goserelin acetate


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Related to goserelin acetate: Cosudex

goserelin acetate

Zoladex, Zoladex LA (CA) (UK), Zoladex 3-Month

Pharmacologic class: Gonadotropin-releasing hormone (GnRH) analog

Therapeutic class: Antineoplastic, hormone

Pregnancy risk category D (breast cancer), X (endometriosis)

Pregnancy risk category D (breast cancer), X (endometriosis)

Action

Synthetic form of luteinizing hormone-releasing hormone (LHRH); inhibits gonadotropin production by acting directly on pituitary gland. Enhances release of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone, lowering testosterone and estradiol levels.

Availability

Implant: 3.6 mg, 10.8 mg (in preloaded syringes)

Indications and dosages

Palliative treatment of advanced prostate cancer

Adults: 3.6 mg subcutaneously q 4 weeks or 10.8 mg subcutaneously q 12 weeks into upper abdominal wall

Adjunct to radiation therapy and flutamide in stage B2-C prostate cancer

Adults: 3.6 mg subcutaneously q 4 weeks starting on day 1 of radiation or during last week of radiation. Alternatively, 3.6 mg subcutaneously 8 weeks before radiation, then 10.8 mg on day 28 or 3.6 mg at 4-week intervals starting 8 weeks before radiation, for a total of four doses (two depots before and two during radiation therapy).

Palliative treatment of advanced breast cancer in pre- and perimenopausal women

Adults: 3.6 mg subcutaneously q 4 weeks. If serum estradiol doesn't fall to postmenopausal levels, may increase to 7.2 mg q 4 weeks.

Endometriosis

Adults ages 18 and older: 3.6 mg subcutaneously q 4 weeks, continued for 6 months

Endometrial thinning before ablation for dysfunctional uterine bleeding

Adults: 3.6 mg subcutaneously 4 weeks before surgery. Alternatively, initial 3.6-mg dose may be followed 4 weeks later by a second 3.6-mg dose, with surgery 2 to 4 weeks after second dose.

Contraindications

• Hypersensitivity to drug or its components or to GnRH, GnRH agonist analogs
• Pregnant patients

Precautions

Use cautiously in:
• risk factors for osteoporosis
• chronic alcohol or tobacco use
• patients receiving drugs that affect bone density
• hyperglycemia, cardiovascular risk factors
• breastfeeding patients
• children younger than age 18 (safety not established).

Administration

• Administer pretreatment pregnancy test to female of childbearing age.
• Know that drug should be given only by a clinician experienced in its use.
• Implant is placed subcutaneously into upper abdominal wall using aseptic technique. Give local anesthetic and stretch skin with one hand. Insert needle into subcutaneous fat, then change needle angle until it parallels abdominal wall. Push needle in until hub touches patient's skin, and withdraw about 1 ml before depressing plunger all the way.
• Don't aspirate after inserting needle. Blood will be visible in syringe if needle enters blood vessel.

Don't give by I.V. route.
• Be aware that 10.8-mg implant should not be used in women.
• Be aware that if implant must be removed, it can be located by ultrasound.

Adverse reactions

CNS: headache, anxiety, depression, dizziness, fatigue, insomnia, lethargy, pain, emotional lability, weakness, cerebrovascular accident, spinal cord compression

CV: vasodilation, chest pain, hypertension, palpitations, peripheral edema, myocardial infarction, arrhythmias, sudden cardiac death

EENT: blurred vision

GI: nausea, vomiting, diarrhea, constipation, ulcer, anorexia

GU: urinary obstruction, lower urinary tract symptoms, breast swelling or tenderness, vaginitis, amenorrhea, infertility, decreased libido, erectile dysfunction, other sexual dysfunction, decreased testicular size, renal insufficiency

Hematologic: anemia

Musculoskeletal: increased bone pain, joint pain, decreased bone density

Metabolic: gout, hyperglycemia, hypercalcemia

Respiratory: dyspnea, chronic obstructive pulmonary disease, upper respiratory tract infection

Skin: rash, acne, diaphoresis, seborrhea

Other: hirsutism, chills, fever, hot flashes, infection, weight gain, tumor flare phenomenon, hypersensitivity, antibody formation, acute anaphylactic reactions

Interactions

Drug-diagnostic tests.Calcium, glucose, high- and low-density lipoproteins, triglycerides: increased levels

FSH, LH: initially increased, then decreased, levels

Patient monitoring

• Assess menstrual symptoms and watch for breakthrough bleeding.

Monitor neurologic status. Watch closely for signs and symptoms of cerebrovascular accident.

Closely monitor cardiovascular and respiratory status.
• Monitor blood glucose and glycosylated hemoglobin periodically.

Patient teaching

• Advise female patient to avoid pregnancy and to use a nonhormonal contraceptive method.
• Instruct patient to call prescriber if menstrual bleeding persists or breakthrough bleeding occurs.
• Inform patient that menstruation may be delayed after therapy ends.

Instruct patient to recognize and immediately report signs and symptoms of hyperglycemia, and cardiovascular or neurological adverse reactions.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.

goserelin acetate

Zoladex® Oncology A LHRH/GRH analogue used to suppress pitutitary seretion of gonadotropins Indications Hormone-responsive prostate and breast CAs, uterine fibroids, endometriosis Adverse effects Hypersensitivity, rash, hypotension, HTN. See Androgen ablation therapy.
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References in periodicals archive ?
As for surgical interventions, hysterectomies occurred in 21% of the goserelin acetate group and 15% of the placebo group.
Amenorrhea rates at a 6-month follow up were 40% in the goserelin acetate group and 26% in the placebo group.
Pretreatment with goserelin acetate improves long-term outcomes in patients undergoing endometrial ablation for dysfunctional uterine bleeding, a recent study found.
This suggested the goserelin acetate was stimulating FSH and LH secretion from his previously non-functioning pituitary macroadenoma.
The goserelin acetate was stopped and a bilateral subcapsular orchidectomy was performed.