A somatostatin analogue
Pasireotide
A somatostatin analogue for Cushing's disease and acromegaly that notably raises blood sugar.
What is Pasireotide?
Pasireotide is a somatostatin analogue, a medicine that mimics a natural hormone to slow the release of other hormones. It is used for Cushing's disease (too much cortisol) and acromegaly (too much growth hormone), usually when surgery has not worked or is not suitable. Its most notable side effect is that it raises blood sugar, sometimes enough to cause diabetes, so glucose is closely monitored. Like other medicines in its group it can also cause gallstones and digestive upset. The main brand is Signifor.
Education and reference only. This is a plain-language guide to Pasireotide — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Pasireotide is a man-made version of somatostatin, a natural hormone that acts as a brake on the release of several other hormones. It is used in two conditions: Cushing's disease, where a pituitary tumour drives the body to make too much cortisol (a stress hormone), causing weight gain, high blood pressure and other problems; and acromegaly, where too much growth hormone enlarges the hands, feet and features. It is usually used when an operation has not fully worked or is not an option. It is given as an injection — a twice-daily injection under the skin, or a long-acting monthly injection into the muscle, depending on the condition.
How it works
Somatostatin naturally tells various glands to release less of their hormones. Pasireotide copies this effect and binds quite broadly to the body's somatostatin receptors. In Cushing's disease it reduces the pituitary tumour's drive to make cortisol, lowering cortisol levels and easing symptoms. In acromegaly it lowers growth hormone and the related hormone IGF-1. Its broad action is also why it has a stronger effect on blood sugar than some similar medicines, because it reduces the release of insulin and other hormones that control glucose.
Company & origin
Originated / developed by: Recordati.
A somatostatin analogue used in the UK for Cushing's disease and acromegaly, known for raising blood sugar.
Practical use
How to take Pasireotide
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given by injection — either twice a day under the skin or as a long-acting monthly injection into the muscle, depending on your condition.
- If you have the under-the-skin form, you or a carer may be trained to give it; the monthly form is given by a nurse.
- Have your blood sugar checked before and regularly during treatment, as it commonly rises.
- Follow any new or changed diabetes treatment closely if your glucose goes up.
- Report severe tummy pain (possible gallstones) or feeling very tired, dizzy or faint (possible low cortisol).
Weighing it up
Advantages & disadvantages of Pasireotide
Advantages
- Controls cortisol in Cushing's disease and hormone levels in acromegaly when surgery is not enough.
- Available as a twice-daily or a long-acting monthly injection depending on the condition.
- Acts broadly on somatostatin receptors, which can help when other treatments have not worked.
Disadvantages
- Frequently raises blood sugar and can cause or worsen diabetes, needing close monitoring.
- Makes gallstones more likely and commonly causes diarrhoea, nausea and tummy upset.
- Can slow the heart and affect its rhythm, and must be given by injection.
Practical use
Good to know
The stand-out point with pasireotide is its effect on blood sugar: it commonly raises glucose and can cause diabetes or worsen existing diabetes, so blood sugar is checked before and regularly during treatment, and new or stronger diabetes medicines are often needed. Like other somatostatin analogues it slows the gallbladder, making gallstones more likely, and it commonly causes diarrhoea, nausea and tummy upset. It can also slow the heart rate and affect the heart's electrical rhythm, so the heart may be checked. In Cushing's disease, lowering cortisol can sometimes drop it too far, causing tiredness, dizziness and low blood pressure, which should be reported. Treatment is overseen by a specialist with regular blood tests and monitoring.
Who should not take it / use with caution
- It is used with great caution in people with diabetes or poorly controlled blood sugar.
- It is used cautiously in those with certain heart rhythm problems or a slow heart rate.
- It is used carefully in people with gallstones or significant liver problems.
Monitoring
- Frequent blood-sugar monitoring before and during treatment.
- Blood tests for cortisol in Cushing's disease, or growth hormone and IGF-1 in acromegaly.
- Heart tracing and gallbladder and liver checks during treatment.
Side effects
- Raised blood sugar, sometimes causing diabetes, is the most notable effect.
- Diarrhoea, nausea, tummy pain and gallstones are common.
- A slower heart rate, heart-rhythm changes, tiredness and, in Cushing's, sometimes low cortisol.
Key interactions
- Medicines for diabetes, including insulin, often need adjusting because it raises blood sugar.
- Caution is needed with medicines that affect the heart's rhythm, as it can add to this.
- Medicines that slow the heart rate, such as some beta-blockers, may need their doses reviewed.
Available as: Solution given by injection under the skin (twice daily) or a long-acting injection into the muscle (monthly).
Answers
Pasireotide: frequently asked questions
What is pasireotide used for?
It is used for Cushing's disease (too much cortisol) and acromegaly (too much growth hormone), usually when surgery has not fully worked or is not suitable.
Why does it affect my blood sugar so much?
It acts broadly on somatostatin receptors and reduces the release of insulin and other glucose-controlling hormones, so it commonly raises blood sugar and can cause diabetes.
How is it given?
Depending on the condition, it is either an injection under the skin twice a day or a long-acting injection into the muscle once a month.
Can it cause gallstones?
Yes, like other somatostatin analogues it slows the gallbladder and makes gallstones more likely, so report severe tummy pain.
What should I watch for in Cushing's disease?
Lowering cortisol can sometimes go too far, causing tiredness, dizziness, faintness and low blood pressure, which should be reported to your team.
The wider class
About Somatostatin analogue
Pasireotide belongs to the somatostatin analogue class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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