VIPomas Medication
- Author: Sai-Ching Jim Yeung, MD, PhD, FACP; Chief Editor: George T Griffing, MD more...
Medication Summary
Somatostatin reduces serum vasoactive intestinal polypeptide (VIP) levels and controls diarrhea in patients with VIPomas.[11] To circumvent the short serum half-life of somatostatin, the derivative octreotide is used. An available long-acting formulation of octreotide called Sandostatin LAR allows for once-monthly intragluteal administration.
Long-term treatment with octreotide often causes resistance to the drug. When maximum tolerable octreotide doses cannot control symptoms, interferon alpha may be added to control diarrhea, with a possible modest reduction in tumor size.
Glucocorticoids are less effective but also less expensive, reducing symptoms in approximately 50% of patients.
Somatostatin Analogs
Class Summary
These agents may control diarrheal symptoms in as many as 80% of patients with unresectable or metastatic tumors. High-dose treatment may lead to additional, antiproliferative effects. However, the long-term application of somatostatin may down-regulate receptor expression levels, resulting in decreased efficiency despite increasing doses. Short-acting and long-acting depot preparations are available.
Octreotide acetate (Sandostatin, Sandostatin LAR)
Octreotide acetate acts similarly to the natural hormone somatostatin and has the ability to suppress the secretion of gastroenteropancreatic peptides, including VIP. Start with small doses in patients with VIPomas, and titrate the dose based on response. The LAR preparation is a long-acting depot dosage form for intramuscular injection.
Corticosteroids
Class Summary
Glucocorticoids, which elicit anti-inflammatory properties and cause profound and varied metabolic effects, modify the body's immune response to diverse stimuli. These agents are less effective but are also less expensive; they reduce symptoms in approximately 50% of patients.
Prednisone
Prednisone is an immunosuppressant for the treatment of autoimmune disorders. It may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear (PMN) leukocyte activity. It stabilizes lysosomal membranes and also suppresses lymphocytes and antibody production.
Prednisolone (Pediapred, Prelone, Orapred)
Prednisolone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear (PMN) leukocyte activity. It is a commonly used oral agent.
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