Octreotide injection for hyperinsulinemia

What is octreotide?

Octreotide is a medication used to treat hyperinsulinemia, a condition where the body makes too much insulin. Insulin is a hormone that helps to keep blood glucose (blood sugar) levels normal. However, too much insulin can cause low blood glucose levels.

Low blood sugar can be very dangerous because sugar is the main energy source for the brain and the body. If the brain does not get the glucose it needs, it may lead to seizures, coma and death.

Octreotide acts by lowering the levels of insulin the body makes.

You may hear octreotide called by its brand name, Sandostatin, among others.

Octreotide comes as a clear liquid for injection. It is given by a needle just under the skin (subcutaneously or sc).

What do you need to know before giving your child octreotide?

Before starting octreotide, your health-care team will order blood tests as well as an ultrasound of your child's liver and gallbladder.

Tell your health-care provider if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:

• a latex allergy, as some octreotide products contain latex
• kidney disease
• liver disease
• heart problems, particularly heart failure or heart rhythm problems
• low thyroid

How is octreotide given?

Octreotide is an injection given by a needle in the subcutaneous fat (the fat just underneath the skin). It is usually given every eight hours, but check with your health-care provider as your child's dosing schedule may be different.

What should you do if your child misses a dose of octreotide?

• If your child has missed their injection, please give the injection as soon as you remember and reach out to your health-care team.
• Do not give two doses of octreotide to make up for a missed dose.

How long does octreotide take to work?

Octreotide starts to work within an hour after the subcutaneous injection to treat hyperinsulinemia.

What are the possible side effects of octreotide?

Octreotide lowers insulin levels in the body and can sometimes lead to blood sugars that are too high. If blood sugars remain high for a long period of time, this can lead to diabetes, which can be dangerous for your child. If you note blood sugars that are rising above 8 mmol/L, contact your health-care team to review; the dose of octreotide may be adjusted.

Local reactions at the injection site include pain, tingling, stinging and/or burning, as well as redness and/or swelling. These are quite common but should not be severe. If you are concerned, please speak to your health-care team.

Your child may have some of these side effects while they are receiving octreotide. Check with your child's health-care provider if your child continues to have any of these side effects, and they do not go away, or they bother your child:

• sweating
• high blood pressure
• low heart rate
• upset stomach or feeling nauseous
• feeling bloated and/or passing lots of gas
• vomiting (throwing up)
• dizziness
• headache
• feeling tired
• changes in bowel habits (either constipation or diarrhea)
• hair loss
• joint pain
• unexpected weight gain or loss

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's health-care provider right away or take your child to Emergency if your child has any of these side effects:

• extremely bad pain in abdomen, particularly the upper-right side of the abdomen, especially if there is also an unexplained fever
• yellowing of the skin or whites of the eyes (this may be a sign of a severe liver problem called jaundice)
• severe skin rash, or hives (raised, red itchy areas on the skin)
• trouble breathing, wheezing or shortness of breath
• swelling of face, lips, tongue or throat

What safety measures should be taken while your child is on octreotide?

There are some medicines that should not be taken together with octreotide, or, in some cases, the dose of octreotide or the other medicine may need to be adjusted if they are taken together. It is important that you tell your health-care provider if your child takes any other medications (prescription, over the counter or herbal), including:

• cyclosporine
• digoxin
• other medications that affect blood sugar levels
• hormonal contraceptives (octreotide may decrease the effectiveness of contraceptives; alternative contraceptive methods need to be used)
• antibiotics of the quinolone class (e.g., ciprofloxacin, moxifloxacin, levofloxacin)
• selective serotonin reuptake inhibitors (SSRIs; e.g., sertraline, fluoxetine, citalopram)

During treatment, your child will need regular blood work as well as an ultrasound of the liver and gallbladder every six to 12 months.

Please continue to monitor your child's blood glucose and contact your health-care team as directed.

Because octreotide affects insulin levels, and insulin has many effects throughout the body apart from blood sugar regulation, it is possible for octreotide to have other unexpected side effects apart from the ones listed above.

Please bring up any concerns you may have about changes in your child's growth and development to your health-care team.

What other important information should you know about octreotide?

• The use of octreotide is currently off label, meaning the medication is being used to treat a condition/disease that it has not been approved to treat. While this does not mean that it is hazardous, your child's health-care provider should discuss this with you before use.
• Do not share your child's medication with others and do not give anyone else's medication to your child.
• Make sure you always have enough octreotide to last through weekends, holidays and vacations. Call your pharmacy at least two days before your child runs out of medicine to order refills.
• Do not keep any medications that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medications.

Keep octreotide out of your child’s sight and reach and locked up in a safe place. If your child takes too much octreotide, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.