gastrointestinal side effects of octreotide during long term treatment of acromegaly. J Clin Endocrinol Metab 71:1658–1662, 1990

    Google Scholar 

  30. Dowling RH, Hussaini SH, Murphy GM, Besser GM, Wass JAH: Gallstones during octreotide therapy. Metabolism 41(suppl 2):22–33, 1992

    Google Scholar 

  31. Debas HT, Gittes G: Somatostatin analogue therapy in functioning neuroendocrine gut tumors. Digestion 54 (suppl 1):68–71, 1993

    Google Scholar 

  32. Marsh HM, Martin JKJ, Kvols LK, Gracey DR, Warner MA, Warner ME, Moertel CG: Carcinoid crisis during anesthesia: Successful treatment with a somatostatin analogue. Anesthesiology 66(1):89–91, 1987

    Google Scholar 

  33. Bissonnette RT, Gibney RG, Berry BR, Buckley AR: Fatal carcinoid crisis after percutaneous fine-needle biopsy of hepatic metastasis: Case report and literature review. Radiology 174:751–752, 1990

    Google Scholar 

  34. Lubeck DP, Bennett CL, Mazonson PD, Fifer SK, Fries JF: Quality of life and health service use among HIV-infected patients with chronic diarrhea. J Acquir Immune Defic Syndr 6:478–484, 1993

    Google Scholar 

  35. Moroni M, Esposito R, Cernuschi M, Franzetti F, Carosi GP, Fiori GP: Treatment of AIDS-related refractory diarrhoea with octreotide. Digestion 54(suppl 1):30–32, 1993

    Google Scholar 

  36. Cello JP, Grendell JH, Basuk P, Simon D, Weiss L, Wittner M, Rood RP, Wilcox CM, Forsmark CE, Read AE, Satow JA, Weikel CS, Beaumont C: Effect of octreotide on refractory AIDS-associated diarrhea. A prospective multicenter clinical trial. Ann Intern Med 115:705–710, 1991

    Google Scholar 

  37. Cascinu S, Fedeli A, Fedeli SL, Catalano G: Control of chemotherapy-induced diarrhea with octreotide. Oncology 51:70–73, 1994

    Google Scholar 

  38. Ohnuma T, Holland JF: Nutritional consequences of cancer chemotherapy and immunotherapy. Cancer Res 37:2395–2406, 1977

    Google Scholar 

  39. Ely P, Dunitz J, Rogosheske J, Weisdorf D: Use of somatostatin analogue, octreotide acetate, in the management of acute gastrointestinal graft-versus-host disease. Am J Med 90:707–710, 1991

    Google Scholar 

  40. Feldman M, Schiller LR: Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 98:378–384, 1983

    Google Scholar 

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, The Ohio State University College of Medicine, N-1123 Doan Hall, 410 West 10th Avenue, 43210-1228, Columbus, Ohio

    A. G. Harris,  T. M. O'Dorisio, E. A. Woltering, L. B. Anthony, F. R. Burton, R. B. Geller, J. H. Grendell, B. Levin & J. S. Redfern

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  1. A. G. Harris
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  2. T. M. O'Dorisio
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  3. E. A. Woltering
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  4. L. B. Anthony
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  5. F. R. Burton
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  6. R. B. Geller
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  7. J. H. Grendell
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  8. B. Levin
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  9. J. S. Redfern
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Additional information

Development of this manuscript was supported by an educational grant from Sandoz Pharmaceuticals Corporation, East Hanover, New Jersey.

Members of the Consensus Development Panel were: Thomas M. O'Dorisio, MD (co-chairman), Division of Endocrinology and Metabolism, The Ohio State University College of Medicine, Columbus, Ohio; Alan G. Harris, MD (co-chairman), Division of Clinical Pharmacology, Department of Medicine, Cedars-Sinai Medical Center/UCLA School of Medicine, Los Angeles, California; Lowell B. Anthony, MD, Division of Medical Oncology, The Vanderbilt Clinic, Nashville, Tennessee; Frank R. Burton, MD, Division of Gastroenterology Hepatology, St. Louis University Medical Center, St. Louis, Missouri; Robert B. Geller, MD, Director, Leukemia Service, The Emory Clinic, Atlanta, Georgia; James H. Grendell, MD, Division of Gastroenterology, San Francisco VA Medical Center, San Francisco, California; Bernard Levin, MD, Department of Gastrointestinal Oncology, MD Anderson Cancer Center, Houston, Texas; and Eugene A. Woltering, MD, Department of Surgery, Louisiana State University, New Orleans, Louisiana; Jan Stephanie Redfern, PhD, formerly Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.

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Harris, A.G., O'Dorisio, T.M., Woltering, E.A. et al. Consensus statement: Octreotide dose titration in secretory diarrhea. Digest Dis Sci 40, 1464–1473 (1995). https://doi.org/10.1007/BF02285194

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  • DOI: https://doi.org/10.1007/BF02285194

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