INTRODUCTION: Acromegaly is a rare systemic disorder caused by an excess of growth hormone. Since surgical resection of the underlying tumor is not always successful, pharmacotherapy plays an invaluable role in managing this condition. While current treatment options are generally effective and well-tolerated, there remains significant room for improvement. AREAS COVERED: This paper explores recent developments in the treatment of acromegaly that either propose new mechanisms of delivering established agents or introduce entirely new treatment strategies. It reviews available clinical data and discusses the progress of various new pharmacological agents. EXPERT OPINION: Advancements in acromegaly pharmacotherapy are focused on overcoming current treatment limitations by developing more effective, tolerable, and personalized therapies. Emerging approaches, including small molecules, monoclonal antibodies, and antisense oligonucleotides, along with biomarker-driven precision medicine, aim to improve patient outcomes, minimize side effects, and enhance long-term disease management.