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Practical Tips for Patients on "The Shot" (Somatostatin Analog)

Many NET patients are on a somatostatin analog (SSA), also known as “the shot” in the patient community. The purpose of the shot is to stop the growth of the tumor or to manage symptoms of functional tumors. (Click here for the LACNETS podcast episode on this topic.)


Currently, there are two major SSAs on the market, which may be referred to by their brand names (e.g. Sandostatin© LAR) or generic names (e.g. octreotide), similar to the pain reliever brand name (Tylenol©) that may also be referred to by its generic name (acetaminophen). The following table lists these drugs by generic and brand names, and notes the manufacturer of each:

While SSAs are common, the terms may be confusing, and some feel anxious or stressed about them (see this blog post). When discussing being treated with an SSA, your doctor may allow you to choose which shot you would prefer to receive. There are some importantand significantdifferences between them. This table notes some key differences patients have identified that might influence your choice:


Note: These medications must be administered by a trained medical professional.



Sandostatin© LAR

Somatuline© Depot

Needle length

Longer needle — goes deeper into muscle

​Shorter needle — only goes into fat layer

Preparation

Complex mixing process at time of use

​Requires refrigeration and thawing/warming to room temperature for 30 minutes prior to injection

Cheek position before inserting needle (both are always at 90° to skin surface)

Pinch the cheek

Spread the cheek out flat

Administration time (how much time it takes to squeeze the plunger to empty the barrel)

No time given however, the plunging time can be quick to avoid the medicine hardening in the syringe/needle

20+ seconds

Administration video

Administration Comparison

Administration instructions/graphics

Short-acting “rescue shots” available to relieve carcinoid syndrome symptoms?

Yes

No

General product patient page

​Patient financial assistance (Note: there are exclusions for Medicare and other government programs)

Mobile administration while away from your clinic or at home

Prescribing information with required FDA information and warnings

Sandostatin© LAR prescribing information

Somatuline© Depot prescribing information


People have a wide variety of experiences with the shot; some say that it's not painful at all, but for others, it may be painful. Brainstorming ways to reduce the anxiety, stress, and pain associated with receiving SSA injections has been a frequent topic in our weekly virtual support group. The following suggestions have been made by patients and caregivers. If you are just starting treatment, consider asking your doctor to start you at a low dose and increase the dose each month instead of starting your first injection with the full dose.

  • You may request ice 30 minutes before your injection to numb the target area. Target areas for each product are shown below:


Sandostatin Sites:


Somatuline Depot Sites:



  • Alternate between left and right for each dose.

    • Tip: LACNETS founder, Giovanna Joyce Imbesi shared this trick: use ROLE (Right = Odd months, Left = Even months). If reversed, RELO and LORE works just as well. And yes, there are some months where this falls apart like long months that have 2 shots during the 28-day cycle. Whatever your system is, the key is to keep track of which side is injected each month.

  • Receiving the injection while lying down will keep the gluteus muscle relaxed. To keep it from tensing while receiving the injection in a standing position, place all your weight on the leg NOT receiving the injection.

  • The time removed from the refrigerator can be verified yourself. The pharmacy or nurse may write the “Out Time” on the box, meaning the time it is taken out of the refrigerator.

  • Ask questions of any new person before allowing them to administer your shot. A poorly administered shot can be costly and could add to discomfort during or after the injection. Worse yet, it may mean not receiving the full benefit of the medicine until the next dose (usually 28 days).

  • Here are some questions to ask your nurse before receiving the shot:

    • Have you given this before?

    • Have you been trained on the process to prepare and administer this medication?

    • Do you squeeze or pinch the cheek?

    • Plunger time — how long?

    • Can you point me to the location you’ll be inserting the needle? Note: You can feel to make sure there are no lumps from past shots.

Gently draw their attention to the prescribing information if any items are missed. If your nurse fails more than once you might ask to talk with the charge nurse to request someone else.

  • Somatuline© Depot syringes have a needle retraction mechanism. When the plunger is bottomed-out, make sure the nurse keeps downward pressure on the plunger, remove the syringe needle from you, and then relieve pressure on the plunger. Failure to do so will retract the needle and your skin into the syringe body, giving a huge (and unnecessary) skin pinch.

  • Once you’ve received the injection, here are some Do’s, Don’ts, and things to watch out for:

    • Make sure the nurse does not massage or rub the injection area after the injection.

    • Afterwards, walk around for ~ 20 minutes. Heating or ice will help reduce any residual pain.

      • Tip: Remember, Do NOT rub/massage the area.

    • You may feel tired after the injection or experience other symptoms such as headache or change in bowel habits for several hours or days, even after taking the shot for many months.

      • Tip: You may want to take changes of clothes/digestive aids, anti-diarrheal medicine, pain reliever, etc. to address these side-effects after discussing what is safest with your doctor.

    • Travel: If you plan to travel during the time of your injection, talk to the drug company about having a home health nurse administer it at your hotel/other location, or coordinate with another facility to receive your injection at the location you will be visiting.

      • Tip: When looking for another facility, you might start with your healthcare network.

For more helpful tips after receiving The Shot, be sure to review the previous blog here, under the section “WHAT CAN I DO TO MAKE “THE SHOT” LESS PHYSICALLY, EMOTIONALLY, OR FINANCIALLY STRESSFUL?”


This blog is for educational purposes only and does not constitute medical advice. It does not provide a medical professional’s opinion or advice nor is it an endorsement for particular treatments. You are advised to seek appropriate licensed medical/professional help and discuss your individual care and treatment plan with your medical team.


The content in this blogpost is the opinion of the author and the information is neither provided by nor endorsed by pharmaceutical companies, including Ipsen or Novartis.

Note: External website URLs are current at the time of initial posting of this blog. Some links may be unavailable outside of the United States.


 

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