Xermelo (telotristat ethyl) is a brand-name drug prescribed for carcinoid syndrome diarrhea in adults in certain situations. Xermelo comes as an oral tablet that’s typically taken three times per day.

Xermelo belongs to a drug class called tryptophan hydroxylase inhibitors. Xermelo isn’t available in a generic version.

Keep reading for specific information about the dosage of Xermelo, including its strength and how to take medication. For a comprehensive look at Xermelo, see this article.

Note: This article describes the typical dosage for Xermelo provided by the drug’s manufacturer. When taking Xermelo, always follow the dosage prescribed by your doctor.

Below is information about Xermelo’s form, strength, and dosage.

Xermelo form

Xermelo comes as an oral tablet packaged in a monthly case of four weekly blister packs. Each weekly pack contains seven daily doses of the drug.

Xermelo strength

Xermelo comes in one strength of 250 milligrams (mg).

Typical dosage

The following information describes the dosage that’s commonly recommended. However, be sure to take the dosage your doctor prescribes for you. They’ll determine the best dosage to fit your needs.

Dosage for diarrhea related to carcinoid syndrome

Doctors may prescribe Xermelo to treat diarrhea due to carcinoid syndrome that’s not responding well to prior treatment. (Carcinoid syndrome is a group of symptoms caused by a neuroendocrine tumor.) Xermelo is typically taken with a type of drug called a somatostatin analog such as Sandostatin (octreotide acetate).

If your doctor prescribes Xermelo, your dose will likely be 250 mg. Typically, you’ll take this three times per day.

For more information about your specific dosage, talk with your doctor.

Long-term treatment

Xermelo is meant to be taken as a long-term treatment. If you and your doctor determine that Xermelo is safe and effective for you, you’ll likely take it long term.

Before you start taking Xermelo, your doctor will discuss your treatment plan with you.

Xermelo comes as an oral tablet that you swallow whole. The drug’s prescribing information doesn’t say whether to crush, chew, or split the tablets. Be sure to take your dose with a meal or snack.

Xermelo tablets are packaged in a monthly case of weekly blister packs. Each pack contains 21 tablets (three doses per day for 7 days). You should keep each tablet in the package until you’re ready to take your dose.

It may be helpful to take Xermelo around the same times each day. This helps maintain a steady level of the drug in your body so Xermelo can work effectively.

Your doctor may prescribe a somatostatin analog such as short-acting* Sandostatin (octreotide acetate) in combination with Xermelo. If so, follow your doctor’s instructions for taking these medications. They’ll typically advise you to take the octreotide at least 30 minutes after taking your Xermelo dose.

If you have trouble swallowing tablets, see this article for tips on how to take this form of medication. You can also talk with your doctor or pharmacist if you need help taking Xermelo.

* Short-acting drugs work quickly but don’t last very long in the body. So you take them more than once per day.


Some pharmacies offer labels with large print, braille, or a code you scan with a smartphone to convert text to speech. If your local pharmacy doesn’t have these options, your doctor or pharmacist might be able to recommend a pharmacy that does.

If you’re having trouble opening medication bottles, ask your pharmacist about putting Xermelo in an easy-open container. They also may recommend tools that can make it easier to open bottles.

If you miss a dose of Xermelo, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and take your next scheduled dose. Do not take two doses to make up for the missed one. If you’re not sure whether you should take a missed dose or skip it, talk with your doctor or pharmacist.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or putting a note where you’ll see it, such as on your bathroom mirror or bedside table. You could also download a reminder app on your phone.

It’s important that you don’t take more Xermelo than your doctor prescribes. For some medications, taking more than the recommended amount may lead to harmful effects or overdose.

If you take more than the recommended amount of Xermelo

Call your doctor right away if you believe you’ve taken too much Xermelo. Another option is to call America’s Poison Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 or your local emergency number, or go to the nearest emergency room.

Below are some frequently asked questions about Xermelo and dosage.

Is the dosage of Xermelo similar to the dosage of Lomotil?

No, the dosage for Xermelo differs from the dosage of Lomotil (diphenoxylate/atropine). These drugs have different active ingredients, so the dosage in milligrams (mg) and how frequently they’re taken differs.

Xermelo is usually taken three times per day, while Lomotil is taken as needed. Your doctor may adjust your Lomotil dosage based on the severity of your symptoms.

Both Xermelo and Lomotil are prescribed to treat diarrhea. However, Xermelo is used specifically for diarrhea related to carcinoid syndrome in adults. Lomotil is prescribed for diarrhea in adults and some children. Your doctor will prescribe the drug and the dosage that’s right for you.

To learn more about how these drugs compare, talk with your doctor or pharmacist.

How long does it take for Xermelo to start working?

Xermelo starts to work after your first dose, as your body absorbs the drug within hours. But it can take time to see a difference in diarrhea and bowel movement frequency. (Xermelo is prescribed to treat diarrhea related to carcinoid syndrome.)

In clinical trials, bowel movements became less frequent as soon as 1–3 weeks after starting Xermelo. Your doctor will monitor you during treatment to determine whether the drug is working to treat your condition.

Talk with your doctor if you have questions about what to expect with Xermelo treatment.

The dosage in this article is the typical dosage provided by the drug’s manufacturer. If your doctor recommends Xermelo for you, they’ll prescribe the dosage that’s right for you. Always follow the dosage that your doctor prescribes.

As with any drug, never change your dosage of Xermelo without your doctor’s recommendation. If you have questions about the dosage of Xermelo that’s best for you, talk with your doctor.

Besides learning about dosage, you may want other information about Xermelo. These additional articles might be helpful:

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.