The first-line treatment for acromegaly is transsphenoidal surgery. Somatostatin receptor ligands are usually prescribed if surgery fails, or, in some patients, as pre-surgical medical treatment. The efficacy and tolerance of first-generation somatostatin receptor ligands is well established, but they incur unmet medical needs due to their mode of administration and side-effects. We report results for new compounds that may be used in the near future as alternatives to first-generation somatostatin receptor ligands, with data on efficacy and tolerance: oral octreotide, paltusotine and long-acting subcutaneous octreotide are reviewed in detail, together with potential new compounds under investigation. We also discuss their potential role in the therapeutic armamentarium for acromegaly.