Management of carcinoid syndrome depends on getting early diagnosis, proper monitoring, and treatment. Your doctor will discuss the best treatment for you and help you to set up an easy-to-follow treatment plan.
Medical Therapy for Carcinoid Syndrome
Most patients with carcinoid syndrome are diagnosed after they have already started experiencing symptoms like diarrhea and flushing, and they want some relief from these debilitating symptoms. This is the primary goal of treating carcinoid syndrome.1,2
There is medical therapy available to help give you control over the severe diarrhea and flushing associated with carcinoid syndrome. Antidiarrheal medications do not work to control the severe diarrhea associated with carcinoid syndrome. Your doctor will discuss the best treatment for you and help you set up an easy-to-follow treatment plan. It is important that you speak to your doctor about starting treatment at the first sign of symptoms.3,4
Sandostatin® (octreotide acetate) is a somatostatin analogue, which is a type of medicine that works directly at the site of the carcinoid tumors to help decrease the production of hormones that lead to the severe diarrhea and flushing of carcinoid syndrome. It is the only approved medical treatment for the control of the severe diarrhea and flushing associated with carcinoid syndrome.5,6, 7
Learn more about medical treatment with Sandostatin® LAR Depot and Sandostatin® Injection.
Monitoring carcinoid syndrome
Carcinoid syndrome occurs when carcinoid tumors produce different hormones that end up circulating in the body. The increase in these hormones is what causes the symptoms associated with carcinoid syndrome, such as severe diarrhea and flushing.8
One such hormone that is overproduced by carcinoid tumors is serotonin. Serotonin breaks down into smaller parts called metabolites. The most important serotonin metabolite is a substance called 5-hydroxyindoleacetic acid (5-HIAA). Doctors can measure 5-HIAA as a diagnostic test for carcinoid syndrome.8,9
Most doctors rely on tests to monitor carcinoid syndrome. They will also keep track of your disease by monitoring the intensity of symptoms you may experience (eg, severe diarrhea and flushing). This is why it is important for you to keep track of your symptoms and report any changes to your healthcare provider.8
One common test measures the level of the serotonin metabolite 5-HIAA in your urine (see figure below). This test is highly useful because most patients with carcinoid syndrome overproduce serotonin and its metabolite, 5-HIAA.8
Before getting tested for 5-HIAA
Some foods are rich in serotonin and the consumption of these foods can lead to a false-positive test. Please talk to your doctor or nurse who can advise you not to eat the following foods for 24 hours before taking a 5-HIAA test:
Selected foods that may alter 5-HIAA testing1,9
- Avocados
- Bananas
- Pecans
- Pineapple
- Tomatoes
- Walnuts/Hickory nuts
There are also certain medications that can affect your 5-HIAA test1
- Acetaminophen (such as Tylenol®*)
- Salicylates (aspirin)
- Guaifenesin (found in some cough medicines)
- L-dopa (used to treat Parkinson's disease)
Please consult your physician before taking the 5-HIAA test.1
*Tylenol is a registered trademark of McNeil Consumer Products Company.
INDICATIONS AND USAGE
Sandostatin® LAR Depot (octreotide acetate for injectable suspension) is a prescription medicine indicated for patients in whom initial treatment with immediate release Sandostatin® (octreotide acetate) Injection has been shown to be effective and tolerated for:
- Long-term maintenance therapy in acromegalic patients who have had inadequate response to surgery and/or radiotherapy or for whom surgery and/or radiotherapy is not an option (the goal of treatment in acromegaly is to reduce GH and IGF-1 levels to normal).
- Long-term treatment of the severe diarrhea and flushing episodes associated with metastatic carcinoid tumors.
- Long-term treatment of the profuse watery diarrhea associated with VIP-secreting tumors
In patients with carcinoid syndrome and VIPomas, the effect of Sandostatin Injection and Sandostatin LAR Depot on tumor size, rate of growth and development of metastases has not been determined.
IMPORTANT SAFETY INFORMATION
Warnings and precautions: Treatment with Sandostatin LAR Depot may affect gallbladder function, sugar metabolism, thyroid and heart function, and nutritional absorption, which may require monitoring by your doctor.
Before taking Sandostatin LAR Depot: Tell your doctor if you have a history of heart disease or are taking other medications, including: cyclosporine, insulin, oral hypoglycemic agents, beta-blockers, and bromocriptine.
Common side effects: Most patients experience side effects at some time. Some common side effects you may experience include:
- Acromegaly: diarrhea, gallstones, abdominal pain, and flatulence
- Carcinoid tumors: back pain, fatigue, headache, abdominal pain, nausea, and dizziness
Other information: Patients with carcinoids tumors and VIPomas should adhere closely to their scheduled return visits for reinjection in order to minimize exacerbation of symptoms. Patients with acromegaly should adhere to their return visit schedule to help assure steady control of GH and IGF-1 levels.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
