Buserelin (Suprefact ®)
Buserelin is a hormonal therapy drug that is used to treat prostate cancer. This information is best read with our general information about prostate cancer. You will see a cancer doctor or nurse regularly while you have this treatment so they can monitor its effects.
Hormones are substances produced naturally in the body. They act as chemical messengers and help control the activity of cells and organs. Hormonal therapies interfere with the way hormones are made or how they work in the body.
Most prostate cancers need the hormone testosterone to grow. Almost all testosterone in men is made by the testicles. Buserelin stops the testicles from making testosterone. This reduces testosterone levels and may shrink the prostate cancer or stop it growing.
When buserelin is given
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Buserelin is given to treat prostate cancer that has spread to other parts of the body (advanced or metastatic prostate cancer). Some men may have intermittent therapy with buserelin, which involves having buserelin for a few months until the cancer is at a very low level. This level is measured by a blood test called PSA test. You then have a break from treatment and restart it when needed. Your doctor or nurse will explain how long you have buserelin treatment for.
How buserelin is given
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For the first seven days, buserelin is given as an injection under the skin (subcutaneously) three times a day. The injection can be given by your GP, practice nurse or at your local hospital. Some men, or their partners, are taught how to give it themselves.
Sometimes people find the injection slightly uncomfortable and may notice an area of redness at the injection site afterwards.
From the eighth day, you take buserelin as a nasal spray six times a day in each nostril. Your doctor or nurse will advise you how to use the spray and at what times of the day. You will be asked to avoid using nasal decongestants for 30 minutes before, and after using the nasal spray.
There are some important things to remember:
Keep buserelin in a safe place and out of the reach of children.
Get a new prescription a few weeks before you run out and make sure you have plenty for holidays.
Return any remaining buserelin to the pharmacist if your treatment is stopped.
Possible side effects of buserelin
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We explain the most common side effects of buserelin here. But we don’t include all the rare ones that are unlikely to affect you. You may get some of the side effects we mention but you are very unlikely to get all of them. If you are having other treatments, you may have some side effects that we don’t list here. Always tell your doctor or nurse about the side effects you have.
Always tell your doctor or nurse about the side effects you have. They can prescribe drugs to help control them and give you advice about managing them.
There may be a temporary increase in testosterone levels in the first few days or weeks after starting buserelin. This may make symptoms caused by the cancer, such as problems passing urine or bone pain, worse. Doctors call this tumour flare. Your doctor may prescribe a hormonal therapy for you to take as a tablet to prevent or reduce tumour flare. You usually begin taking the tablets before starting treatment with buserelin, and continue with them for a few weeks after. If you notice any increase in symptoms in the first month after starting buserelin, let your doctor know.
The nasal spray may cause temporary irritation to the lining of your nose.
Hot flushes and sweats
These are common and can be mild or more severe. During a hot flush, you feel warmth in your neck and face and your skin may redden. Mild flushes last for a few seconds up to about a couple of minutes. More severe flushes can last for 10 minutes or more. You may have sweats and then feel cold and clammy. Some people feel anxious or irritable during a hot flush.
There are things you can do to try to reduce hot flushes, such as cutting down on nicotine, alcohol and hot drinks that contain caffeine, such as tea and coffee.
If hot flushes are troublesome your doctor can prescribe drugs to help reduce them.
Hot flushes and sweats may get less troublesome as your body adjusts to hormonal treatment. They usually stop completely a few months after treatment finishes.
Most men lose their sex drive and have erection difficulties (impotence) during hormonal therapy. Things often return to normal after you stop taking the drug, but some men continue to have difficulties after treatment is over. Your doctor can prescribe treatments to help with erection difficulties but these don’t affect sex drive.
If you need support coping with sexual difficulties, your nurse or doctor can give you information and refer you for specialist support services.
These can usually be relieved with painkillers such as paracetamol. Tell your doctor or cancer nurse if headaches are troublesome.
Tiredness is a common side effect. There is evidence that doing exercise and resistance training (such as lifting weights) at least twice weekly can reduce tiredness in men on hormonal therapy. It’s important to get medical advice before starting exercise. Ask your doctor or nurse what is safe for you to do.
You may find that your skin gets dry. Some men develop a skin rash but this is usually mild and often gets better without treatment. Tell your doctor if you notice any skin changes.
Dizziness, blurred vision, drowsiness
Occasionally buserelin can case these side effects. Don’t drive or operate machinery if you have them.
Possible side effects of buserelin with long term use
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Men taking buserelin for more than six months may also have some of the following side effects:
Weight gain and loss of muscle strength
You may gain weight, particularly around your waist, and you may lose some muscle strength. Eating a healthy diet and exercising regularly can help control your weight. Resistance exercises, such as lifting weights, may help you to reduce loss of muscle strength. Ask your doctor or nurse for advice.
Bone thinning (osteoporosis)
Taking buserelin for a few years increases your risk of bone thinning (osteoporosis). In some men, this can increase the risk of a broken bone (fracture). Your doctor can give you advice on how this can be monitored and treated if needed. Gentle exercises, such as regular walking, and resistance exercises like lifting weights can help to keep your bones strong. Eating a healthy diet, not smoking and sticking to sensible drinking guidelines will also help to protect your bones.
Let your doctor know if you have any discomfort in your bones or joints.
You may experience mood swings. Some men can become low in mood or depressed after taking buserelin for several months or more. Tell your doctor if you notice any mood changes.
Memory and concentration
You may notice changes in your memory or ability to concentrate. Try using a notebook, post it notes and a calendar to help you keep track of things.
Muscle and joint pain
If you have soreness or stiffness in the joints or shoulders, your doctor can prescribe painkillers to ease this.
Breast swelling or tenderness
Occasionally, buserelin may cause breast swelling or tenderness, known as gynaecomastia. Your doctor can advise you about how this can be prevented or treated.
Risk of heart disease and diabetes
There may be an increased risk of developing heart disease, changes in heart rhythm or diabetes when taking buserelin. But, the benefits of hormonal treatment generally outweigh the possible risks. You can talk to your specialist about the possible risks and benefits in your situation. It’s important to tell your doctors if you have ever had heart rhythm problems or if you’re taking any medicines for this.
Eating a healthy diet, not smoking, staying within the recommended limits for alcohol, keeping to a healthy weight and being physically active can help reduce your risk of heart disease and diabetes.
Always let your doctor or nurse know about any side effects you have. There are usually ways in which they can be controlled or improved.
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are taking buserelin. Explain you are taking hormonal therapy and that no one should stop or restart without checking with your cancer doctor first. Tell them the name of your cancer doctor so they can ask for advice.
Buserelin can interact with other drugs. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including ones you can buy for yourself, complementary therapies, vitamins and herbal drugs.
The information in this section has been produced in accordance with the following sources and guidelines:
British National Formulary. www.bnf.org/bnf/index.htm (accessed June 2014)
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed June 2014).
NICE clinical guideline 175. Prostate cancer: diagnosis and treatment. 2014.
If you’d like further information on the sources we use, please feel free to contact us.
Thanks to Marilyna Chong, Pharmacist, who reviewed this edition.
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