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Octreotide Ameliorates Sulfonylurea-Induced Hypoglycemia

Apr 29, 2008

Administration of octreotide (brand name Sandostatin, Novartis Pharmaceuticals) increases serum glucose levels in patients with sulfonylurea-induced hypoglycemia, according to a report in the April Annals of Emergency Medicine.

Dr. Charles J. Fasano from Albert Einstein Medical Center, Philadelphia reports that, "Patients with sulfonylurea-induced hypoglycemia are at high risk for persistent hypoglycemia", and that “octreotide is an effective treatment in this clinical scenario."

Dr. Fasano and associates investigated whether administration of octreotide acetate in addition to standard therapy increased serum glucose levels measured at serial intervals in 40 patients presenting to the emergency department with sulfonylurea-induced hypoglycemia.

Patients given octreotide had consistently higher glucose values than did patients given placebo during the first 8 hours, the authors report, but there were no differences between the groups in subsequent hours.

Ten of the 22 (45%) octreotide-treated patients had solitary hypoglycemic events, the report indicates. Five of these events were at the first hourly serum glucose measurement.

In contrast, 6 of 18 (33%) placebo-treated patients experienced 13 hypoglycemic events, including 3 patients who had 2 to 4 hypoglycemic events.

No adverse events were reported at 24 and 72 hours, the researchers note.

"Our results suggest that it would be prudent to admit all patients with sulfonylurea-induced hypoglycemia to the hospital for frequent blood glucose determinations," the investigators say. "We found that although patients who received a single dose of octreotide were less likely to experience multiple subsequent hypoglycemic episodes compared with placebo, such patients are still at risk of further solitary hypoglycemic events."

"This is one of only a handful of prospective, double-blind antidote studies in emergency department patients," Dr. Fasano said. "Future studies may perhaps delineate the ideal dosing regimen and role of quantitative serum markers."
"We are currently enrolling patients in a similar follow-up study utilizing octreotide at time zero and 6 hours with quantitative drug levels and c-peptide and insulin levels," Dr. Fasano added.

"We and most toxicology experts recommend the administration octreotide for sulfonylurea-induced hypoglycemia," Dr. Fasano concluded.

Ann Emerg Med 2008;51:400-406.