Octreotide for chemotherapy induced diarrhea – pro
Chemotherapy-induced diarrhea is a common complication of chemotherapy. The first steps are stopping the chemo, hydration and anti-diarrheal agents. Several small trials have reported good results using subcutaneously administered, short-acting octreotide acetate in patients who have failed initial therapy with loperamide. Although several recent studies appear to show that octreotide is not effective in prophylaxis, it continues to be recommended in review articles and guidelines. While the optimal dose of octreotide has not been determined, a panel of experts has recommended that complicated cases of diarrhea should be managed with IV fluids, octreotide at a starting dose of 100 to 150 μg subcutaneously (SC) 3 times a day or 25 to 50 μg/hour IV with a dose escalation to 500 μg 3 times a day, and administration of antibiotics. This regimen should be continued until the patient has been diarrhea free for 24 hours.
Based on these, admittedly older guidelines, octreotide is still “supported”. NCCN on PLA-19 also recommends it for grade 3-4 diarrhea.
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NCCN, Palliative Care PAL-19, 2020