Class: Antineoplastic Agents
VA Class: AN500
Chemical Name: 5 - Oxo - L - prolyl - L - histidyl - L - tryptophyl - L - seryl - L - tyrosyl - D - leucyl - L - leucyl - L - arginyl - N - ethyl - L - prolinamide acetate (salt)
Molecular Formula: C59H84N16O12•C2H4O2
CAS Number: 74381-53-6
Brands: Eligard, Lupron, Lupron Depot
Antineoplastic agent and gonadotropin releasing hormone (GnRH) agonist; a synthetic nonapeptide analog of naturally occurring GnRH (luteinizing hormone releasing hormone [LHRH], gonadorelin).1 2 3 80 81 99 100 116 155 156 180 187 190 191 192
Uses for Leuprolide Acetate
Palliative treatment of endometriosis (e.g., pain relief, reduction in endometriotic lesions [dysmenorrhea and pelvic pain, tenderness, and induration]).5 55 71 96 105 106 107 108 116 126 131 191 Experience with leuprolide has been limited to women ≥18 years of age.105 116 126 191
Used in conjunction with norethindrone acetate (5 mg daily) if symptoms recur after the initial course of therapy (retreatment).116 191 Retreatment with leuprolide alone is not recommended.116 191 (See Endometriosis under Dosage and Administration and see Musculoskeletal Effects under Cautions.)
Correction of anemia associated with uterine leiomyomata (uterine fibroids) prior to surgery;116 181 191 used in conjunction with iron therapy.116 181 191 Experience with leuprolide has been limited to women ≥18 years of age.116 181 191
Treatment of central (via activation of the hypothalamic-pituitary-gonadal axis) precocious puberty (true precocious puberty, GnRH-dependent sexual precocity, complete isosexual precocity) in children155 156 157 158 159 160 161 162 163 164 165 166 177 (designated an orphan drug by FDA for this use).179
Treatment with a GnRH analog is indicated for children (girls <8 or boys <9 years of age) who have a clinical diagnosis (confirmed by pubertal response to a GnRH stimulation test) of central idiopathic or neurogenic precocious puberty with onset of secondary sexual characteristics155 156 157 159 160 177 and subsequent rapid advancement of height, height velocity, and/or bone age (e.g., ≥1 year more advanced than their chronologic age).155 156 157 159 160 161 162 163 164 165 177
Some clinicians also state that GnRH analog therapy is indicated in boys <8 years of age with a serum testosterone concentration >100 ng/dL157 177 and in girls with onset of menarche and recurrent menses at <9 years of age.177 178
GnRH analogs are ineffective as primary therapy in the treatment of GnRH-independent† (peripheral; gonadal steroid secretion is independent of gonadotropin secretion) precocious puberty, including familial male precocious puberty (testotoxicosis), congenital virilizing adrenal hyperplasia (e.g., secondary to steroid 21-hydroxylase, 11β-hydroxylase, or 3β-hydroxysteroid dehydrogenase deficiency), and McCune-Albright syndrome.157 158 169 170 171 172 173 174 177 178
Leuprolide Acetate Dosage and Administration
In patients with stage B2 or C prostate cancer, initiate leuprolide and antiandrogen 8 weeks prior to and continue during radiation therapy.200
In patients with stage D2 metastatic prostate cancer, initiate leuprolide and antiandrogen therapy concomitantly and continue until disease progression.200
Lupron Depot: Release characteristics of a fractional dose of the 11.25-mg (3-month) injectable suspension formulation are not equivalent to the same dose of the 3.75-mg (once-monthly) formulation and should not be used for monthly doses.116 191
Use of the 3-month formulation of leuprolide acetate injectable suspension (Lupron Depot-3 month 11.25 mg) recommended only when 3 months of hormonal suppression is necessary.191
Precocious Puberty: Baseline Evaluation Prior to Initiating Therapy
Leuprolide acetate injection and suspension (Lupron Depot) have comparable efficacy and safety in the treatment of advanced prostate cancer.100 101 In most patients, use of the suspension may be preferred to use of the injection because of greater convenience of administration and patient compliance with therapy.101 121
