Osilodrostat Side Effects

Medically reviewed by Drugs.com. Last updated on Jun 11, 2024.

Applies to osilodrostat: oral tablet.

Precautions

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Osilodrostat lowers the cortisol levels (hypocortisolism) in the body, which could lead to adrenal insufficiency, hypertension (low blood pressure), electrolyte imbalance, or hypoglycemia (low blood sugar levels). Cortisol is lowered further during an infection or physical stress. Check with your doctor right away if you have nausea, vomiting, unusual tiredness or weakness, stomach pain, loss of appetite, or dizziness.

Contact your doctor right away if you have any changes to your heart rhythm. You might feel dizzy or faint, or you might have a fast, pounding, or uneven heartbeat. Make sure your doctor knows if you had a heart rhythm problem, such as QT prolongation.

Osilodrostat may cause hypokalemia (low potassium levels in the blood), edema (swelling), or worsen hypertension (high blood pressure). Your doctor may give you a medicine, supplement, or salt substitute the contains potassium to correct your potassium levels. Check with your doctor right away if you have seizures, decreased urine, dry mouth, irregular heartbeat, increased thirst, loss of appetite, mood changes, muscle pain or cramps, nausea, vomiting, numbness or tingling in the hands, feet, or lips, trouble with breathing, unusual tiredness or weakness, swelling in the arms or legs, blurred vision, dizziness, headache, or pounding in the ears.

This medicine may cause acne and increased hair growth on the face, back, arms, and legs in female patients. Talk to your doctor if you have concerns about this.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

Serious side effects of osilodrostat

Along with its needed effects, osilodrostat may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking osilodrostat:

Other side effects of osilodrostat

Some side effects of osilodrostat may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

For healthcare professionals

Applies to osilodrostat: oral tablet.

General adverse events

The most common side effects reported were adrenal insufficiency, fatigue, nausea, headache, vomiting, and edema. The most serious side effect was adrenal insufficiency.^[Ref]

Cardiovascular

• Very common (10% or more): Increased QTcF (corrected QT interval by Fridericia; up to 13%), hypotension (includes orthostatic hypotension, decreased blood pressure, decreased diastolic blood pressure, decreased systolic blood pressure; up to 11.7%), hypertension (up to 10.2%)
• Common (1% to 10%): Tachycardia, ECG QT prolonged, QT prolongation
• Frequency not reported: Clinically relevant ECG findings^[Ref]

Adverse reactions of QT prolongation and clinically relevant ECG findings were reported; 4% of patients had an event of QT prolongation, 2% of patients had a QTcF increase of greater than 60 milliseconds (ms) from baseline, and 13% of patients had a new QTcF value of greater than 450 ms.^[Ref]

Dermatologic

• Very common (10% or more): Rash (includes erythematous rash, generalized rash, maculopapular rash, papular rash; up to 15.3%)
• Common (1% to 10%): Hirsutism, acne, alopecia^[Ref]

Hirsutism and acne were "very common" in female patients.^[Ref]

Endocrine

• Very common (10% or more): Adrenal insufficiency (includes glucocorticoid deficiency, acute adrenocortical insufficiency, steroid withdrawal syndrome, decreased urine free cortisol, decreased cortisol; up to 51%), accumulation of adrenal steroid precursors (up to 42%), hypocortisolism (up to 31%), increased blood corticotrophin (up to 13.9%), abnormal hormone level (up to 11.7%), increased blood testosterone (up to 10.9%)
• Frequency not reported: Increased adrenocorticotropic hormone (ACTH)^[Ref]

Of the patients with adrenal insufficiency, one-third had low cortisol levels indicative of this event; most patients had normal cortisol levels suggesting a cortisol withdrawal syndrome.

Hypocortisolism was reported at a rate of 31% up to 12 weeks and 18% from weeks 12 to 26; most cases were managed by reducing the dose of this drug and/or adding low-dose, short-term glucocorticoid therapy.

Increased blood testosterone was "very common" in female patients.

