What medications may be effective when somatostatin analogues do not adequately control carcinoid symptoms?
- Telotristat is an orally administered inhibitor of tryptophan hydroxylase, the rate-limiting step in serotonin synthesis.
- Telotristat used in combination with somatostatin analogues has been shown to significantly reduce both 5-HIAA excretion and diarrhea.
- This agent may also be effective in preventing or reducing progression of carcinoid heart disease.
- Other antiflushing and antidiarrheal strategies can be added if symptom control is inadequate.
The below table lists various medication options for relief of refractory symptoms.
Medications for Relief of Symptoms Related to Carcinoid Syndrome
| Medications to Control Carcinoid Flushing | |
| Octreotide (Sandostatin) Octreotide, long acting (Sandostatin LAR) Lanreotide (Somatuline) Phentolamine (Regitine) Phenoxybenzamine (Dibenzyline) Cyproheptadine (Periactin) Methysergide (Sansert) Prochlorperazine (Compazine) Chlorpromazine (Thorazine) Clonidine (Catapres) Methyldopa (Aldomet) Cimetidine (Tagamet), plus: • Diphenhydramine (Benadryl) • Glucocorticoids | 50–150 mcg 2 or 3 times/day subcutaneously 20–30 mg every month intragluteally 60–120 mg every month subcutaneously 25–50 mg 1–3 times/day 30 mg/day 2–4 mg 3 or 4 times/day 2 mg 3 times/day 5–10 mg every 4–6 hours 10–25 mg every 4–6 hours 0.1–0.2 mg 2 times/day 250 mg 3 times/day 300 mg 3 times/day 50 mg 4 times/day |
| Medications to Control Carcinoid Diarrhea | |
| Standard antidiarrheal measures, plus: Octreotide (Sandostatin) Octreotide, long acting (Sandostatin LAR) Lanreotide (Somatuline) Telotristat (Xermelo) Clonidine (Catapres) Cyproheptadine (Periactin) Methysergide (Sansert) Ondansetron (Zofran) | 50–150 mcg 2 or 3 times/day subcutaneously 20–30 mg every month intragluteally 60–120 mg every month subcutaneously 250–500 mg 3 times/day 0.1–0.2 mg 2 times/day 2–4 mg 3 or 4 times/day 2 mg 3 times/day 8 mg 3 times/day |