Administer leuprolide acetate suspension (Lupron Depot) by IM injection once monthly as the 3.75- or 7.5-mg depot 1-month formulation;100 101 116 155 180 187 once every 3 months as the 11.25- or 22.5-mg long-acting 3-month formulation;100 101 116 155 180 187 190 191 once every 4 months as the 30-mg long-acting 4-month formulation,100 101 116 155 180 187 190 or once every 24 weeks as the 45-mg long-acting 6-month formulation.190
Release characteristics of a fractional dose of the 22.5-mg (3-month), 30-mg (4-month), or 45-mg (6-month) suspension formulation (Lupron Depot) are not equivalent to the same dose of the 7.5-mg (once-monthly) formulation and should not be used for monthly doses for treatment of prostate cancer.180 187 190
Release characteristics of a fractional dose of the 11.25-mg (3-month) suspension formulation (Lupron Depot) are not equivalent to the same dose of the 3.75-mg (once-monthly) formulation and should not be used for monthly doses for treatment of endometriosis or uterine leiomyomata.116 191
Administer leuprolide acetate suspension (Lupron Depot-Ped) by IM injection once every 4 weeks as a 3.75-, 7.5-, or 15-mg depot 1-month formulation.155
Leuprolide acetate powder for injectable suspension (Lupron Depot) is available in a dual-chamber, disposable, single-use syringe;100 116 155 190 191 chamber 1 of the system contains leuprolide acetate lyophilized powder, and chamber 2 contains the sterile diluent supplied by the manufacturer.100 116 155 190 191
Reconstitute dual-chamber, disposable, single-use syringes containing 3.75, 7.5, 11.25, 15, 22.5, 30, or 45 mg of leuprolide acetate extended-release for injectable suspension with the accompanying diluent in accordance with the instructions provided by the manufacturer.100 116 155 190 191
Following reconstitution, immediately inject entire contents of the syringe to provide a 3.75-, 7.5-, 11.25-, 15-, 22.5-, 30-mg, or 45-mg dose, depending on the labeled concentration of the syringe used.100 116 155 190 191
Administer leuprolide acetate suspension (Eligard) by sub-Q injection once monthly as a 7.5-mg formulation, once every 3 months as a 22.5-mg formulation, once every 4 months as a 30-mg formulation, or once every 6 months as a 45-mg formulation.192
Administer leuprolide acetate suspension (Eligard) in an area with sufficient soft or loose sub-Q tissue (e.g., upper- or mid-abdominal area, upper buttocks).192 Avoid areas with excessive pigment, hair, or brawny or fibrous sub-Q tissue (nodules, lesions) or locations that could be rubbed or compressed (e.g., with a belt or clothing waistband).192
When substitution of another syringe for the one provided by the manufacturer for use with leuprolide acetate injection is required, a disposable, low-dose, U-100 insulin syringe is the only syringe that should be used.98 104 193
Leuprolide acetate powder for injectable suspension (Eligard) is available in a single-use kit, containing 2 separate disposable syringes;192 syringe 1 of the system contains leuprolide acetate powder, and syringe 2 contains the polymeric (non-gelatin-containing) delivery system (Atrigel).192
Allow the kit to reach room temperature before reconstituting.192
Reconstitute single-use syringes containing 7.5, 22.5, 30, or 45 mg of leuprolide acetate powder for injectable suspension with the accompanying polymeric delivery system in accordance with the instructions provided by the manufacturer.192
Central Precocious Puberty
Individualize dosage according to actual body weight;155 156 161 younger children (i.e., children weighing <25 kg) generally appear to require higher dosages on a mg/kg basis than older children (i.e., children weighing ≥25 kg).155 156
Confirm inhibition of gonadotropin secretion and suppression of ovarian or testicular steroidogenesis after 1–2 months of initial therapy or when changing dosage by evaluation of GnRH stimulation test, Tanner staging, and sex steroid concentrations.155 156 159
