How should octreotide be prescribed for optimal symptom control?
The optimum approach for using this drug is to initiate therapy in the form of s.c. injections of the IR formulation for 3 7 days to test for tolerability before giving the LAR formulation i.m. The s.c. injections should be continued for 14 days after the LAR injection since therapeutic levels are not achieved until that time. It is important to emphasize to the patient that the IR octreotide should be used for breakthrough symptoms after the start of LAR treatment. The use of this as rescue medication is vital to optimize control of the symptoms. The initial dose of IR octreotide may range from 100 to 500 µg s.c., two to four times daily. A reasonable starting dose is 150 µg s.c. three times daily (t.i.d.). Some investigators prefer continuous s.c. infusion of octreotide by pump at a dose of 1000 2000 µg daily. The dose of IR octreotide may be escalated until maximum control of symptoms is achieved by doubling the dose at 3- or 4-day intervals. The majority of patients will prefer the
