CONSENSUS STATEMENT - OCTREOTIDE DOSE TITRATION IN SECRETORY DIARRHEA- DIARRHEA MANAGEMENT CONSENSUS DEVELOPMENT PANEL

Octreotide is an effective therapeutic option in controlling secretory diarrhea of varied etiology. However, marked patient-to-patient diffe rences in the antidiarrheal effects necessitate titration of octreotid e dose in individual patients to achieve optimal symptom control. A co nsensus development panel established guidelines for octreotide dose t itration in patients with secretory diarrhea. Overall, the panel recom mended an aggressive approach in selecting the initial octreotide dose and in making subsequent dose escalations in patients with secretory diarrhea due to gastrointestinal tumors (eg, carcinoids, VIPomas), AID S, dumping syndrome, short bowel syndrome, radiotherapy, or chemothera py. To avoid hypoglycemia in patients with diabetes mellitus-associate d secretory diarrhea, the panel recommended a low initial octreotide d ose and a conservative titration regimen with close monitoring of bloo d glucose levels. The end point of therapy should focus on a reduction in diarrhea (frequency of bowel movements or stool volume) rather tha n normalization of hormonal profile. Overall, octreotide is well toler ated; principal side effects are transient injection site pain and gas trointestinal discomfort. For many patients with secretory diarrhea, o ctreotide therapy is expected to improve the overall health and qualit y of life and in the long run will lessen health care costs.