Data currently are insufficient for specific dosage recommendations in children in whom therapy was initiated at a low dosage and at a very young age and whose weight has changed such that the patient would be in a different weight range/dose category.155 156 The manufacturer recommends that inhibition of gonadotropin secretion and suppression of ovarian or testicular steroidogenesis be monitored closely in children whose weight has increased considerably while receiving therapy.155 156
Dosage of leuprolide acetate suspension (Lupron Depot-Ped)
7.5 mg every 4 weeks
11.25 mg every 4 weeks
15 mg every 4 weeks
Titrate dose upward in increments of 3.75 mg every 4 weeks until clinical or laboratory tests indicate no disease progression.155
Therapy usually is continued until fusion of the epiphyses157 or attainment of appropriate chronologic pubertal age (e.g., consideration made at 11 and 12 years of age in girls and boys, respectively).155 156 157
Leuprolide acetate injection (Lupron for Pediatric Use): Initially 50 mcg/kg once daily for girls <8 years of age or boys <9 years of age.156 158 If total suppression of ovarian or testicular steroidogenesis is not achieved, titrate dosage upward by 10 mcg/kg daily to establish maintenance dosage.156
Advanced Prostate Cancer
Daily Therapy with Leuprolide Acetate InjectionSub-Q
For patients at risk of serious adverse affects, consider initiating therapy with daily administration of leuprolide acetate injection for 2 weeks prior to IM administration of leuprolide acetate suspension (Lupron Depot) to permit discontinuance of therapy if warranted.101 180 187 (See Endocrine Effects under Cautions.)
Therapy with Extended-release SuspensionIM
7.5 mg once monthly as the monthly formulation (Lupron Depot),100 101 or 22.5 mg every 12 weeks as the 3-month formulation (Lupron Depot 22.5 mg for 3-month administration),180 190 or 30 mg once every 16 weeks as the 4-month formulation (Lupron Depot 30 mg for 4-month administration),187 190 or 45 mg once every 24 weeks as the 6-month formulation (Lupron Depot 45 mg for 6-month administration).190
If a monthly dose is missed, a delay of ≤12 days may or may not compromise the patient’s treatment; however, if a monthly dose is missed by ≥2 weeks, serum testosterone concentrations will increase substantially.101Sub-Q
Eligard: 7.5 mg once monthly as the monthly formulation, or 22.5 mg once every 3 months as the 3-month formulation, or 30 mg once every 4 months as the 4-month formulation, or 45 mg once every 6 months as the 6-month formulation.192
3.75 mg once monthly as the monthly formulation (Lupron Depot) for 6 consecutive months116 or 11.25 mg every 3 months as the 3-month formulation (Lupron Depot-3 month 11.25 mg) for a total of 6 months.191 Administer with or without norethindrone acetate (5 mg daily).116 191
Retreatment If Symptoms Recur after Initial Treatment
Retreatment with additional courses of leuprolide alone is not recommended; if retreatment is considered, administer a single 6-month course of leuprolide acetate suspension in conjunction with norethindrone acetate (and elemental calcium 1 g daily).116 191
3.75 mg once monthly as the monthly formulation (Lupron Depot) for a total of 6 months or 11.25 mg every 3 months as the 3-month formulation (Lupron Depot-3 month 11.25 mg) for a total of 6 months.116 191 Administer in conjunction with oral norethindrone acetate (5 mg daily).116 191
3.75 mg once monthly as the monthly formulation (Lupron Depot) for up to 3 consecutive months in conjunction with iron therapy.116
11.25 mg of the 3-month formulation (Lupron Depot-3 month 11.25 mg) as a single injection in conjunction with iron therapy.191 Use of the 3-month formulation recommended only when 3 months of hormonal suppression is necessary.191
Retreatment If Symptoms Recur after Initial TreatmentIM
Lupron Depot 3.75 mg monthly formulation: Maximum 3 consecutive months of therapy recommended.116
Lupron Depot 11.25 mg (3-month formulation): A single injection of 11.25 mg recommended.191
Safety and efficacy of >6 months of therapy not evaluated.191
Cautions for Leuprolide Acetate
Fetal/Neonatal Morbidity and Mortality
