In this episode, I’ll discuss when octreotide can be discontinued in patients with variceal bleeding.
When given to patients with variceal bleeding, octreotide helps achieve hemostasis and prevent rebleeding.
While it is a relatively inexpensive intervention at between $50 and $100 per day, octreotide does carry a high incidence of side effects, especially cardiovascular effects. As with any medication, it is desirable to limit use to the minimum duration necessary.
According to the evidence available, the duration of treatment with octreotide in variceal bleeding should be 5 days.
The two major studies that are used to support the benefits of octreotide in variceal bleeding used a 5-day duration of therapy:
In the European Acute Bleeding Oesophageal Variceal Episodes (ABOVE) trial at the end of 5 days, active bleeding from esophageal varices was less frequent in the octreotide group.
In another study published in NEJM in 1995 after five days, the proportion of patients who had survived without rebleeding was higher in the octreotide group.
Members of my Hospital Pharmacy Academy have access to my training video on treatment of patients with acute upper GI bleeding from a pharmacist’s point of view. It covers variceal and non-variceal bleeding, how care changes before and after endoscopy, and when to consider resuming anticoagulation. To sign up, go to pharmacyjoe.com/academy.
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