Somatostatin analogue (SSTR1, 2, 3, 5)
Pasireotide
Brand names: Signifor
Adult dose
Dose: Cushing's: 600 micrograms SC BD initially. Acromegaly LAR: 40mg IM monthly
Route: SC/IM
Frequency: BD or monthly
Clinical pearls
- Cushing's disease and acromegaly when surgery not curative
- Glucose monitoring essential — frequent treatment-emergent diabetes
Contraindications
- Severe hepatic impairment
- QT prolongation/risk factors
- Concurrent QT-prolonging drugs
Side effects
- Hyperglycaemia / new-onset diabetes (very common)
- Diarrhoea
- Cholelithiasis
- QT prolongation
- Hepatotoxicity
- Bradycardia
Interactions
- QT-prolonging drugs
- CYP3A4 substrates
- Antidiabetics (often need adjustment)
Monitoring
- Glucose/HbA1c
- ECG
- LFTs
- Cortisol
- Gallbladder ultrasound
Reference: BNF; NICE; SmPC; https://bnf.nice.org.uk/drugs/pasireotide/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016