Expected hormonal changes increase the risk for pregnancy loss and fetal harm when administered to a pregnant woman; teratogenicity, fetotoxicity, and fetolethality demonstrated in animals.1 100 155 156 180 187 190 191 192 193 194
Women of childbearing potential should avoid pregnancy and use an effective nonhormonal method of contraception during therapy.116 191 If used during pregnancy or patient becomes pregnant, discontinue and apprise of potential fetal hazard.1 100 116 156 180 187 190 191 192 193 194
Initial Worsening of Hormone-dependent Disease
Transient increases in serum testosterone (in men) or estrogen (in women) concentrations1 10 32 33 35 99 100 108 115 116 145 146 155 156 180 187 190 191 192 may result in worsening (flare) of signs and/or symptoms (e.g., increased bone pain) of hormone-dependent disease (e.g., endometriosis, prostatic carcinoma, central precocious puberty) during the initial 1–2 weeks of therapy; generally subsides during continued therapy.1 10 32 33 35 99 100 108 115 116 145 146 155 156 180 187 190 191 192 Concomitant antiandrogen therapy (e.g., flutamide, nilutamide) has been used to decrease disease flare severity and improve overall response rates in patients with advanced prostate cancer.3 49 50 102 111 130
Risk of spinal cord compression which may contribute to paralysis with or without fatal complications and/or ureteral obstruction (dysuria, hematuria) in men with prostate cancer.1 82 100 145 187 190 192 Monitor patients with metastatic vertebral lesions and/or urinary tract obstruction closely during initial therapy for temporary weakness or paresthesia of the lower limbs and/or worsening of urinary signs and symptoms.99 100 180 190 192 If spinal cord compression or urinary obstruction develops, institute standard treatment.100 192
Use with extreme caution in patients with life-threatening disease in whom rapid symptomatic relief is necessary;1 2 4 exacerbation of signs and/or symptoms of the disease potentially may result in a rapid fatal outcome.1 75 99 100
Possible hyperglycemia and increased risk of diabetes in patients receiving GnRH agonists for treatment of prostate cancer.100 189 190 Studies evaluating risk of diabetes in women and children receiving GnRH agonists not performed to date.188
Periodically monitor blood glucose and/or HbA1c in patients receiving GnRH agonists for treatment of prostate cancer.189 190 Manage hyperglycemia or diabetes according to current standards of care.100 189 190
Combination Therapy with Norethindrone Acetate
If leuprolide acetate suspension (Lupron Depot) is used in conjunction with norethindrone acetate for management of endometriosis, consider the precautions, cautions, and contraindications associated with the concomitant agent.116 191
Noncompliance or Inadequate Dosage in Central Precocious Puberty.
Noncompliance with dosage regimen or use of inadequate dosage may result in inadequate control of the pubertal process including return of pubertal signs (e.g., menses, breast development, testicular growth).155 156 Long-term effects of inadequate control of gonadal (sex) steroid secretion are not known; further compromise of adult stature may occur.155 156
Serious and occasionally fatal hypersensitivity reactions, including anaphylactoid or asthmatic process reported rarely.99 100 116 155 156 187 190 191 192 194 Rash, urticaria, and photosensitivity reactions also reported.99 100 116 155 156 187 190 194
Leuprolide acetate injection contains benzyl alcohol as a preservative.1 99 156 193 194 Risk of local hypersensitivity reactions (e.g., erythema, induration at the injection site); use with caution in patients with known hypersensitivity to benzyl alcohol.1 156 193 194 99
Pituitary apoplexy, a clinical syndrome resulting from infarction of the pituitary gland, reported rarely.100 116 155 190 Most cases occur within 2 weeks of the first dose, sometimes within the first hour.100 116 155 190 If manifestations (e.g., sudden headache, vomiting, visual changes, ophthalmoplegia, altered mental status, sometimes cardiovascular collapse) occur, immediate medical attention required.100 116 155 190 In most cases, pituitary adenoma diagnosed.100 116 155 190
