What Is Octreotide?

Octreotide is a synthetic analog of the natural hormone somatostatin. It is FDA-approved for the treatment of acromegaly (excess growth hormone), carcinoid syndrome (severe diarrhea and flushing from metastatic carcinoid tumors), and VIPomas (watery diarrhea from vasoactive intestinal peptide-secreting tumors). The oral capsule form, Mycapssa, is approved for long-term maintenance in acromegaly patients who have responded to injectable octreotide or lanreotide.

Beyond its approved uses, Octreotide is widely used off-label for gastroenteropancreatic neuroendocrine tumors, esophageal variceal bleeding, hepatorenal syndrome, dumping syndrome, refractory diarrhea, and prevention of carcinoid crisis during surgery.

How Does Octreotide Work?

Octreotide mimics the action of somatostatin, a hormone that naturally inhibits the release of many other hormones and biological substances. It works by binding to somatostatin receptors (primarily SSTR2 and SSTR5) on target cells throughout the body.

Once bound, Octreotide activates inhibitory G proteins, which suppress adenylyl cyclase activity and modulate calcium channels. This cascade results in:

• Reduced secretion of growth hormone, insulin, glucagon, and gastrointestinal peptides
• Decreased splanchnic blood flow, which helps control variceal bleeding
• Inhibited release of vasoactive intestinal peptide (VIP), reducing watery diarrhea in VIPoma patients
• Smooth muscle contraction in the GI tract

The LAR (long-acting release) formulation uses biodegradable microspheres that slowly release Octreotide over approximately 4 weeks, allowing once-monthly dosing.

What Doses Are Available for Octreotide?

• Immediate-release injection: 50 mcg/mL, 100 mcg/mL, 200 mcg/mL, 500 mcg/mL, and 1000 mcg/mL vials
• Sandostatin LAR Depot (intramuscular): 10 mg, 20 mg, and 30 mg kits
• Generic Octreotide LAR (Teva): 10 mg, 20 mg, and 30 mg kits
• Bynfezia Pen (subcutaneous): 50 mcg, 100 mcg, and 500 mcg per injection (discontinued by Sun Pharma in 2021)
• Mycapssa oral capsules: 20 mg delayed-release capsules

How Hard Is It to Find Octreotide in Stock?

Octreotide has a findability score of 45 out of 100, meaning it is frequently difficult to find — especially in LAR (long-acting) formulations. As of 2025–2026, intermittent shortages have been reported across manufacturers, particularly for LAR depot kits. Sagent has reported manufacturing delays for immediate-release injection, and Teva's generic LAR 20 mg kit has experienced back-order issues.

Generic immediate-release octreotide injection is available from multiple manufacturers (Avet, Fresenius Kabi, Hikma, Sagent), so the subcutaneous form is generally easier to find. However, the LAR formulations — which are the most commonly used for long-term maintenance — remain supply-constrained due to manufacturing complexity of the microsphere formulation and a limited number of producers.

If you're having trouble finding Octreotide, Medfinder can help locate pharmacies with current stock near you.

Who Can Prescribe Octreotide?

Octreotide is typically prescribed by specialists, including:

• Endocrinologists — for acromegaly and other hormone-related conditions
• Oncologists — for carcinoid syndrome and neuroendocrine tumors
• Gastroenterologists — for VIPomas, variceal bleeding, and refractory diarrhea
• Hepatologists — for hepatorenal syndrome and portal hypertension
• Surgeons — for perioperative use to prevent carcinoid crisis

Most insurance plans require the prescriber to be a specialist or to have specialist consultation for prior authorization approval. Octreotide LAR must be administered by a healthcare professional, while immediate-release injections can often be self-administered at home after training.

Is Octreotide a Controlled Substance?

No, Octreotide is not a controlled substance. It does not have a DEA schedule classification. However, access to Octreotide is still tightly regulated through insurance prior authorization requirements, specialty pharmacy distribution for LAR formulations, and prescriber specialty restrictions on many plans.

Common Side Effects of Octreotide

• Diarrhea (up to 58% of patients)
• Abdominal pain (up to 44%)
• Nausea (up to 30%)
• Flatulence and bloating
• Constipation
• Headache and dizziness
• Fatigue
• Injection site pain or reactions
• Gallstones (up to 27% with long-term use)
• Hyperglycemia or hypoglycemia
• Steatorrhea (fatty stools)

Serious side effects can include gallstones requiring surgery, pancreatitis, bradycardia, severe blood sugar changes, hypothyroidism, and intestinal obstruction. Long-term users should have regular gallbladder monitoring.

Alternative Medications to Octreotide

• Lanreotide (Somatuline Depot) — Another somatostatin analog given as a deep subcutaneous injection every 4 weeks. FDA-approved for acromegaly and gastroenteropancreatic neuroendocrine tumors, with a prefilled syringe for easier administration.
• Pasireotide (Signifor / Signifor LAR) — A second-generation somatostatin analog that binds to a broader range of receptors (SSTR1, 2, 3, and 5). Used for acromegaly when first-generation SSAs are not adequate, and for Cushing's disease. Higher risk of hyperglycemia.
• Pegvisomant (Somavert) — A growth hormone receptor antagonist for acromegaly. Works by blocking GH action rather than suppressing release. Used when somatostatin analogs are not fully effective.
• Telotristat Ethyl (Xermelo) — A tryptophan hydroxylase inhibitor used alongside somatostatin analogs for carcinoid syndrome diarrhea not adequately controlled by SSA therapy alone.

Drug Interactions with Octreotide

• Cyclosporine — Octreotide may decrease cyclosporine blood levels; close monitoring and dose adjustment required
• Insulin and oral diabetes medications — Octreotide can raise or lower blood sugar unpredictably; antidiabetic doses may need adjustment
• Beta-blockers — Additive risk of bradycardia (slow heart rate); dose adjustment may be needed
• Bromocriptine — Octreotide increases bromocriptine bioavailability
• Calcium channel blockers — Potential for additive heart rate reduction
• Digoxin — Octreotide may affect absorption
• Oral contraceptives — May reduce effectiveness due to altered GI absorption
• QT-prolonging medications — Potential additive risk of cardiac rhythm changes

Always inform your prescriber of all medications you are taking, including over-the-counter drugs and supplements. Mycapssa oral capsules must be taken on an empty stomach for proper absorption.

Final Thoughts on Octreotide

Octreotide is a critical medication for patients with acromegaly, carcinoid syndrome, and neuroendocrine tumors. While generic immediate-release injections are relatively affordable, the LAR depot formulations that most patients rely on for convenient once-monthly dosing remain expensive and can be challenging to find due to ongoing supply constraints.

If you're struggling to locate Octreotide — particularly the LAR formulation — in stock at your pharmacy, Medfinder can help you search for pharmacies with current availability near you. For financial assistance, ask your doctor about Novartis Patient Support copay cards or patient assistance programs through the PAN Foundation and HealthWell Foundation.