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Octreotide acetate in refractory bone marrow transplant-associated diarrhea
M A Crouch1, M S Restino, J M Cruz
1Department of Hospital Pharmacy Practice and Administration, Medical University of South Carolina, Charleston 29425, USA.
Objective:
To evaluate the effectiveness of octreotide acetate in the treatment of refractory bone marrow transplant-associated diarrhea.
Design:
Case series encompassing 30 months.
Setting:
A 12-bed bone marrow transplant unit at a tertiary care medical center.
Participants:
Twenty-four patients with bone marrow transplant-associated diarrhea who did not improve with supportive or attapulgite therapy.
Interventions:
Patients received subcutaneous octreotide acetate at doses ranging from 50 to 250 micrograms 2 to 3 times daily. Concurrent treatment with antimotility or antisecretory agents did not occur.
Main Outcome Measures:
The number of bowel movements and stool volumes were recorded daily. Complete response to octreotide therapy was defined as a reduction of both stool output and stool frequency by more than 50% within 72 hours. Partial response was defined as a reduction of either stool output or stool frequency by more than 50% within 72 hours. Treatment failure occurred if neither of the two parameters decreased by 50% within the designated time period.
Results:
Twenty-eight treatment challenges were initiated in the 24 patients evaluated. Diarrhea completely or partially subsided in 23 of 28 challenges (82.1%) within 72 hours. Stool output decreased from 1143 +/- 595 at baseline to 252 +/- 356 mL/d within 72 hours (p < 0.005). Stool frequency decreased from a baseline of 7.5 +/- 3.4 to 2.7 +/- 2.2 stools per day within 72 hours (p < 0.005). Adverse effects associated with octreotide were pain or burning at the injection site (24.1%), abdominal pain (13.8%), and increased stool output (6.9%).
Conclusions:
These data suggest octreotide acetate significantly reduces stool output and frequency in patients with refractory bone marrow transplant-associated diarrhea. Additional research is necessary before this agent can be recommended for routine use in this patient population.