Decreases in bone mineral density (BMD) have been reported in men100 190 192 193 187 and women.105 106 108 110 116 126 127 128 129 131 133 134 135 191 For management of endometriosis in women, concurrent use of norethindrone acetate (5 mg daily) and calcium supplementation (1 g elemental calcium daily) reduces the drug-induced loss of BMD without compromising the efficacy of the drug.116 191
Use in women for management of endometriosis for periods exceeding 6 months, for uterine leiomyomata for periods exceeding 3 months, or in patients with other risk factors for decreased BMD (e.g., chronic alcohol and/or tobacco use, strong family history of osteoporosis, chronic use of drugs that can reduce bone mass [e.g., corticosteroids, phenytoin]) may result in additional bone loss.116 191 Carefully weigh risks and benefits of therapy.116 191 In women with risk factors for decreased BMD, consider concomitant treatment with norethindrone acetate 5 mg daily.116 191
Adverse cardiovascular effects (e.g., hypotension,100 116 190 MI,100 116 190 DVT,116 PE,100 116 190 stroke,116 and TIA116 ) reported. Possible increased risk of certain cardiovascular diseases (e.g., MI, sudden cardiac death, stroke) in patients receiving GnRH agonists for treatment of prostate cancer.100 189 190 192 Studies evaluating risk of heart disease in women and children receiving GnRH agonists not performed to date.188
Periodically monitor patients receiving GnRH agonists for treatment of prostate cancer for manifestations of cardiovascular disease; manage cardiovascular disease according to current standards of care.100 189 190 192
Risk of prolonged QT interval associated with long-term androgen deprivation therapy.190 Carefully weigh benefits and risks of androgen deprivation therapy in patients with congenital long QT syndrome, electrolyte abnormalities, or CHF and in patients taking class IA (e.g., quinidine, procainamide) or class III (e.g., amiodarone, sotalol) antiarrhythmic agents.190
Patient Monitoring in Prostate Cancer
Periodically determine serum testosterone1 64 100 190 192 193 and PSA1 64 100 192 193 concentrations to monitor therapeutic response. Precision of testosterone assays varies; consider specific type used.180 187 190 192
Patient Monitoring in Central Precocious Puberty
Determine serum sex steroid concentrations and perform GnRH stimulation test 1–2 months after initiation of therapy155 156 159 and periodically (e.g., every 6 months thereafter)159 to monitor therapeutic response.155 156 159
Inadequate dosage may lead to increased sex steroid concentrations;155 156 once a therapeutic dosage has been achieved, gonadotropin and sex steroid concentrations will decline to prepubertal concentrations.155 156
Risk of increased LDL-cholesterol/HDL-cholesterol ratio, increased total and LDL cholesterol and triglycerides, and decreased HDL-cholesterol in women receiving leuprolide acetate alone and in conjunction with norethindrone acetate for endometriosis.116 191
Assess and manage cardiovascular risk factors, including cigarette smoking, before initiating combined therapy with leuprolide acetate in conjunction with norethindrone acetate for endometriosis.116 191
Safety and efficacy of leuprolide acetate injection and leuprolide acetate injectable suspension (7.5-, 11.25-, or 15-mg pediatric formulations of Lupron Depot-Ped) for uses other than treatment of central precocious puberty not established.116 155
Safety and efficacy of the 3.75 mg (monthly), 11.25 mg (3-month), 22.5-mg (3-month), 30-mg (4-month), or 45-mg (6-month) formulations of leuprolide acetate injectable suspension (Lupron Depot) not established.116 190 191
Safety and efficacy of the 7.5-, 22.5-, 30-, 45-mg formulations of leuprolide acetate injectable suspension (Eligard) not established.192
Evaluate patients prior to initiating therapy and periodically during therapy to evaluate response to the drug.155 156 159 (See Baseline Evaluation prior to Initiating Therapy under Dosage and Administration and also see Patient Monitoring in Central Precocious Puberty under Cautions.)
