The value in healing intestinal fistulas is yet to be proven and routine use is limited because of the side effects. Hypoglycemia Octreotide is also used in the treatment of refractory hypoglycemia in neonates and sulphonylurea-induced hypoglycemia in adults. It is useful in overdose management of sulfonylurea type antidiabetic medications, when recurrent or refractory to parenteral dextrose. Mechanism of action is the suppression of insulin secretion. Gastrointestinal secretions Octreotide is used in the palliative care setting to reduce gastrointestinal secretions, with the intention of alleviating vomiting associated with bowel obstruction. Contraindications Octreotide has not been adequately studied for the treatment of children as well as pregnant and lactating women. The drug is given to these groups only if a risk-benefit analysis is positive. Adverse effects The most common adverse effects are headache, hypothyroidism, cardiac conduction changes, gastrointestinal reactions (including cramps, nausea/vomiting and diarrhoea or constipation), gallstones, reduction of insulin release, hyperglycemia or sometimes hypoglycemia, and (usually transient) injection site reactions. Slow heart rate, skin reactions such as pruritus, hyperbilirubinemia, hypothyroidism, dizziness and dyspnoea are also fairly common (more than 1%). Rare side effects include acute anaphylactic reactions, pancreatitis and hepatitis. Some studies reported alopecia in those who were treated by octreotide. Rats which were treated by octreotide experienced erectile dysfunction in a 1998 study. A prolonged QT interval has been observed, but it is uncertain whether this is a reaction to the drug or the result of an existing illness. Interactions Octreotide can reduce the intestinal reabsorption of ciclosporin, possibly making it necessary to increase the dose. People with diabetes mellitus might need less insulin or oral antidiabetics when treated with octreotide, as it inhibits glucagon secretion more strongly and for a longer time span than insulin secretion. The bioavailability of bromocriptine is increased; besides being an antiparkinsonian, bromocriptine is also used for the treatment of acromegaly. Pharmacology Since octreotide resembles somatostatin in physiological activities, it can: inhibit secretion of many hormones, such as gastrin, cholecystokinin, glucagon, growth hormone, insulin, secretin, pancreatic polypeptide, TSH, and vasoactive intestinal peptide, reduce secretion of fluids by the intestine and pancreas, reduce gastrointestinal motility and inhibit contraction of the gallbladder, inhibit the action of certain hormones from the anterior pituitary, cause vasoconstriction in the blood vessels, and reduce portal vessel pressures in bleeding varices. It has also been shown to produce analgesic effects, most probably acting as a partial agonist at the mu opioid