BNF for Children (BNFC) 2018-2019

eiiiiF 466

Octreotide 17-Oct-2016

lINDICATIONS AND DOSE

Persistent hyperinsulinaemic hypoglycaemia

unresponsive to diazoxide and glucose

▶BY SUBCUTANEOUS INJECTION

▶Neonate:Initially 2 – 5 micrograms/kg every 6 – 8 hours,

adjusted according to response; increased if necessary

up to 7 micrograms/kg every 4 hours, dosing up to

7 micrograms/kg may rarely be required.

▶Child:Initially 1 – 2 micrograms/kg every 4 – 6 hours,

adjusted according to response; increased if necessary

up to 7 micrograms/kg every 4 hours, dosing up to

7 micrograms/kg may rarely be required

Bleeding from oesophageal or gastric varices

▶BY CONTINUOUS INTRAVENOUS INFUSION

▶Child: 1 microgram/kg/hour, higher doses may be

required initially, when no active bleeding reduce dose

over 24 hours; Usual maximum 50 micrograms/hour

lUNLICENSED USENot licensed in children.
lINTERACTIONS→Appendix 1 : octreotide

lSIDE-EFFECTS

SIDE-EFFECTS, FURTHER INFORMATIONAdministering

non-depot injections of octreotide between meals and at

bedtime may reduce gastrointestinal side-effects.

lCONCEPTION AND CONTRACEPTIONEffective
contraception required during treatment.

lPREGNANCYPossible effect on fetal growth; manufacturer
advises use only if potential benefit outweighs risk.

lBREAST FEEDINGManufacturer advises avoid—present in
milk inanimalstudies.

lMONITORING REQUIREMENTS
▶Monitor thyroid function on long-term therapy.
▶Monitor liver function.

lTREATMENT CESSATIONAvoid abrupt withdrawal of short-
acting subcutaneous octreotide (associated with biliary
colic and pancreatitis).
lDIRECTIONS FOR ADMINISTRATIONForintravenous
injectionorintravenous infusion, dilute with Sodium
Chloride 0. 9 % to a concentration of 10 – 50 %.

lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Octreotide (Non-proprietary)
Octreotide (as Octreotide acetate) 50 microgram per
1mlOctreotide 50 micrograms/ 1 ml solution for injection pre-filled
syringes| 5 pre-filled disposable injectionP£ 18. 85 DT = £ 18. 85
Octreotide 50 micrograms/ 1 ml solution for injection ampoules|
5 ampouleP£ 14. 85 – £ 18. 60
Octreotide 50 micrograms/ 1 ml solution for injection vials|
5 vialP£ 22. 00 DT = £ 22. 00
Octreotide (as Octreotide acetate) 100 microgram per
1mlOctreotide 100 micrograms/ 1 ml solution for injection ampoules
| 5 ampouleP£ 32. 65 DT = £ 27. 97
Octreotide 100 micrograms/ 1 ml solution for injection pre-filled
syringes| 5 pre-filled disposable injectionP£ 30. 34 – £ 32. 90 DT =
£ 30. 34
Octreotide 100 micrograms/ 1 ml solution for injection vials|
5 vialP£ 32. 65 DT = £ 32. 65
Octreotide (as Octreotide acetate) 200 microgram per
1mlOctreotide 1 mg/ 5 ml solution for injection vials| 1 vialP
£ 65. 00 – £ 69. 66
Octreotide (as Octreotide acetate) 500 microgram per
1mlOctreotide 500 micrograms/ 1 ml solution for injection vials|
5 vialP£ 158. 25
Octreotide 500 micrograms/ 1 ml solution for injection ampoules|
5 ampouleP£ 169. 35 DT = £ 135. 47

Octreotide 500 micrograms/ 1 ml solution for injection pre-filled

syringes| 5 pre-filled disposable injectionP£ 154. 22 – £ 169. 00 DT

=£ 154. 22

▶Sandostatin(Novartis Pharmaceuticals UK Ltd)

Octreotide (as Octreotide acetate) 50 microgram per

1mlSandostatin 50 micrograms/ 1 ml solution for injection ampoules

| 5 ampouleP£ 14. 87

Octreotide (as Octreotide acetate) 100 microgram per

1mlSandostatin 100 micrograms/ 1 ml solution for injection ampoules

| 5 ampouleP£ 27. 97 DT = £ 27. 97

Octreotide (as Octreotide acetate) 500 microgram per

1mlSandostatin 500 micrograms/ 1 ml solution for injection ampoules

| 5 ampouleP£ 135. 47 DT = £ 135. 47

Powder and solvent for suspension for injection

▶Sandostatin LAR(Novartis Pharmaceuticals UK Ltd)

Octreotide (as Octreotide acetate) 10 mgSandostatin LAR 10 mg

powder and solvent for suspension for injection vials| 1 vialP

£ 549. 71 DT = £ 549. 71

Octreotide (as Octreotide acetate) 20 mgSandostatin LAR 20 mg

powder and solvent for suspension for injection vials| 1 vialP

£ 799. 33 DT = £ 799. 33

Octreotide (as Octreotide acetate) 30 mgSandostatin LAR 30 mg

powder and solvent for suspension for injection vials| 1 vialP

£ 998. 41 DT = £ 998. 41

4 Disorders of bone

metabolism

Bone metabolism

Disorders of bone metabolism

The two main disorders of bone metabolism that occur in

children are rickets and osteoporosis. The two most common

forms of rickets are Vitamin D deficiency rickets and

hypophosphataemic rickets. See also calcium.

Osteoporosis

Osteoporosis in children may be primary (e.g.osteogenesis

imperfectaandidiopathic juvenile osteoporosis), or secondary

(e.g. due to inflammatory disorders, immobilisation, or

corticosteroids); specialist management is required.

Corticosteroid-induced osteoporosis

To reduce the risk of osteoporosis doses of oral

corticosteroids should be as low as possible and courses of

treatment as short as possible.

Calcitonin

Calcitonin is involved with parathyroid hormone in the

regulation of bone turnover and hence in the maintenance of

calcium balance and homoeostasis. Calcitonin (salmon)

p. 471 (synthetic or recombinant salmon calcitonin) is used

by specialists to lower the plasma-calcium concentration in

children with hypercalcaemia associated with malignancy.

Bisphosphonates

A bisphosphonate such as pamidronate disodium p. 469 is

used in the management of severe forms ofosteogenesis

imperfectaand other causes of osteoporosis in children to

reduce the number of fractures; the long-term effects of

bisphosphonates in children has not been established. Single

doses of biphosphonates are also used to manage

hypercalcaemia. Treatment should be initiated under

specialist adviceonly.

Other drugs used for Disorders of bone metabolism

Calcitriol, p. 631

BNFC 2018 – 2019 Disorders of bone metabolism 467

Endocrine system

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