Side effects of drug therapy for acromegaly
| Medication | Side effects | Comments |
|---|---|---|
| Octreotide Octreotide long-acting release Lanreotide depot/autogel | Common: abdominal cramps, flatulence and diarrhea; these symptoms usually subside with continued treatment; cholelithiasis and gallbladder sludge occur in approximately 25% of patients, usually without symptoms Less common: local skin irritation, pain at the injection site, reversible hair loss Glycemic control usually improves because these agents inhibit both insulin and glucagon as well as growth hormone secretion; rarely, glycemic control may worsen | Endocrine Society guidelines recommend against routine abdominal ultrasound for monitoring for cholelithiasis in patients receiving somatostatin receptor ligands (SRLs) because symptomatic gallbladder disease is infrequent. |
| Pasireotide | In contrast to other SRLs, pasireotide causes hyperglycemia in 57% of patients Other side effects are similar to those of the other SRLs | |
| Pegvisomant | Elevated liver aminotransferases in 9% of patients Injection site reactions (local discomfort, reversible lipohypertrophy, or lipoatrophy) in 2.2% of patients | The Endocrine Society guidelines suggest monitoring liver function tests monthly for the first 6 months, and then every 6 months in patients receiving pegvisomant. Stop the drug if liver aminotransferase levels are elevated > 3 times the upper level of normal. |
| Cabergoline | Gastrointestinal upset, nasal congestion, fatigue, orthostasis, headache Cardiac valve abnormalities have occurred in patients with Parkinson disease on high doses of cabergoline (> 2 mg/week) | There is no consensus on frequency of cardiac valve monitoring in patients on cabergoline. If the dose exceeds 2 mg a week, consider obtaining a baseline echocardiogram and then serial echocardiograms; no specific recommendation currently exists. |
Based on information in reference 14.