Why is this medication prescribed?

Telotristat is prescribed for the treatment of carcinoid syndrome diarrhea in patients with metastatic neuroendocrine tumors (NETs) who are inadequately controlled by somatostatin analog therapy. Carcinoid syndrome is a condition that occurs in some patients with NETs, leading to symptoms such as diarrhea, flushing, abdominal pain, and wheezing due to the release of certain substances by the tumors. Telotristat works by inhibiting the enzyme tryptophan hydroxylase, which is involved in the production of serotonin, a key mediator of carcinoid syndrome symptoms.

How should this medicine be used?

Telotristat is typically administered orally in the form of tablets. The usual recommended dosage is 250 mg taken three times daily with food. The tablets should be swallowed whole with water and should not be crushed, chewed, or broken.

Here are some general guidelines for the use of telotristat:

• Dosage: The recommended dosage of telotristat is 250 mg taken three times daily, with intervals of approximately every 8 hours. The total daily dosage should not exceed 750 mg.
• Administration with Food: Telotristat should be taken with food to maximize its absorption and reduce the risk of gastrointestinal side effects. Patients should avoid taking it on an empty stomach.
• Consistent Timing: It’s important for patients to take telotristat at consistent intervals each day to maintain steady drug levels in the body and optimize its effectiveness.
• Monitoring: Patients should undergo regular monitoring while on telotristat therapy, including liver function tests to assess for potential liver abnormalities. Healthcare providers may also monitor for symptom control and adjust the dosage as necessary.
• Duration of Treatment: Telotristat is typically used as a long-term treatment for carcinoid syndrome diarrhea in patients with metastatic neuroendocrine tumors who are inadequately controlled by somatostatin analog therapy. The duration of treatment may vary depending on the individual patient’s response and treatment goals.
• Drug Interactions: Patients should inform their healthcare provider about all medications, supplements, and herbal products they are taking, as telotristat may interact with certain drugs. Healthcare providers can evaluate potential drug interactions and make adjustments to the treatment regimen as needed.
• Pregnancy and Lactation: Telotristat should not be used during pregnancy unless the potential benefits outweigh the risks to the fetus. Women of childbearing potential should use effective contraception during telotristat therapy and for at least one month after the last dose. Breastfeeding should be avoided during treatment.

Patients should follow their healthcare provider’s instructions carefully regarding the use of telotristat and report any concerning symptoms or side effects promptly. It’s essential to adhere to the prescribed dosage and administration schedule to achieve optimal therapeutic outcomes.

Other uses for this medicine

Some potential alternative uses may include:

• Irritable Bowel Syndrome (IBS): Telotristat has shown some promise in reducing bowel movements and symptoms associated with diarrhea-predominant IBS (IBS-D), though more research is needed in this area.
• Inflammatory Bowel Disease (IBD): Telotristat may be investigated as a potential treatment for reducing diarrhea symptoms in patients with IBD, such as Crohn’s disease or ulcerative colitis, particularly in cases where diarrhea is a prominent symptom.
• Other Neuroendocrine Tumors: Telotristat may be explored for its efficacy in managing diarrhea associated with other types of neuroendocrine tumors beyond metastatic NETs, though further clinical studies are necessary to establish its effectiveness.

What special precautions should I follow?

Regarding special precautions for telotristat, here are some important points to keep in mind:

• Liver Function Monitoring: Telotristat can potentially cause liver function abnormalities. Liver function tests should be performed before initiating treatment, at regular intervals during treatment, and as clinically indicated. Patients should report any signs or symptoms of liver dysfunction, such as jaundice, abdominal pain, nausea, vomiting, dark urine, or pale stools, to their healthcare provider promptly.
• Drug Interactions: Telotristat may interact with other medications, particularly those metabolized by the cytochrome P450 (CYP) enzyme system. Healthcare providers should review the patient’s current medication regimen to assess for potential drug interactions before initiating telotristat therapy.
• Pregnancy and Lactation: The safety of telotristat during pregnancy and breastfeeding has not been established. Women of childbearing potential should use effective contraception during treatment with telotristat and for at least one month after the last dose. Breastfeeding should be avoided during telotristat therapy.
• Gastrointestinal Effects: Telotristat may cause gastrointestinal adverse effects, including nausea, abdominal pain, and constipation. Patients should be monitored for these symptoms, and appropriate supportive care measures should be implemented as needed.
• Serotonin Syndrome: Telotristat inhibits the enzyme tryptophan hydroxylase, which can potentially lead to an increase in serotonin levels. Patients taking telotristat in combination with other serotonergic medications should be monitored for signs of serotonin syndrome, such as agitation, hallucinations, fever, sweating, shivering, rapid heart rate, and muscle stiffness.