Leuprolide acetate injection or leuprolide acetate injectable suspension (7.5-, 22.5-, 30-, 45-mg formulations of Eligard or Lupron Depot): Clinical studies for use in prostate cancer have been conducted principally in patients ≥65 years of age.100 190 192 193
Leuprolide acetate injectable suspension (11.25- or 15-mg pediatric formulations of Lupron Depot-Ped): Safety and efficacy not established in those ≥65 years of age.155
Common Adverse Effects
Men with metastatic prostate cancer (leuprolide acetate injection): Hot flushes (flashes),1 2 3 4 10 32 33 34 35 36 100 101 193 impotence,1 2 33 34 36 193 decreased libido,2 10 32 33 testicular atrophy,1 193 general pain,1 ECG changes/ischemia,1 193 peripheral edema,1 193 asthenia.1 193
Men with metastatic prostate cancer (leuprolide acetate suspension [Lupron Depot]): Hot flushes,100 121 180 187 190 impotence,100 180 190 decreased libido,100 180 testicular atrophy,100 180 190 general pain,100 180 187 190 GI disorders,100 187 190 edema,100 187 190 injection site reaction,180 187 190 urinary disorder,100 180 187 190 respiratory disorder,100 190 infection,100 joint disorder,180 187 190 peripheral edema,99 100 116 190 asthenia,100 190 fatigue/lethargy.190
Men with metastatic prostate cancer (leuprolide acetate injectable suspension [Eligard]): Injection site reactions (transient burning/stinging),192 hot flushes,192 malaise and fatigue,192 testicular atrophy.192
Women with endometriosis: Hot flushes, 105 106 108 116 121 126 amenorrhea,105 106 116 hypercholesterolemia,116 depression/emotional lability,116 dizziness,116 insomnia/sleep disorder,105 libido changes (e.g., decreased libido),116 asthenia,116 general pain,116 headache,116 nausea/vomiting,116 altered bowel function, weight gain/loss,116 acne,116 skin reactions,116 joint disorder,116 vaginitis.116
Children with precocious puberty: Injection site reaction (e.g., abscess),155 156 emotional lability,155 general pain,155 156 acne/seborrhea,155 156 headache,155 rash (e.g., erythema multiforme),155 156 vaginitis/bleeding/discharge,155 156 vasodilation.155
Interactions for Leuprolide Acetate
Specific Drugs and Laboratory Tests
Drug or Test
Antiandrogen (e.g., flutamide, bicalutamide, nilutamide)
Tests, diagnostic tests of pituitary gonadotropic and gonadal function
Leuprolide Acetate Pharmacokinetics
Peak plasma concentrations usually attained 3.3–5 hours following sub-Q administration of long-acting injectable suspension (Eligard) in prostate cancer patients.192
Following IM administration of the long-acting injectable suspension (Lupron Depot) or sub-Q administration of the long-acting injectable suspension (Eligard), the drug is released slowly and gradually from its biodegradable copolymer-containing vehicle.100 101 116 155 117 118 180 187 190 192
Onset of estradiol suppression occurs 4–28 days following IM administration of a single 11.25-mg dose of the long-acting injectable suspension in healthy women;191 mean estradiol concentration is in the menopausal range 21 days following administration.191
Peak plasma concentrations remain stable for approximately 2.5 weeks following IM administration of Lupron Depot 7.5-mg in prostate cancer patients, and then decline over the next several weeks.101
Plasma concentrations decrease to trough levels 4 weeks following IM administration of Lupron Depot 7.5-, 11.25-, or 15-mg in children with central precocious puberty.155
Steady plasma concentrations persist through the 1-, 3-, 4-, or 6-month dosing interval following IM administration of the 7.5-, 22.5-, 30-, or 45-mg long-acting injectable suspension (Eligard), respectively, in prostate cancer patients.192 No drug accumulation observed after repeated dosing.192
Similar changes from baseline in estradiol serum concentration observed in women with endometriosis receiving 11.25- or 3.75-mg IM doses of the long-acting suspension (Lupron Depot) every 12 weeks or every 4 weeks, respectively, for 24 weeks.191
Mean serum estradiol concentrations ranged from the menopausal to the early follicular range for 12 weeks following IM administration of a single 11.25-mg dose of the long-acting injectable suspension (Lupron Depot) in healthy women.191
Plasma Protein Binding
Injectable Suspension (Eligard)
Injectable Suspension (Lupron Depot or Lupron Depot-Ped)