CYP450 11B1 inhibition by this drug was associated with accumulation of adrenal steroid precursors and increased testosterone. The most common adrenal hormone precursor-related adverse reactions were hypertension (14%) and hypokalemia (17%); edema (7%) and elevated blood pressure (15%) were reported. All cases of hypokalemia responded to potassium supplementation and/or mineralocorticoid antagonist therapy. In male patients, testosterone levels generally increased but remained within normal limits; all patients were asymptomatic with no values above the upper limit of normal at last measure. In female patients, mean testosterone levels increased from high normal at baseline to above the upper limit of the normal range; the increases reversed when treatment was interrupted. Increased testosterone was associated with mild to moderate cases of hirsutism (12%) or acne (11%) in a subset of female patients.

ACTH values greater than 10-fold the upper limit of normal were observed in some Cushing's disease patients treated with this drug in clinical trials.^[Ref]

Gastrointestinal

• Very common (10% or more): Gastrointestinal disorders (up to 69%), nausea (up to 42%), vomiting (up to 22%), diarrhea (up to 14.6%), abdominal pain (includes upper abdominal pain, abdominal discomfort; up to 13.1%)
• Common (1% to 10%): Dyspepsia, gastroenteritis^[Ref]

Gastrointestinal disorders (mainly nausea, vomiting, diarrhea, and abdominal pain) were reported in 69% of patients; in many cases, the episodes were of short duration ( 1 to 2 days) and the severity was mild to moderate.^[Ref]

Genitourinary

• Very common (10% or more): Urinary tract infection (up to 11.7%)^[Ref]

Hematologic

• Very common (10% or more): Decreased absolute neutrophil count (ANC; up to 13%), anemia (up to 10.2%)
• Common (1% to 10%): Neutropenia^[Ref]

Of the 137 patients from the 48-week study, 18 patients had at least 1 measured ANC below the normal limit and 2 patients had neutropenia. No concomitant infections and/or fever were reported in patients with decreased ANC.^[Ref]

Hepatic

• Common (1% to 10%): Increased transaminases, increased ALT/AST
• Frequency not reported: Elevated liver enzymes, abnormal liver parameters^[Ref]

Liver enzyme elevations in patients treated with this drug were infrequent, typically mild, and reversed spontaneously or after dose adjustment. Most abnormal liver parameters occurred during dose-titration and no patients discontinued therapy due to abnormal liver chemistry parameters. Increased ALT or AST greater than 3 times the upper limit of normal was reported in 4% of patients during the 48-week study.^[Ref]

Metabolic

• Very common (10% or more): Hypokalemia (includes decreased blood potassium; up to 12.4%), decreased appetite (up to 11.7%)^[Ref]

Musculoskeletal

• Very common (10% or more): Arthralgia (up to 17.5%), back pain (up to 15.3%), myalgia (up to 12.4%)^[Ref]

Nervous system

• Very common (10% or more): Headache (includes head discomfort; up to 34%), dizziness (includes postural dizziness; up to 13.9%)
• Common (1% to 10%): Syncope^[Ref]

Oncologic

• Very common (10% or more): Changes in pituitary corticotroph tumor volume^[Ref]

Increased pituitary corticotroph tumor volume greater than 20% from baseline was reported in 21/137 (15%) patients, while decreased tumor volume greater than 20% from baseline was reported in 24/137 (18%) patients at week 48. There was no correlation between tumor volume increase and increased ACTH. There was no specific pattern of timing of the tumor volume increase and no relationship with the total and last dose of this drug used in the study.^[Ref]

Other

• Very common (10% or more): Fatigue (includes lethargy, asthenia; up to 44%), edema (includes peripheral edema, generalized edema, localized edema; up to 21.2%), pyrexia (up to 10.9%)
• Common (1% to 10%): Malaise^[Ref]

Psychiatric

• Common (1% to 10%): Insomnia, anxiety, depression^[Ref]

Respiratory

• Very common (10% or more): Nasopharyngitis (up to 19.7%), cough (up to 10.2%)^[Ref]

See also:

Further information

Osilodrostat side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

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