Background Octreotide has several uses within palliative care including the management of bowel obstruction, fistulas and secretions. It is usually administered via a syringe driver or in regular subcutaneous injections. The depot form is licensed for use in acromegaly, neuroendocrine tumours and certain adenomas. We used Sandostatin LAR 20 mg depot IM injection to manage excessive secretions from a primary rectal tumour in a mobile and active 81 year old.

Results The decision to use the depot formulation was a complex one, taking into account unsuccessful attempts to manage the secretions with hyoscine. As he was mobile and very active, he didn’t want a syringe driver. He was uncomfortable with the DN resources needed to administer a twice daily subcutaneous injection, as well as the time constraints of this. During an admission to the hospice for pain control, he was started on the subcutaneous formulation before starting the depot. It provided significant relief initially, with the need to increase the dose from 20 mg to 30 mg after 2 months. When he was too unwell to attend clinic, it was added to the syringe driver at 200 mcg; increased to 300 mcg. He died peacefully at home with his family present.

Conclusion There is no evidence for the use of the depot formulation in patients with rectal tumours, so we used the PCF in combination with the drug’s SPC to create a regime. Despite the multiple practical difficulties, the team will now be considering the use of the depot formulation for similar situations.