DRUG	SUPPLIED	DOSE	COMMENTS
OCTREOTIDE (Paeds) (Sandostatin) Mechanism of action: Long-acting analogue of somatostatin; inhibits release of vasodilator hormones to indirectly cause splanchnic vasoconstriction and decreased portal inflow Ref: 1, 32, 44, 209, 468, 469, 470 Last update: 2019-08-08	injection: 50 mcg/mL, 100 mcg/mL, 500 mcg/mL	Children: Secretory Diarrhea: 0.5-5 mcg/kg/dose SC Q12H. Dose may be increased by 0.3 mcg/kg/dose every 3 days as needed. Doses as high as 30 mcg/kg/24 hr (maximum 1500 mcg/24 hr) have been used in patients with high output secretory diarrhea. Severe Gastrointestinal Bleeding: Loading dose: 1-2 mcg/kg/dose IV bolus over 2-5 min. followed by 1-2 mcg/kg/hr by continuous IV infusion. Titrate infusion rate, based on response, to a maximum of 10 mcg/kg/hr. When there is no active bleeding for 24 hours, taper dose by 50% every 12 hours, and therapy may be discontinued when the dose is 25% of the initial dose. Hyperinsulinemic Hypoglycemia: Initial dose: 0.5-2.5 mcg/kg/dose SC Q6H or 0.7-3 mcg/kg/dose SC Q8H (2-10 mcg/kg/day) Titrate to effect by increasing dose or frequency (every 3-4 hours) up to a maximum of 30 mcg/kg/day. Chylothorax: Continuous IV infusion: Initial rate: 0.5 -1 mcg/kg/hr. May increase by 1 mcg/kg/hr daily, based on response, to a max of 10 mcg/kg/hr. Usual range is 0.5-4 mcg/kg/hr IV intermittent: Initial: 10 mcg/kg/24 hr IV div. Q8H. Increase by 5-10 mcg/kg/24 based on response to a max of 40 mcg/kg/24 hr Subcutaneous: Initial: 10 mcg/kg/24 hr SC div. Q8H Increase by 5-10 mcg/kg/24h based on response to a max of 40 mcg/kg/24 hr Sulfonylurea Toxicity: Refer to Drug and Poison Information Centre	Somatostatin analogue. Dosing in infants and children is based on limited data. Monitor blood glucose at onset of therapy and periodically. Local reaction at the injection site may be reduced by allowing solution to reach room temperature and administering slowly. Potential drug interactions: Caution with QTcprolonging agents. May decrease cyclosporine concentrations. May cause cholelithiasis, biliary sludge, blood glucose changes, hypothyroidism, GI effects, transient elevation in liver enzymes, dry mouth, headache and dizziness. There have been case reports of necrotizing enterocolitis with the use of octreotide in neonates and infants Continuous IV infusion is not compatible with IV lipids 1 mcg/kg/hr IV infusion is equivalent to 18 mcg/kg/24 hr SC div. Q8H Standard Prescription: octreotide__mcg SC Q__H (__mcg/kg/24hr) octreotide__mcg IV x 1 loading dose (__mcg/kg/dose) octreotide __mcg/kg/hr continuous IV infusion