Octreotide

Octreotide is a synthetic cyclic octapeptide developed as SMS 201-995. Natural somatostatin is degraded within minutes; the analog lasts longer and permits practical treatment. Product forms include Sandostatin injection, Sandostatin LAR Depot and oral Mycapssa.

Octreotide mainly binds somatostatin receptor subtype 2. It suppresses growth hormone/IGF-1 and gastrointestinal mediators including serotonin, VIP and gastrin. In acromegaly this improves biochemical control and symptoms and can reduce pituitary-tumor size. In carcinoid syndrome it relieves flushing/diarrhea by reducing hormone output, and in VIPoma it controls severe secretory diarrhea. Symptom control is distinct from a universal tumor-shrinkage claim.

In metastatic midgut neuroendocrine tumors, PROMID found median time to tumor progression of 14.3 months with long-acting depot versus 6.0 months with placebo. That antiproliferative outcome is a named trial result, not an approved indication for every formulation or every neuroendocrine tumor.

Supporting references: progression.

FDA approved short-acting Sandostatin in 1988, followed roughly a decade later by monthly LAR Depot. Mycapssa was approved in 2020 for maintenance in acromegaly after response and tolerance to injectable somatostatin analogs. Depot and oral options can reduce the need for multiple daily injections, but their labeled eligibility and instructions remain product-specific.

Supporting references: approved.

Uses include acromegaly and control of carcinoid flushing/diarrhea or VIPoma-associated profuse diarrhea. The oral maintenance population is specifically people with acromegaly already responding to and tolerating injectable analogs, rather than a generic oral substitute for every use.

Diarrhea, abdominal pain, nausea, gas, injection-site pain, gallstones/biliary sludge and high or low glucose are reported. Longer treatment can produce gallbladder disease; glucose and thyroid function can change. Bradycardia and cardiac-conduction effects are additional serious considerations.