Mycapssa
Clinical Notes
Mycapssa (octreotide oral capsules) is an oral somatostatin analog for acromegaly in patients stabilized on injectable octreotide/lanreotide.
| Indication | Maintenance treatment of acromegaly in patients who have responded to and tolerated treatment with octreotide or lanreotide |
|---|---|
| Mechanism of Action | Somatostatin analog that binds to somatostatin receptors (SSTR2, SSTR5), inhibiting growth hormone and IGF-1 secretion from pituitary adenoma |
| Pharmacokinetics | Uses transient permeability enhancer (TPE) technology for oral absorption; highly variable bioavailability; taken on empty stomach; hepatic metabolism; half-life ~2.5 hours |
| Dosing | Start 20 mg PO BID on empty stomach (1h before or 2h after food). Titrate based on IGF-1 levels: increase to 40 mg BID if needed. Take with water only |
| Contraindications | Hypersensitivity to octreotide |
| Adverse Effects | Nausea, diarrhea, abdominal pain, cholelithiasis/biliary sludge, hyperglycemia or hypoglycemia, bradycardia, QT prolongation, hypothyroidism; injection site reactions eliminated with oral |
| Drug Interactions | May decrease cyclosporine levels; may affect insulin/oral hypoglycemic requirements; bromocriptine bioavailability increased; beta-blockers/CCBs may enhance bradycardia |
| Monitoring | IGF-1 levels, GH levels; gallbladder ultrasound (baseline and periodically); thyroid function; glucose; heart rate; ECG if risk factors |
| Other Considerations | First oral somatostatin analog; only for patients already stabilized on injectable therapy; must take on empty stomach with water only; eliminates need for injections |
| Reference | UpToDate, Lexicomp, Mycapssa prescribing information, Endocrine Society acromegaly guidelines |
Quick-reference tip: Mycapssa – first oral octreotide; only for patients already stable on injectables; take on empty stomach with water only; BID dosing.
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