Medications for Relief of Symptoms of Carcinoid Syndrome

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
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