Buserelin (Suprefact®)

Hormones are chemicals that our bodies make. Hormones act as messengers and help control how cells and organs work. Hormonal therapies are drugs that change the way hormones are made or how they work in the body.

Most prostate cancers need the hormone testosterone to grow. Almost all testosterone 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.

Buserelin is given as a combination of injections and nasal sprays. 

During treatment you will have regular blood tests to check the level of testosterone in your blood. You may also have blood tests to check:

• the number of blood cells in your blood
• how well your liver and kidneys are working 
• your general health. 

For the first 7 days, buserelin is given as an injection under the skin (subcutaneously). You will be given 3 injections each day. 

The injection can be given by your GP, practice nurse or at your local hospital. You may be shown how to give yourself the injection. You may see bruising or have some pain, swelling or redness where the injection is given (the injection site). Or the skin may be a darker colour. If this happens, let your doctor know. Painkillers may help. 

If you are taking any medicines to thin your blood, tell your doctor or nurse. This may increase your bruising. 

From day 8, you take buserelin as a nasal spray. You spray it 6 times a day into each nostril. Your doctor or nurse will advise you on how to use the spray and when you should take it. You need to avoid using nasal decongestants for 30 minutes before and after using the nasal spray.

Here are some important things to remember:

• If you forget to take your buserelin spray, take it as soon as you remember it. However, if is nearly time for the next dose, skip the missed dose. Take your next dose at the normal time. Do not take a double dose to make up for the forgotten dose.
• Keep buserelin in a safe place, out of the sight and reach of children.
• Get a new prescription before you run out. If you are travelling or going away, make sure you have plenty to take with you.
• If your treatment is stopped, return any remaining buserelin to the pharmacist.
• Do not stop taking buserelin without talking to your doctor first.

When you start this treatment, your testosterone levels may increase for the first few days or weeks. This may make some symptoms worse. This is called tumour flare.

Your doctor, nurse or pharmacist may prescribe another hormonal therapy tablet to prevent or reduce tumour flare. You usually start taking these tablets before starting the hormonal therapy drug to treat the cancer. You may need to continue taking them for a few weeks.

Hot flushes are a common side effect of this treatment. During a flush, your neck and face may feel warm. If you have white skin, your skin may look red. If you have black or brown skin, your skin colour may deepen. Flushes can last up to 5 minutes. You might also have sweats or feel anxious or irritable during a flush. 

Here are some things you can do to reduce the effects of hot flushes:

• Wear natural fabrics, such as cotton.
• Wear layers so you can remove clothes as needed. 
• Use cotton sheets and layers of bedding you can remove. 
• Try cooling pads or pillows to keep you cool.
• Keep rooms cool or use a fan.
• Have cold drinks and avoid caffeine and alcohol. 

You might have fewer hot flushes as your body adjusts to this treatment. You could try therapies to help you cope with hot flushes, such as:

• talking therapies like cognitive behaviour therapy (CBT)
• controlled breathing exercises
• yoga
• acupuncture. 

If they do not improve, talk to your doctor. Certain drugs can help to improve hot flushes. 

Flushes usually stop a few months after treatment ends. But some people continue to have them.

It is common to lose your sex drive and have erection difficulties with hormonal therapy. Hormonal therapy may also make your penis shorter and your testicles smaller. 

Your doctor can prescribe drugs and treatments to help with erection difficulties. These will not increase your sex drive. But they might work, even with a low sex drive. 

Things can improve a few months after you stop taking the drug. But it depends on how long you take hormonal therapy, and what other treatments you have had. Some people continue to have problems after treatment ends.

The nasal spray may cause temporary irritation to the lining of your nose. Some people have nosebleeds or notice changes in their sense of smell. If you notice any of these symptoms, tell your doctor, nurse or pharmacist.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

If you feel sleepy, do not drive or operate machinery.

Buserelin can make you feel sick (nauseous) or give you abdominal (tummy) pain. This is usually mild. If it does not improve, your doctor can give you anti-sickness medicines to help.

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor, nurse or pharmacist can give you drugs called laxatives to help.

If you notice any bleeding, contact the hospital straight away.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:

• try to drink at least 2 litres (3½ pints) of fluids each day
• avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
• contact the hospital for advice.

If you notice any bleeding, contact the hospital straight away.

This treatment can affect your skin. It may cause a rash, which may be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day. 

Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Changes to your skin usually improve when treatment ends.

Your hair may become thinner when you are taking this treatment. This is usually mild. Some people notice more hair growth. Ask your nurse for advice if you are worried about this. 

You may also notice your nails break more easily. It might be helpful to wear gloves when washing up or cleaning to protect your skin and nails.

Buserelin can affect the nervous system. Occasionally, buserelin can cause dizziness, drowsiness, or sleep problems. If you feel like this, do not drive or operate machinery.

You may have pins and needles or feel tingling in your arms and legs. These symptoms are usually mild. If you notice any of these symptoms, tell your doctor or nurse straight away.

You may notice changes in your memory. You may also find it harder to concentrate. To help you remember things, try using: 

• a notebook
• notes or alarms on your phone 
• a calendar.

You may get pain in your muscles or joints. If this happens, tell your doctor or nurse. They can give you advice and painkillers or other drugs to help. Being physically active and keeping to a healthy weight may help with the pain. It can keep your joints flexible and reduce stress on them. If the pain does not get better, tell your doctor or nurse. They may talk to you about changing to a different hormonal drug.

Taking this treatment for several months or more can increase the risk of bone thinning. This is called osteoporosis. It can make you more likely to get a broken bone (fracture). 

You may have bone density scans to check your bone health before and during treatment. These scans can diagnose osteoporosis or osteopenia (low bone density) so that it can be monitored. If your scan shows osteoporosis, your doctor usually prescribes:

• drugs to protect your bones called bisphosphonates
• calcium and vitamin D supplements. 

Regular exercise where you support your body weight, like walking, running and dancing, can help look after your bones. This is called weight-bearing exercise. Other types of strength exercises are also helpful. If you have any bone thinning or the cancer is affecting your bones, get advice from your cancer team first. 

Eating a healthy diet and not smoking also helps take care of your bones.

This treatment may cause swelling and tenderness of your breast tissue. This is called gynaecomastia. To prevent this, some people have 1 or more low-dose radiotherapy treatments to the chest before treatment starts. Another type of hormonal drug might be used to treat the breast swelling. Your doctor can give you more advice.

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

This treatment may affect how your liver works. This is usually mild. You will have blood tests to check how well your liver is working.

This treatment can raise the level of cholesterol. This is a fatty substance in the blood. You may have a blood test to check the level of cholesterol. Your doctor may refer you to a dietitian for advice on diet, or prescribe medicines to control your cholesterol levels.

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Your doctor, nurse or pharmacist will advise you not to make someone pregnant while having this treatment. The drug may harm the developing baby. It is important to use effective contraception during treatment and for a while after it finishes.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.