Telotristat (Xermelo™)

OncoLink Team
Last Modified: March 24, 2017

Pronounced: tell-o-tre-stat

Classification: Tryptophan hydroxylase inhibitor

About Telotristat (Xermelo™)

Telotristat is used to treat diarrhea associated with carcinoid syndrome, which is seen in patients with carcinoid or neuroendocrine tumors. These tumors cause the body to overproduce certain hormones, including serotonin, which leads to symptoms, known as "carcinoid syndrome". Overproduction of serotonin causes diarrhea. Telotristat is a medication that inhibits tryptophan hydroxylase which, in turn, reduces the production of serotonin. Telotristat is often used in combination with another type of medication, called a somatostatin analog (octreotide, lanreotide).

How to Take Telotristat

Telotristat is a tablet taken by mouth. It should be taken with food according to your provider’s instructions. If you are using telotristat in combination with short acting octreotide, you should take this medication 30 mins before the octreotide. If you miss a dose, take the next dose at your regular scheduled time. You should not take 2 doses at the same time to make up for a missed dose.

This medication can interact with certain medications called CYP3A4 substrates (e.g. midazolam). Be sure to tell your healthcare provider about all medications, vitamins, and supplements you take.

Storage and Handling

Telotristat is dispensed in a monthly case (28 day supply). Each monthly case contains four boxes (1 per week), which contain 7 daily dose packs. It should be stored at room temperature. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.

Where do I get this medication?

Certain cancer medications are only available through specialty pharmacies. If you need to get this medication through a specialty pharmacy, your provider will help you start this process. Where you can fill your prescriptions may also be influenced by your pharmaceutical insurance coverage. Ask your health care provider or pharmacist for assistance in identifying where you can get this medication.

Insurance Information

This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.

Possible Side Effects of Telotristat

There are a number of things you can do to manage the side effects of telotristat. Talk to your healthcare provider about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Constipation

This medication may cause constipation, which can be serious. If you experience constipation or persistent, worsening abdominal pain, stop taking this medication and contact your healthcare provider.

Nausea and/or Vomiting

Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Headache and Fever

Your healthcare provider can recommend medication and other strategies to relieve pain. Report any temperature of 100.4F or greater to your healthcare provider. 

Depression

This medication can cause mood changes. If you experience ongoing feelings of sadness, hopelessness, decreased interest and inability to participate in daily activities because of your mood, contact your healthcare provider.

Decrease in Appetite

Nutrition is an important part of your care. Cancer treatment can affect your appetite and, in some cases, the side effects of treatment can make eating difficult. Ask your nurse about nutritional counseling services at your treatment center to help with food choices.

  • Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
  • If you are not eating enough, nutritional supplements may help.
  • You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.
  • Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell. Sometimes cold food has less of an odor.
  • Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary to add flavor. Bacon, ham and onion can add flavor to vegetables. 
Peripheral Edema

This medication can cause edema, which is swelling due to an accumulation of fluid. This typically occurs in the lower extremities (feet, legs and ankles) or hands. Report any swelling you experience to your healthcare provider.

Flatulence

This medication can cause gas, bloating, burping or gas pain. This can be embarrassing in public situations. Consider using a flatulence deodorizer pad that contains activated charcoal. When placed in your undergarments, it can reduce the odor associated with excess gas. There are also some over the counter medications available to relieve gas pain and bloating. Certain foods can aggravate flatulence. You may want to keep a record of food you have eaten to help identify triggers. Talk to your healthcare provider before starting any medications or if this side effect is causing distress.

Reproductive Concerns

You should consult with your healthcare team before becoming pregnant, fathering a child or breastfeeding while receiving this medication.

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