Octreotide acetate in refractory bone marrow transplant-associated diarrhea.
OBJECTIVE
To evaluate the effectiveness of octreotide acetate in the treatment of refractory bone marrow transplant-associated diarrhea.


METHODS
Case series encompassing 30 months.


METHODS
A 12-bed bone marrow transplant unit at a tertiary care medical center.


METHODS
Twenty-four patients with bone marrow transplant-associated diarrhea who did not improve with supportive or attapulgite therapy.


METHODS
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.


METHODS
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.
Crouch
M A
MA
Department of Hospital Pharmacy Practice and Administration, Medical University of South Carolina, Charleston 29425, USA.
Restino
M S
MS
Cruz
J M
JM
Perry
J J
JJ
Hurd
D D
DD
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003967:Diarrhea / Q000188:drug therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies
D005765:Gastrointestinal Agents; D015282:Octreotide