Leuprorelin acetate (Prostap ® SR, Prostap ® 3)
Leuprorelin acetate is a hormonal therapy drug used to treat prostate cancer. This information is best read with our general information on prostate cancer.
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 in order to grow. Almost all testosterone in men is made by the testicles. A very small amount is made by the adrenal glands, which sit above the kidneys. Leuprorelin stops the testicles from making testosterone. This reduces testosterone levels and may shrink the prostate cancer or stop it growing.
When leuprorelin is given
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Leuprorelin can be used on its own or with other types of treatment. It may be used before or after surgery or radiotherapy. It may also be used to control prostate cancer that has spread to other parts of the body (advanced or metastatic prostate cancer).
Leuprorelin can be given for months or years, depending on your situation. Some men with advanced prostate cancer may have intermittent therapy with leuprorelin. This involves having leuprorelin treatment for a few months until the cancer is at a very low level (measured by a blood test called a PSA test). You then have a break from treatment and restart leuprorelin when it’s needed.
Your doctor or nurse will explain how long you will take leuprorelin for.
How leuprorelin is given
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Leuprorelin is given as an injection. It can be given under the skin (subcutaneously) of the tummy or arm, or into a muscle (intramuscularly) in the buttocks or thigh. It is given once a month or as a longer-acting preparation every three months.
Tell your doctor or nurse if you are taking any medicines to thin your blood as this may increase any bruising, and might affect the way that the injection can be given.
The injections will usually be given by your practice nurse at your doctor’s surgery. If you’re not able to visit the surgery, a district nurse can give you the injection at home.
Some people may find the injection slightly uncomfortable and notice redness or a darker colour around the area afterwards. You may have a local anaesthetic cream applied before the injection to reduce any discomfort.
Possible side effects of leuprorelin
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We explain the most common side effects of leuprorelin 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 drugs as well, you may have some side effects that we don’t list here.
Always tell your doctor, nurse or pharmacist about the side effects you have. They can prescribe drugs to help control some side effects and give you advice about managing side effects.
Rarely, leuprorelin may cause an allergic reaction within a few hours of being given. Signs of a reaction can include flu-like symptoms (headaches, high temperature or chills); feeling flushed, dizzy or short of breath; having pain in your back, tummy or chest; or feeling generally unwell. If you develop any of these symptoms, contact your doctor straight away for advice.
There may be a temporary increase in testosterone levels in the first few days or weeks after starting leuprorelin. This may make symptoms caused by the cancer 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 leuprorelin and continue taking them for a few weeks after.
Let your doctor know if you notice any increase in symptoms in the first month after starting leuprorelin. In particular, if you have blood in the urine, back pain, or numbness or tingling in your legs, tell your doctor straight away.
Hot flushes and sweats
These are common and can be mild or more severe. During a flush, you feel warmth in your neck and face and your skin may redden. Mild flushes last from a few seconds to about a couple of minutes. More severe flushes can last for 10 minutes or more. You may have sweats, 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 flushes. These include 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 lessen 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 during hormonal therapy. These often return to normal after you stop taking the drug, but some men continue to have difficulties after treatment has finished. 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.
Tiredness is a common side effect. There is evidence that exercising and doing resistance training (such as lifting weights) at least twice a week can reduce tiredness in men taking hormonal therapy. It’s important to get medical advice before starting exercise. Ask your doctor or nurse what is safe to do.
If tiredness makes you feel sleepy, don’t drive or operate machinery.
Some men find that leuprorelin causes headaches. These are usually mild and easily controlled with medicines.
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 leuprorelin can cause dizziness, blurred vision or drowsiness. Don’t drive or operate machinery if you have these side effects.
Leuprorelin can make you feel sick (nausea) but this is usually mild. If it doesn’t improve, your doctor can prescribe anti-sickness drugs.
Possible side effects of leuprorelin with long-term use
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Men taking leuprorelin 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.
You may experience mood swings. Some men feel low or depressed after taking leuprorelin 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. Talk to your doctor if you’re having problems.
Breast swelling or tenderness
You may notice slight breast swelling and tenderness. This is called gynaecomastia. Your doctor can advise you on how this can be prevented or treated.
Bone thinning (osteoporosis)
Taking leuprorelin for a few years increases your risk of bone thinning (osteoporosis), which can increase your risk of a broken bone (fracture).Your doctor can give you advice on how this can be monitored and treated. Regular walking and resistance exercises, such as lifting weights, can help to keep your bones strong. Eating a healthy diet, not smoking and drinking alcohol within the recommended limits will also help to protect your bones.
Let your doctor know if you have any discomfort in your bones or joints.
Effect on liver
Your doctor will take blood samples to test how well your liver is working. Leuprorelin can sometimes change the amount of certain chemicals produced by the liver. Usually this is only mild and you can continue to take leuprorelin. Very occasionally you may need to stop taking the drug.
Risk of heart changes and diabetes
There may be an increased risk of developing heart disease, changes in heart rhythm or diabetes when taking leuprorelin. 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.
Other information about leuprorelin
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Missing an injection
If an injection is delayed by 2-3 days, this should not make a big difference. But you should try to have your injections as regularly as possible.
Leuprorelin may interact with other drugs. This includes medicine 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.
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are taking leuprorelin. Explain you are taking hormonal therapy that no one should stop or restart without advice from your cancer doctor. Tell them the name of your cancer doctor so they can ask for advice.
This information 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.
With thanks to: Paik Hang Ooi, Senior Oncology Pharmacist; Miss Jaymi Teli, Specialist Rotational Pharmacist in Oncology and Haematology; who reviewed this edition.
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