Octreotide causes a marked reduction in blood levels of ciclosporin and inadequate immunosuppression may result
A diabetic man with kidney and pancreatic segment transplants was successfully immunosuppressed with azathioprine,methylprednisolone and ciclosporin. When he was also given subcutaneous octreotide 100 micrograms twice daily to reduce fluid collection around pancreatic graft, his trough ciclosporin blood levels fell below assay detection limit of 50 nanograms/mL. Serum creatinine increased dramatically, which was interpreted as a selective rejection episode of kidney transplant. Nine other diabetics similarly treated with octreotide for peripancreatic fluid collection and fistulas after pancreatic transplantation also had significant falls in their ciclosporin blood levels within 24 to 48 hours,in 3 of them to undetectable levels (See reference number 1). A similar interaction was seen in another patient (See reference number 2).
A suggestion is that octreotide reduces intestinal absorption of ciclosporin (See reference number 1,2)
The interaction between octreotide and ciclosporin is established and clinically important, although documentation is limited. The authors of one report recommend that before giving octreotide oral dosage of ciclosporin should be increased on average by 50 % and serum levels monitored daily (See reference number 1). The manufacturers of lanreotide say that, as with other somatostatin analogues, it may reduce absorption of ciclosporin from gut (See reference number 3). As yet there appear to be no reports of this interaction in practice; however, it would be prudent to monitor outcome of use of lanreotide with ciclosporin.
1. Landgraf R,Landgraf-Leurs MMC, Nusser J, Hillebrand G, Illner W-D, Abendroth D, Land
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Somatuline LA (Lanreotide acetate). Ipsen Ltd. UK Summary of product characteristics,August 2003.