The Medical Letter on Drugs and Therapeutics
Telotristat Ethyl (Xermelo) for Carcinoid Syndrome Diarrhea
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The FDA has approved telotristat ethyl (Xermelo – Lexicon), a tryptophan hydroxylase inhibitor, for use in combination with a somatostatin analog (SSA) for treatment of carcinoid syndrome diarrhea inadequately controlled with SSA therapy alone. Telotristat ethyl is the first oral drug to be approved in the US for this indication.

THE DISORDER — Carcinoid syndrome occurs in about 20% of patients with neuroendocrine tumors.1 It is characterized by diarrhea, flushing, bronchoconstriction, and cardiac valvular fibrosis. These symptoms occur as a result of tumor production of biogenic amines such as serotonin and other peptide hormones. Serotonin plays a major role in the regulation of intestinal motility, secretion, and visceral sensitivity, and its overproduction is thought to be the main cause of carcinoid syndrome diarrhea.

STANDARD TREATMENT — ... more      

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