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metyrosine

Generic Demsar
Used for Adrenal Cancer
Used for Adrenal Cancer

Metyrosine (Demser) is used to treat symptoms of a rare type of tumor called pheochromocytoma. It’s typically taken 4 times a day by mouth, and comes as both brand-name and generic capsules. The most common side effect is drowsiness, but this usually gets better within a few days of starting the medication.

Reviewed by:
reviewer
Kristianne Hannemann, PharmD
reviewer
Kieu-My Huynh, PharmD Candidate
reviewer
Daisy Chau, PharmD
Last reviewed on July 17, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostAlternativesReferencesPricesMedicare
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What is Metyrosine (Demser)?

What is Metyrosine (Demser) used for?

  • Treatment of pheochromocytoma for:

    • Preparation for surgery to remove the tumors

    • People who aren't able to have surgery

    • Long-term treatment of people with malignant pheochromocytoma (cancer)

How Metyrosine (Demser) works

Metyrosine (Demser) is a tyrosine hydroxylase inhibitor, meaning it blocks a protein in the body called tyrosine hydroxylase. This protein is responsible for making hormones called catecholamines.

People who have pheochromocytoma have tumors that make too many of these catecholamines. So metyrosine (Demser) works by lowering the amount of catecholamines that are made. This can reduce the symptoms like high blood pressure, headaches, sweating, and a fast heart beat.

Drug Facts

Common BrandsDemser
Drug ClassTyrosine hydroxylase inhibitor
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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Avg retail price
$62330.12(save 72.42%)
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$17189.10
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What are the side effects of Metyrosine (Demser)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

These side effects occurred in at least 10% of people taking the medication:
  • Drowsiness
  • Drooling
  • Difficulty speaking
  • Shakiness
  • Diarrhea

Other Side Effects

  • Anxiety
  • Depression
  • Confusion
  • Stuffy nose
  • Dry mouth
  • Headache
  • Enlarged breasts
  • Nausea
  • Stomach pain
  • Difficulty getting or maintaining an erection
  • Painful urination

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Mental health changes: depression, hallucinations (seeing things that aren't there), confusion
  • Extrapyramidal symptoms (EPS): drooling, trouble speaking, tremor, muscle spasms, tightness in your jaw
  • Low blood cell counts: feeling tired, paleness, blood in urine or stool, unexplained bruising
  • Severe allergic reaction: hives, swelling in the throat, trouble breathing

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common

Diarrhea

drooling

trembling and shaking of hands and fingers

trouble in speaking

Less common

Anxiety

confusion

hallucinations (seeing, hearing, or feeling things that are not there)

mental depression

Rare

Black, tarry stools

blood in urine or stools

unusual bleeding or bruising

muscle spasms, especially of neck and back

painful urination

pinpoint red spots on skin

restlessness

shortness of breath

shuffling walk

skin rash and itching

swelling of feet or lower legs

tic-like (jerky) movements of head, face, mouth, and neck

unusual tiredness or weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Drowsiness

Less common

Decreased sexual ability in men

dryness of mouth

nausea, vomiting, or stomach pain

stuffy nose

swelling of breasts or unusual milk production

After you stop using this medicine, it may still produce some side effects that need attention. During this period of time, check with your doctor immediately if you notice the following side effects:

More common

Diarrhea

Also, after you stop taking this medicine, you may have feelings of increased energy or you may have trouble sleeping. However, these effects should last only for two or three days.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Metyrosine (Demser)

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Pros

Dose can be adjusted based on your response to the medication

A good option for people who can't have surgery

Can work well to lower the amount of hormones causing symptoms

Can be added to other pheochromocytoma treatments like phenoxybenzamine (Dibenzyline)

Available as a lower-cost generic

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Cons

Must be taken 4 times a day

Must drink plenty of fluids while taking this medication to lower the risk of kidney stones

Commonly causes drowsiness and diarrhea

Unknown if safe or works well in children under 12 years old

Interacts with many other medications

pharmacist-tips

Pharmacist tips for Metyrosine (Demser)

pharmacist

  • Set an alarm to help you remember to take all of your doses of metyrosine (Demser) each day.

    • Drowsiness is a common side effect of metyrosine (Demser). Avoid alcohol and other sedating medications (e.g., sleeping medications, muscle relaxants). Make sure you know how this medication affects you before driving or doing activities that require you to be alert.

      • It's important to drink plenty of fluids while taking metyrosine (Demser). This will help prevent the medication from forming crystals in your urine, which could lead to kidney stones.

        • If you experience diarrhea while taking metyrosine (Demser), talk to your provider about ways to manage it if you need to continue taking the medication.

          • Provide your healthcare team with a current list of your medications. Metyrosine (Demser) can interact with many medications, including phenothiazines and haloperidol (Haldol). Your provider or pharmacist can check to make sure your medications are safe to take together.

