Xermelo
Xermelo (telotristat ethyl) is a medication taken by mouth used to treat diarrhea in people with carcinoid syndrome who aren't responding to somatostatin analog medications alone. It's available as a brand name only, which can be expensive.
What is Xermelo (telotristat ethyl)?
What is Xermelo (telotristat ethyl) used for?
- Used together with a somatostatin analog for carcinoid syndrome diarrhea
How Xermelo (telotristat ethyl) works
Xermelo (telotristat ethyl) is a tryptophan hydroxylase inhibitor. It blocks tryptophan hydroxylase, an enzyme (protein) that helps your body make a chemical called serotonin in your gut. People with carcinoid syndrome have too much serotonin in their gut which can cause diarrhea. Xermelo (telotristat ethyl) stops tryptophan hydroxylase from working, which lowers the amount of serotonin in the gut. This then leads to fewer bowel movements.
Drug facts
Side effects of Xermelo (telotristat ethyl)
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
- Nausea (13%)
- Headache (11%)
- Depression (9%)
- Swelling in arms and legs (7%)
- Passing gas (7%)
- Low appetite (7%)
- Fever (7%)
Less Common Side Effects
- Stomach pain
- Constipation
Xermelo (telotristat ethyl) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe constipation
The following Xermelo (telotristat ethyl) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Severe stomach pain
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome.):
- Constipation
- Gas
- Headache
- Loss of appetite
- Nausea
- Swelling of the ankles, hands, or feet
Pros and cons of Xermelo (telotristat ethyl)
Pros
- Works well to treat carcinoid syndrome diarrhea
- Available as an oral tablet
- Comes as a daily dose pack that has 3 tablets in it
Cons
- Can cause severe constipation
- Only approved for use in combination with an SSA
- Needs to be taken three times a day
Pharmacist tips for Xermelo (telotristat ethyl)
- Xermelo (telotristat ethyl) might cause constipation because it works by slowing down the movement in your gut. If you become constipated while taking Xermelo (telotristat ethyl), let your provider know. In cases of severe constipation or worsening stomach pain, stop taking the medication and contact your provider right away.
- Take each dose of Xermelo (telotristat ethyl) with food so your body can absorb all of the medication for it to work better.
- Xermelo (telotristat ethyl) can interact with many commonly used medications. Make sure to tell your provider and pharmacist about all the medications you're taking, including over-the-counter (OTC) medications, vitamins, and supplements before starting Xermelo (telotristat ethyl). Don't start any new medications while taking Xermelo (telotristat ethyl) without talking to your provider or pharmacist first.
- If you're taking short-acting octreotide injection (Sandostatin, Bynfezia Pen), give yourself the octreotide injection at least 30 minutes after taking your dose of Xermelo (telotristat ethyl). This will make sure the Xermelo (telotristat ethyl) levels in your body stay high so it can work to treat your diarrhea.
- If you miss your dose of Xermelo (telotristat ethyl), take your next dose at the regular time. Don't take 2 doses at the same time to make up for the missed dose.
Common questions about Xermelo (telotristat ethyl)
No, it's only FDA approved to be used together with a somatostatin analog (SSA) (e.g., octreotide or lanreotide) for carcinoid syndrome diarrhea in people who aren't getting better with SSA alone. It's not known how well Xermelo (telotristat ethyl) works to treat diarrhea when used alone.
Yes. In fact, it's recommended that you take Xermelo (telotristat ethyl) with food. If you don't take it with food, you might not absorb all of the medication into your body, which will make it not work as well for you.
Xermelo (telotristat ethyl) can begin to work as early as 1 to 3 weeks after starting the medication. But in some people, it might take up to 3 months before you start to see a difference.
Yes, other anti-diarrheal medications can be used with Xermelo (telotristat ethyl) to help treat diarrhea. However, there might be some medications that interact with Xermelo (telotristat ethyl), so don't start any new medications without talking to your provider or pharmacist first. Make sure to tell your provider and pharmacist about all the medications you take before starting Xermelo (telotristat ethyl).
Xermelo (telotristat ethyl) hasn't been studied in people who are pregnant, so it's not completely known if it's safe or works well. Also, the studies on Xermelo (telotristat ethyl) in animals are inconsistent. If you're pregnant or thinking of getting pregnant, don't start taking Xermelo (telotristat ethyl) until you've talked to your provider first.
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Risks and warnings for Xermelo (telotristat ethyl)
Xermelo (telotristat ethyl) 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.
Severe constipation
Since Xermelo (telotristat ethyl) lowers the number of bowel movements you have, it might cause constipation. If it becomes severe, it could lead to serious gut complications that can be life-threatening. If you develop severe constipation or severe, constant, or worsening stomach pain while taking Xermelo (telotristat ethyl), stop taking it and contact your provider right away.
Xermelo (telotristat ethyl) dosage
Typical dosage for Xermelo (telotristat ethyl)
The typical dose is 250 mg by mouth taken with food three times a day.
What are alternatives to Xermelo (telotristat ethyl)?
People who are currently taking and have responded well to short-acting octreotide (Sandostatin) can take Sandostatin Lar Depot (octreotide) for: