Long-term treatment of individuals w/ acromegaly when the circulating levels of growth hormone &/or insulin-like growth factor-1 remain abnormal after surgery &/or RT or in patients who require medical treatment. Symptomatic improvement associated w/ acromegaly; symptomatic reduction associated w/ carcinoid syndrome. Grade 1 & a subset of grade 2 (Ki67 index up to 10%) gastroenteropancreatic neuroendocrine tumours (GEP-NETs) of midgut, pancreatic or unknown origin where hindgut sites of origin have been excluded, in adult patients w/ unresectable locally advanced or metastatic disease.
May reduce gallbladder motility & lead to gallstone formation. Perform gallbladder echography before treatment & every 6 mth during prolonged treatment. Discontinue if cholelithiasis complications (eg, cholecystitis, cholangitis & pancreatitis) are suspected. Possible hypo- or hyperglycaemia. Monitor blood glucose levels when treatment is initiated or when the dose is altered. Perform thyroid function tests if clinically indicated. Monitor vol of the pituitary tumour. May lead to decreased heart rate w/out necessarily reaching bradycardia threshold in patients w/out underlying cardiac problems. Sinus bradycardia may occur in patients suffering from pre-existing cardiac disorders. Patients w/ bradycardia. Dizziness may affect ability to drive & use machines. Avoid use during pregnancy. Not to be used during breast-feeding. Not recommended in childn & adolescents.
May decrease relative bioavailability of ciclosporin. Risk of hypo- or hyperglycaemia w/ insulin, glitazones, repaglinide & sulphonylureas. May have an additive effect on the slight reduction of heart rate w/ bradycardia-inducing drugs (eg, β-blockers). May decrease metabolic clearance of compd known to be metabolised by CYP450 enzymes. Concomitant use w/ other drugs mainly metabolized by CYP3A4 & have low therapeutic index (eg, quinidine).
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