Leuprolide (Lupron, Eligard, Fensolvi)

Leuprolide (pronounced [loo PROE lide]) is also known by the brand names Eligard, Lupron Depot, and Fensolvi.  Lupron is an antineoplastic (anti-cancer) drug that belongs to a class called gonadotropin-releasing hormone (GnRH) agonists. It is also known as androgen deprivation therapy (ADT) or antiandrogen. Lupron is a type of chemotherapy that prevents cancer cells from multiplying and restricts their growth.

What Is Chemotherapy?

Chemotherapy is a cancer treatment in which certain drugs are used to kill cancerous cells. These drugs are usually cytotoxic chemical substances that are toxic to the cells, restrict their growth, prevent their division, and ultimately kill the cells. 

Protection From Chemotherapy

This drug is considered to be a hazardous agent; therefore, it is important to take appropriate precautions for receiving, handling, storing, administering, and disposing of this medication. It is highly recommended to wear gloves while handling and administering this medication and keep it stored in its original container. Avoid inhalation or contact with skin if damaged or accidentally opened. 

How Is Lupron Used?

Lupron has been approved by the Food and Drug Administration (FDA) to treat certain types of prostate cancer for men, and breast cancer and endometriosis for women. It can also treat certain types of anemia and premature puberty in children. It is also used as hormone therapy for transgender females. Lupron can be prescribed alone or with other anti-cancer medications. 

Available Formulations

Lupron is only available as a solution for intramuscular or subcutaneous injections into the muscle under the skin. It is available in several different dosage strengths, which are available as 1-month, 3-month, 4-month, or 6-month long injections. 

Directions for Use

Lupron injections can be given every day, once a month, or once every several months, depending on the condition treated. Verify the correct dose and frequency with your provider. The dose should not be more or less than what is prescribed. Most of the time, it is administered by a health care provider but can be self-administered as well. Wash hands before and after injection. 

General injection administration instructions:

• Use a new needle and syringe every time you inject the medicine.
• Do not concurrently administer partial doses of different formulations or combine different doses.
• Avoid using a combination of syringes to achieve a particular dose.
• Choose an injection site that does not have skin discoloration, nodules, lesions, scars, or excess hair.
• