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Palsonify
paltusotine
Adult Dosing .
Dosage forms: TAB: 20 mg, 30 mg
acromegaly
- [40-60 mg PO qd]
- Start: 40 mg PO qd x2-4wk; Info: for patients ineligible for or who have failed surgery; may temporarily decr. start dose to 20 mg PO qd if tolerability concern; adjust dose based on IGF-1 levels; give at least 6h after and at least 1h before meals
renal dosing
- [see below]
- eGFR >52: no adjustment; eGFR <52: not defined
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- caution: biliary disease
- caution: diabetes mellitus
- caution: thyroid disease
- caution: cardiovascular disease
Drug Interactions .
Overview
paltusotine
somatostatin analog
- CYP3A4 substrate
- alters gallbladder contraction/motility
- bradycardia
- delays atrioventricular conduction
- gastric pH sensitive
- hyperglycemic effects
- hypoglycemic effects
Avoid/Use Alternative
- brigatinib
- ceritinib
- clonidine
- crizotinib
- dexlansoprazole
- esomeprazole
- etrasimod
- fexinidazole
- fingolimod
- lansoprazole
- lofexidine
- omeprazole
- ozanimod
- pantoprazole
- ponesimod
- rabeprazole
- siponimod
- vonoprazan
Monitor/Modify Tx
- acarbose
- acebutolol
- adenosine
- alectinib
- alfentanil
- alogliptin
- amiodarone
- apalutamide
- apraclonidine ophthalmic
- arsenic trioxide
- articaine
- atazanavir
- atenolol
- betaxolol
- betaxolol ophthalmic
- bexagliflozin
- bisoprolol
- bosentan
- bromocriptine
- bupivacaine
- bupivacaine liposomal
- butalbital
- canagliflozin
- carbamazepine
- carteolol ophthalmic
- carvedilol
- cenobamate
- chloroprocaine
- clozapine
- colesevelam
- cyclosporine
- dabrafenib
- dapagliflozin
- dexmedetomidine
- dexmedetomidine injection
- digoxin
- diltiazem
- disopyramide
- donepezil
- dronedarone
- dulaglutide
- efavirenz
- eliglustat
- empagliflozin
- encorafenib
- ensartinib
- enzalutamide
- ertugliflozin
- esmolol
- etravirine
- exenatide
- fentanyl
- flecainide
- fosphenytoin
- galantamine
- glimepiride
- glipizide
- glyburide
- guanfacine
- insulin
- ivabradine
- ivosidenib
- labetalol
- lacosamide
- lamotrigine
- landiolol
- lanreotide
- lasmiditan
- levobunolol ophthalmic
- lidocaine
- linagliptin
- liraglutide
- lixisenatide
- lopinavir/ritonavir
- lorlatinib
- lumacaftor/ivacaftor
- mavacamten
- mefloquine
- mepivacaine
- metformin
- metoprolol
- midodrine
- miglitol
- mitapivat
- mitotane
- modafinil
- nadolol
- nafcillin
- nateglinide
- nebivolol
- neostigmine
- octreotide
- pacritinib
- pasireotide
- pentobarbital
- pexidartinib
- phenobarbital
- phenytoin
- pindolol
- pioglitazone
- pramlintide
- praziquantel
- primidone
- procainamide
- propafenone
- propofol
- propranolol
- pyridostigmine
- quinidine (antiarrhythmic)
- quinine
- regadenoson
- remifentanil
- remimazolam
- repaglinide
- repotrectinib
- rifabutin
- rifampin
- rifapentine
- ritonavir
- rivastigmine
- ropivacaine
- rosiglitazone
- saxagliptin
- semaglutide
- sincalide
- sitagliptin
- sotalol
- sotorasib
- St. John's wort
- succinylcholine
- sufentanil
- sugammadex
- thalidomide
- ticagrelor
- timolol
- timolol ophthalmic
- tirzepatide
- verapamil
Adverse Reactions .
Serious Reactions
- cholelithiasis
- cholecystitis, acute
- gallbladder sludge
- pancreatitis
- diabetes mellitus
- sinus arrest
- AV block
- cardiac conduction disturbance
- hypothyroidism
- exocrine pancreatic insufficiency
- vitamin B12 deficiency
Common Reactions
- diarrhea
- abdominal pain
- nausea
- appetite decr.
- bradycardia
- hyperglycemia
- palpitations
- gastroenteritis
- fat malabsorption
- steatorrhea
Safety/Monitoring .
Monitoring Parameters
blood glucose at baseline and after dose changes; TFTs; vitamin B-12 levels
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available; no known risk of teratogenicity based on animal data at 3x and 11x MRHD
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: liver primarily; CYP450: 2D6 (minor), 3A4/5 substrate; UGT: 1A1, 1A9 substrate
Excretion: feces 90%, urine 3.9%; Half-life: 28h
Subclass: Growth Hormone Antagonists
Mechanism of Action
selectively agonizes somatostatin receptor 2, suppressing growth hormone and insulin-like growth factor-1 secretion
Formulary .
No Formulary Selected
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