A synthetic nonapeptide analog of GnRH; 1 2 3 80 81 99 100 116 155 156 structural modifications result in increased potency (in terms of luteinizing hormone release) compared with GnRH.1 3 4 8 155 156
A potent inhibitor of gonadotropin secretion and suppresser of ovarian and testicular steroidogenesis when given continuously;1 2 5 7 8 9 10 11 12 13 15 69 83 87 105 105 106 109 110 116 131 155 156 157 158 159 177 decreases release through down-regulation of GnRH receptors.1 2 6 7 10 11 12 13 15 16 11 12 13 14 13 19 24 105 106 110 116 157 109 158 159 177
Initially, circulating levels of LH, FSH, testosterone, dihydrotestosterone (DHT) estrone and estradiol surge transiently.1 10 12 15 24 Following long-term administration (generally, 2–4 weeks after initiation of therapy), produces a sustained decrease in LH and FSH secretion and a marked reduction of testicular and ovarian steroidogenesis.1 2 3 4 5 7 10 11 12 13 15 22 23 69 89 100 105 106 109 110 116 155 156 157
Reductions in serum testosterone concentrations in males during therapy are comparable to those achieved after surgical castration (i.e., <50 ng/dL).1 3 12 47 100 101 Testicular and prostatic atrophy may occur.2 12 13 24
Induces reductions in myometrial and leiomyomal volumes; possibly from decreased secretion of somatotropin (growth hormone) and estrogen-dependent growth factors (e.g., insulin-like growth factor I, IGF-I).137 138
Reduces gonadotropins in children with central precocious puberty and resultant depression of ovarian and testicular steroidogenesis may allow for normal physical and psychological growth and development.155 156 157 158 159 164 167 168 177 Effects appear to be reversible; pubertal development resumes following discontinuance of the drug.155 156 157 158 159 177
Advice to Patients
Importance of providing patients or caregivers administering leuprolide acetate injection adequate oral and written instructions regarding proper administration methods (including aseptic technique), use of appropriate syringe (as supplied or low-dose insulin type), drug storage, and proper disposal of used needles and syringes.1 156
Risk of worsening manifestations of disease, such as symptoms (e.g., bone pain, spinal cord injury, hematuria, urethral or bladder outlet obstruction) of prostate cancer, during initial weeks of therapy.1 100
Importance of informing clinicians of persistent skin reactions (burning, itching, or swelling) at injection site.1
Risk of anaphylactoid or other hypersensitivity reactions.1
Risk of new or worsening symptoms of depression while receiving leuprolide therapy.190
Importance of women informing their clinician if regular menstruation persists.116 166 191 Women also should be advised that breakthrough bleeding or ovulation (with potential for conception) may occur if one or more successive doses of the drug are missed.116 166 191
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.1
Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed; necessity for clinicians to advise women to avoid pregnancy during therapy and use nonhormonal contraceptive measures. Advise pregnant women of risk to the fetus.100 116 166 191
Importance of informing patients of other important precautionary information.1 (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
For injectable suspension, extended-release, for IM use
Lupron Depot (available as prefilled dual-chambered syringes)
Lupron Depot (available as prefilled dual-chambered syringes)
Lupron Depot-Ped (available as prefilled dual-chambered syringes)
Lupron Depot-Ped (available as prefilled dual-chambered syringes)
Lupron Depot (available as prefilled dual-chambered syringes)
Lupron Depot-Ped (available as prefilled dual-chambered syringes)
Lupron Depot (available as prefilled dual-chambered syringes)
Lupron Depot (available as prefilled dual-chambered syringes)
Lupron Depot (available as prefilled dual-chambered syringes)
For injectable suspension, extended-release, for subcutaneous use
Eligard (available in a 2-syringe Atrigel Delivery System)
Eligard (available in a 2-syringe Atrigel Delivery System)
Eligard (available in a 2-syringe Atrigel Delivery System)
Eligard (available in a 2-syringe Atrigel Delivery System)
Injection, for subcutaneous use
Leuprolide Acetate Injection
AHFS DI Essentials. © Copyright 2017, Selected Revisions February 2, 2012. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.
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