As with any medication, patients should follow their healthcare provider’s instructions carefully and report any concerning symptoms or side effects promptly.

What special dietary instructions should I follow?

There are no specific dietary instructions for telotristat. However, taking telotristat with food is recommended to maximize absorption and reduce gastrointestinal side effects. Ensure you follow a balanced diet as advised by your healthcare provider.

What should I do if I forget a dose?

If you miss a dose of telotristat, take it as soon as you remember, unless it is close to the time for your next scheduled dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Telotristat, like any medication, can cause side effects. It’s essential to be aware of potential side effects and report any concerning symptoms to your healthcare provider. Common side effects of telotristat may include:

• Nausea: Some patients may experience nausea as a side effect of telotristat.
• Abdominal Pain: Abdominal discomfort or pain may occur with the use of telotristat.
• Constipation: Telotristat can sometimes lead to constipation as a side effect.
• Headache: Headaches may occur in some individuals taking telotristat.
• Fatigue: Feeling tired or fatigued is another possible side effect of telotristat.
• Increased Liver Enzymes: Telotristat may cause elevated liver enzymes, which can be detected through liver function tests. This requires monitoring by a healthcare provider.
• Depression: Some patients may experience mood changes, including depression, while taking telotristat.
• Weight Loss: Telotristat may lead to weight loss in some individuals.
• Flatulence: Increased gas or flatulence may occur as a side effect of telotristat.
• Peripheral Edema: Swelling in the extremities, known as peripheral edema, may occur in some patients.
• Muscle Cramps: Muscle cramps or spasms may be experienced by some individuals taking telotristat.
• Decreased Appetite: A decrease in appetite may occur as a side effect of telotristat.

It’s important to note that not all individuals will experience these side effects, and the severity and frequency of side effects can vary from person to person. Additionally, some side effects may require medical attention, while others may resolve on their own over time.

If you experience any side effects while taking telotristat or have concerns about its use, it’s crucial to contact your healthcare provider for further evaluation and guidance. Your healthcare provider can help determine the best course of action based on your individual medical history and circumstances.

What should I know about storage and disposal of this medication?

Storage and Disposal:

• Storage: Telotristat should be stored at room temperature away from moisture and heat. Keep the medication in its original container and out of reach of children and pets.
• Disposal: When disposing of telotristat tablets that are no longer needed or have expired, follow any specific disposal instructions provided by your healthcare provider or pharmacist. Do not dispose of medications by flushing them down the toilet or pouring them down the drain unless instructed to do so.

In case of emergency/overdose

• In Case of Emergency: If you experience severe or life-threatening symptoms after taking telotristat, such as difficulty breathing, chest pain, or severe allergic reactions, seek immediate medical attention by calling emergency services or visiting the nearest emergency room.
• Overdose: If you suspect an overdose of telotristat or experience symptoms such as severe nausea, vomiting, or unusual dizziness, contact your healthcare provider or local poison control center (in the United States, you can call 1-800-222-1222) for guidance on what to do.

What other information should I know?

• Follow Healthcare Provider’s Instructions: Always follow your healthcare provider’s instructions regarding the use of telotristat, including dosage, timing of administration, and any special precautions or dietary instructions.
• Regular Monitoring: Your healthcare provider may recommend regular monitoring of liver function tests and other parameters while you are taking telotristat to monitor for potential side effects or adverse reactions.
• Keep Appointments: Attend all scheduled follow-up appointments with your healthcare provider to assess your response to telotristat therapy and make any necessary adjustments to your treatment plan.
• Avoid Alcohol: It’s advisable to limit or avoid alcohol consumption while taking telotristat, as alcohol may exacerbate certain side effects and can potentially interact with the medication.
• Inform Healthcare Providers: Make sure to inform all healthcare providers involved in your care, including dentists and pharmacists, about your use of telotristat to avoid potential drug interactions or complications.
• Patient Assistance Programs: If you have difficulty affording telotristat or obtaining insurance coverage for the medication, inquire about patient assistance programs or financial assistance options that may be available through the manufacturer or other organizations.

Always consult with your healthcare provider or pharmacist if you have any questions or concerns about the use of telotristat or any other medication. They can provide personalized advice and guidance based on your individual medical history and needs.