Ryan E, Rushton W. Variations in Octreotide Dosing in Published Reports of Sulfonylurea Toxicity: A Systematic Review, 1988-Present.
J Med Toxicol 2025;
21:260-275. [PMID:
39821850 PMCID:
PMC11933575 DOI:
10.1007/s13181-024-01054-5]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 12/13/2024] [Accepted: 12/13/2024] [Indexed: 01/19/2025] Open
Abstract
BACKGROUND
Octreotide is commonly used to treat hypoglycemia due to sulfonylurea toxicity, but optimal dosing for this indication is not well defined.
METHODS
We performed a systematic review to identify cases in the medical literature of octreotide use for sulfonylurea poisoning. Literature published on octreotide and sulfonylureas between octreotide's FDA approval on 10/21/1988 and 8/15/2024 was reviewed.
RESULTS
Eighty unique patient cases (66 adults/adolescents and 14 pediatric patients) from 61 sources were included in the final analysis. These included 41 octreotide dosing strategies that differed in dose, frequency, and/or route of administration. Subcutaneous dosing, primarily within the range of 50-100 mcg per dose at a frequency of every 6-8 h, was the most common regimen in adults while intravenous dosing of 1 mcg/kg was most prevalent in pediatrics. There were no significant differences in duration of therapy or total dose of octreotide in adults with intermittent subcutaneous vs intravenous dosing. Treatment of hypoglycemia and maintenance of euglycemia was similar among all routes of administration. Infusions had similar durations but higher total doses of octreotide. Higher intermittent bolus doses were associated with shorter durations of therapy. Intentional exposures were associated with higher doses and longer duration of treatment with octreotide. Three adverse reactions to octreotide were reported. Except for 2 cases, all patients survived without any long-term complications.
CONCLUSION
Despite widespread variation in octreotide dosing and administration, our report showed similar efficacy and safety with various octreotide dosing practices.
Collapse