leuprolide (Rx)
Generic: Leuprolide
Brand: Eligard, Lupron Depo, Lupron Depot-Ped, Viadur
(loo-proe'lide)
Pharmacological Action
Causes initial increase in circulating levels of LH, FSH; continuous administration results in decreased LH, FSH; in men testosterone is reduced to castration levels; in premenopausal women estrogen is reduced to menopausal levels
Therapeutic outcome: Prevention of rapidly growing malignant cells in prostate cancer, decreased pain in endometriosis, resolution of central precocious puberty (CPP)
Uses
Metastatic prostate cancer (inj implant), management of endometriosis (depot), CPP, uterine leiomyomata (fibroids)
Contraindications
Pregnancy X, breastfeeding, hypersensitivity to GnRH or analogs, thromboembolic disorders, undiagnosed vaginal bleeding; Viadur implant or Eligard should not be used in women or children
Precautions: Edema, hepatic disease, CVA, MI, seizures, hypertension, diabetes mellitus, CHF, depression, osteoporosis, spinal cord compression, urinary tract obstruction
Dosage & Routes
Prostate cancer
Adult: SUBCUT 1 mg/day; IM 7.5 mg/dose qmo; Viadur implant (72 mg) qyr; or IM 22.5 mg q3 mo; or IM 30 mg q4 mo; or IM 45 mg q6 mo Endometriosis/fibroids
Adult: IM 3.75 mg qmo for 6 mo, 11.25 mg q3 mo for 6 mo, or IM 30 mg q4 mo Central precocious puberty
Child: SUBCUT 50 mcg/kg/day; increase as needed by 10 mcg/kg/day Child >37.5 kg: IM 15 mg q4 wk Child 25-37.5 kg: IM 11.25 mg q4 wk Child ≤25 kg: 7.5 mg q4 wk
Available forms: Powder for inj depot 1 mo 3.75 mg, depot 3 mo/1.25 mg, 22.5 mg; depot 4 mo 30 mg; depot-ped 7.5, 11.25, 15 mg; sol for inj 1 mg/0.2 ml; susp for inj 7.5, 22.5, 30, 45 mg; implant (Viadur) 65 mg
Implementation - Store in tight container at room temp - Use depot only IM; never give SUBCUT - Unused vials may be stored at room temperature Subcut route: - No dilution needed; if patient is self-administering make sure patient uses syringes provided by manufacturer - Viadur Duros implant: Insert in inner aspect of arm, remove after 12 mo - Eligard subcut: Bring to room temp, once mixed give within 30 min; prepare the 2 syringes for mixing, join the 2 syringes by pushing in and twisting until secure; mix the product by pushing the contents of both syringes back and forth between syringes until uniform, should be light tan to tan; hold syringes vertically with syringe B on the bottom, draw entire mixed product into syringe B (short, wide syringe) by depressing the syringe A plunger and slightly withdrawing syringe B plunger, uncouple syringe A while pushing down on syringe A plunger, small air bubbles will remain; hold syringe B upright, remove pink cap, attach needle cartridge to the end of syringe B, remove needle cover, give by subcut route
IM route: - Give monthly: reconstitute single-use vial with 1 ml of diluent; if multiple vials are used, withdraw 0.5 ml and inject into each vial (1 ml), withdraw all and inject at 90-degree angle (3.75 mg) - Give 3 month: reconstitute microspheres using 1.5 ml of diluent and inject in vial, shake, withdraw and inject - 12-month: inserted into upper arm; at the end of 12 months, implant must be removed - Use syringe and product packaged together; give deep in large muscle mass; rotate sites
Adverse Effects
CNS: Memory impairment, depression, seizures
CV: MI, pulmonary emboli, dysrhythmias, peripheral edema
GI: Anorexia, diarrhea, GI bleeding, nausea, vomiting
GU: Edema, hot flashes, impotence, decreased libido, amenorrhea, vaginal dryness, gynecomastia, profuse vaginal bleeding
INTEG: Alopecia
MS: Bone pain Prostate cancer: Increased bone pain for the first 4 wk of treatment, those with metastases in spinal column might have severe back pain
RESP: Dyspnea, pulmonary fibrosis, interstitial lung disease
Pharmacokinetics
Absorption: Rapidly absorbed (SUBCUT); slowly absorbed (IM depot)
Distribution: Unknown
Metabolism: Unknown
Excretion: Unknown
Half-life: 3-4 hr
Pharmacodynamics
Unknown
Interactions
Individual drugs Flutamide, megestrol: increased antineoplastic action
Drug/herb Do not confuse with black cohosh or chaste tree fruit, may interfere with treatment
Nursing Considerations
Assessment - Assess for symptoms of endometriosis/fibroids including lower abdominal pain, excessive vaginal bleeding, bloating if product is given for the diagnosis of endometriosis - For central precocious puberty (CPP): the diagnosis should have been confirmed by development of secondary sex characteristics in children <9 yr; also included to confirm the diagnosis of CPP is estradiol/testosterone, GnRH test, tomography of head, adrenal steroid, chorionic gonadotropin, wrist x-ray, height, weight; patients with CPP display the signs of testicular growth, facial, body hair (boys), breast development, menses (girls) - Monitor liver function tests before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly; prostate-specific antigen in prostate cancer; calcium, testosterone, bone mineral density, blood glucose, HbA1 c - Monitor pituitary gonadotropic and gonadal function during therapy and 4-8 wk after therapy is decreased; check LH, FSH, acid phosphate at beginning of treatment - Tumor flare: monitor worsening of signs and symptoms (normal during beginning therapy): fatigue, increased pulse, pallor, lethargy, edema in feet, joints, stomach pain, shaking - Monitor renal status: • I&O ratio, check for bladder distention daily during beginning therapy (renal obstruction) - Severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing
Patient/family education - Advise patient to notify prescriber if menstruation continues (menstruation should stop); to use a nonhormonal method of contraception during therapy - Teach patient to notify prescriber if pregnancy is planned or suspected (X), avoid breastfeeding - Instruct patient to report any complaints, side effects to nurse or prescriber; hot flashes may occur; record weight, report gain of 2 lb/day - Teach patient how to prepare, administer; to rotate sites for SUBCUT inj; to keep accurate records of dosing (prostate cancer) - Instruct patient that tumor flare may occur: increase in size of tumor, increased bone pain; tell patient that bone pain disappears after 1 wk; may take analgesics for pain - Advise the patient not to breastfeed while taking this product - Inform patient that voiding problems may increase in beginning of therapy, but will decrease in several weeks
Evaluation
Positive therapeutic outcome: Decreased size, spread of malignancy; Decreased pain in endometriosis, fibroids; Decreased signs of CPP; Increased follicle maturation
Reference
Need clinical tools for this drug?
Save notes, bookmark this drug, and run formula method (desire over have) dosage calculations all inside the KosPharm Dashboard.
One-time payment. No subscription. No recurring charges.
Sign in to Get Full Access