INSIGHTS FROM: ZOZO GREENHOLZ, RN; ANDREW E. HENDIFAR, MD; ERIC LIU, MD, FACS; MARIAH MAHOTZ, RN, BSN, OCN
Thursday, January 23, 2020
Eric Liu, MD, FACS: The dosing of octreotide and lanreotide really varies and is up to the physician. If we start with octreotide, because it’s the older version, it comes in essentially 4 versions. The first version is what we call rescue octreotide. It’s a subcutaneous injection. You give it multiple times a day, and it’s mostly for symptom control. But when it comes to giving the long-acting repeatable version, the LAR version, it comes in 3 doses: 10 mg, 20 mg, and 30 mg.
What’s recommended is actually to help with the symptoms and to use the rescue version first. You make sure they tolerate it well and start with 20 mg, because then you increase the dose or decrease the dose. Of course, if someone has other issues, like liver problems or kidney problems, you may want to start at an even lower dose. But most patients go to 30 mg, and that’s the most common standard dose for octreotide.
Lanreotide is slightly different. It has 2 indications. One indication is for tumor control as well as symptom control. Lanreotide comes in 3 doses as well: 60 mg, 90 mg, and 120 mg. The recommended dose by the FDA for tumor control is 120 mg every 4 weeks, and that’s usually where we start. Of course the dosing is really up to the discretion of the physician. But if there are issues—for example, the patient doesn’t tolerate the higher dose so much or is very, very small, those are things to consider—reducing the dose is certainly something to consider. But it all depends, and we really leave it up to the discretion of the physician.