            • After you stop taking metyrosine (Demser), you might experience trouble sleeping and possibly feel even more alert. This effect usually lasts for 2 to 3 days. Don’t stop taking this medication without talking with your provider.

              faqs

              Frequently asked questions about Metyrosine (Demser)

              What is pheochromocytoma?
              Pheochromocytoma is a rare and usually non-cancerous tumor that's typically found within your adrenal glands. The adrenal glands are responsible for releasing hormones called catecholamines into your blood. Many times, the tumor in pheochromocytoma produces too many catecholamines. This can cause symptoms like high blood pressure, sweating, a racing heart, shakiness, and headaches. Metyrosine (Demser) is used to lower the amount of catecholamines being made to help relieve these symptoms.
              How long does it take for metyrosine (Demser) to work?
              While everyone responds differently to metyrosine (Demser), it generally takes about 2 to 3 days for it to reach its maximum effect. You might notice your blood pressure going down slowly over the first 2 days of treatment. But if you aren't getting relief after this time, talk to your provider. They might need to change your dose.
              Does metyrosine (Demser) cure pheochromocytoma?
              No. Metyrosine (Demser) can't cure pheochromocytoma, but it can help treat its symptoms. This medication works best if you take it consistently every day. Once you stop taking metyrosine (Demser), the hormone levels in your body will return to how they were before within 3 or 4 days. This means your symptoms will likely come back gradually over a few days after your last dose.
              Can you drink alcohol while taking metyrosine (Demser)?
              It's best to avoid drinking alcohol while taking metyrosine (Demser). This is because alcohol commonly causes drowsiness, and metyrosine (Demser) can make this effect even stronger. The combination of these two sedating substances can be dangerous, especially when you’re driving or doing activities that require you to be alert.
              Is metyrosine (Demser) safe to use during pregnancy?
              There isn't enough information to know if metyrosine (Demser) is safe to take while pregnant. If you're pregnant or thinking of becoming pregnant, speak with your provider about the risks and benefits of this medication.
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              What are the risks and warnings for Metyrosine (Demser)?

              Metyrosine (Demser) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

              risk-warning

              Crystals in the urine

              • Risk factors: Low fluids in the body | High doses of metyrosine (Demser)

                Metyrosine (Demser) can cause crystals to form in the urine, which could lead to problems like kidney stones. Signs of kidney stones include painful urination, fever, and sometimes blood in the urine. The risk is higher if your dose of metyrosine (Demser) is more than 2 grams per day. To lower this risk, make sure you drink plenty of fluids. Your provider will test your urine regularly to make sure you don't have crystals in it.

                risk-warning

                Excessive drowsiness

                Metyrosine (Demser) can cause you to feel very sleepy and less alert. This usually happens within the first 24 hours of starting this medication and might get worse for 2 or 3 days. It should get better with time, but if it doesn't, you should let your provider know. Avoid taking this medication with alcohol or other medications like sleeping pills, opioid pain medications, and muscle relaxants. Be sure to know how the medication affects you before driving or performing activities that require you to be alert.

                dosage

                Metyrosine (Demser) dosage forms

                The average cost for 180 capsules of 250mg of Metyrosine (Demser) is $17189.10 with a free GoodRx coupon. This is 72.42% off the average retail price of $62330.12.
                capsule
                Capsule
                DosageQuantityPrice as low asPrice per unit
                250mg180 capsules$17189.10$95.49

                Typical dosing for Metyrosine (Demser)

                • Adults and children 12 years and older: The typical starting dose is 250 mg by mouth 4 times a day. Your provider will adjust your dose based on your response to the medication. The maximum dose is 4 grams per day.

                How long you take metyrosine (Demser) depends on what you’re using the medication for.

                interactions

                Interactions between Metyrosine (Demser) and other drugs

                Metyrosine (Demser) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Metyrosine (Demser). Please note that only the generic name of each medication is listed below.

                Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

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                How much does Metyrosine (Demser) cost?

                To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
                Metyrosine (Demser) (generic)
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                alternatives

                What are alternatives to Metyrosine (Demser)?

                There are a number of medications that your doctor can prescribe in place of Metyrosine (Demser). Compare a few possible alternatives below.
                Metyrosine (Demser)
                Used for:

                • Treatment of pheochromocytoma for:

                  • Preparation for surgery to remove the tumors

                  • People who aren't able to have surgery

                  • Long-term treatment of people with malignant pheochromocytoma (cancer)

                $17189.10 Lowest GoodRx priceView Prices
                Phenoxybenzamine (Dibenzyline)
                Used for:
                $587.12 Lowest GoodRx priceView Prices

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                References

                Best studies we found

                Amneal Pharmaceuticals NY LLC. (2023). Metyrosine capsule [package insert]. DailyMed.

                D’Souza, R. S., et al. (2023). Extrapyramidal symptoms. StatPearls.

                Harari, A., et al. (2011). Malignant pheochromocytoma: A review. The American Journal of Surgery.

                View All References (5)

                Kidron, A., et al. (2023). Phenothiazine. StatPearls.

                MedlinePlus. (2016). Pheochromocytoma.

                National Cancer Institute. (n.d.). Catecholamine.

                National Cancer Institute. (2020). Pheochromocytoma.

                You and Your Hormones. (2021). Adrenal glands.

                GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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