Xermelo (telotristat ethyl) tablets are used to treat carcinoid syndrome diarrhea in adults. Xermelo is prescribed alongside another medication, such as octreotide (Sandostatin) when octreotide alone isn't effectively controlling diarrhea. Carcinoid syndrome diarrhea occurs when carcinoid tumors release too much serotonin, causing increased wave-like contractions in the gut (peristalsis). This, in turn, reduces water and electrolyte absorption and leads to diarrhea.

Xermelo specifically targets the underlying cause of carcinoid syndrome diarrhea. Xermelo is a tryptophan hydroxylase inhibitor that works by blocking the enzyme responsible for serotonin production. By inhibiting this enzyme, Xermelo reduces serotonin is made and helps prevent diarrhea.

Xermelo is prescribed together with a somatostatin analog (SSA) therapy, such as octreotide. SSA therapy works by blocking the release of serotonin. When Xermelo is combined with SSA therapy, it helps reduce both the production and release of serotonin, leading to an improvement in diarrhea symptoms.

Xermelo received FDA approval as a medicine on February 28, 2017.

Use only as directed. Tell your doctor if you use other medicines or have other medical conditions or allergies.

Discontinue this medicine if severe constipation or severe persistent or worsening abdominal pain develops

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Xermelo is a tablet that is usually taken 3 times per day with food.

Xermelo comes in a monthly case that contains 4 weekly boxes; 1 box of 7 daily doses for use each week. Keep each tablet in the package until you are ready to take a dose.

Short-acting Octreotide is usually given at least 30 minutes after taking this medicine.

This medicine is only part of a complete treatment program that may also include other medications. Do not change your doses or medication schedule without your doctor's advice.

Tell your doctor if you have ever had liver disease.

Tell your doctor if you are pregnant or breastfeeding.

Not approved for use by anyone younger than 18 years old.

Skip the missed dose and use your next dose at the regular time. Do not use two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Xermelo may cause serious side effects. Stop using Xermelo and call your doctor at once if you have:

• severe constipation; or
• severe or worsening stomach pain.

Common side effects of Xermelo may include:

• nausea, loss of appetite, gas;
• headache, depressed mood;
• swelling in your hands or feet;
• fever; or
• abnormal liver function tests.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.  Using Xermelo with medicines that are CYP3A4 substrates (e.g., midazolam) may decrease their effectiveness. Tell your doctor about all other medicines you use.

Other drugs may affect Xermelo, including prescription and over-the-counter medicines, vitamins, and herbal products.

Click on the link below to check for interactions with Xermelo.