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Xermelo
Xermelo (generic name: telotristat ethyl) is an oral medication used to treat carcinoid syndrome diarrhea in patients with neuroendocrine tumors. It is used in conjunction with somatostatin analogs (e.g., octreotide) when these drugs alone are not sufficient to control diarrhea. Xermelo works by reducing the production of serotonin, a hormone that can cause severe diarrhea in carcinoid syndrome, improving quality of life and controlling symptoms.
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Frequently Asked Questions
How long does it take for Xermelo to start working?
Patients may begin to see a reduction in diarrhea symptoms within a few days to a week after starting Xermelo. The full effect may take a few weeks of consistent use.
Can Xermelo cure carcinoid syndrome?
No, Xermelo is not a cure for carcinoid syndrome. It is used to help manage diarrhea caused by the overproduction of serotonin in patients with neuroendocrine tumors.
What should I do if I miss a dose of Xermelo?
If you miss a dose of Xermelo, take it as soon as you remember, but skip the missed dose if it is almost time for your next scheduled dose. Do not take two doses at once to make up for the missed one.
Can I take Xermelo on an empty stomach?
No, Xermelo should be taken with food to ensure proper absorption and reduce the likelihood of gastrointestinal side effects.
Is Xermelo safe for long-term use?
Yes, Xermelo is generally safe for long-term use, but regular monitoring of liver function and gastrointestinal health is recommended due to the potential side effects. Always follow up with your healthcare provider during treatment.
Comprehensive Drug Guide
How Does Xermelo Work?
Xermelo works by inhibiting the enzyme tryptophan hydroxylase, which is responsible for the production of serotonin. In patients with carcinoid syndrome, excess serotonin is produced by neuroendocrine tumors, leading to severe diarrhea. By reducing serotonin production, Xermelo helps to alleviate the diarrhea associated with carcinoid syndrome.
Common Dosages
- 250 mg oral tablets
Typical Dosing
- The typical dose of Xermelo is 250 mg taken three times daily with food. It is usually prescribed in combination with somatostatin analog therapy.
Typical Dosing
FDA Approved Indications
- Treatment of carcinoid syndrome diarrhea in patients receiving somatostatin analog therapy but who still experience diarrhea.
Who Shouldn't Take Xermelo?
- Severe liver impairment (Xermelo is metabolized by the liver, and severe impairment can affect drug levels).
- Known hypersensitivity to telotristat ethyl or any of the ingredients in the formulation.
Advice From The Pharmacist
- Take Xermelo with food to improve absorption and reduce the risk of gastrointestinal side effects.
- Continue taking somatostatin analogs (e.g., octreotide or lanreotide) as prescribed while using Xermelo, as it is designed to be used in combination with these medications.
- Stay hydrated, especially if diarrhea persists while on treatment, as dehydration can occur with prolonged diarrhea.
Side Effects of Xermelo
Common Side Effects
- Nausea
- Headache
- Fatigue
- Increased liver enzymes (ALT/AST)
- Decreased appetite
Uncommon/Severe Side Effects
- Severe constipation
- Liver injury (jaundice, dark urine, yellowing of the skin or eyes)
- Abdominal pain or discomfort
Risks and Warnings of Xermelo
- Liver Dysfunction: Xermelo can cause elevated liver enzymes and, in rare cases, liver injury. Patients with liver impairment should be monitored closely during treatment, and liver function tests should be conducted periodically.
- Constipation: In some patients, Xermelo may cause severe constipation. Patients should be monitored for signs of constipation, and adjustments to treatment may be necessary if this occurs.
Interactions with Xermelo
Common Drug Interactions
- Somatostatin analogs: Xermelo is used in conjunction with somatostatin analogs (such as octreotide or lanreotide), but no significant drug interactions are known with these medications.
- Other serotonergic drugs: Caution should be used when combining Xermelo with drugs that also affect serotonin levels, such as antidepressants (e.g., SSRIs), as this may alter the effects of Xermelo.
Alternatives to Xermelo
- Somatostatin analogs (e.g., octreotide, lanreotide): These are the primary treatments for controlling carcinoid syndrome symptoms and are often used in combination with Xermelo.
- Peptide receptor radionuclide therapy (PRRT): Used in patients with neuroendocrine tumors to control symptoms, including diarrhea.
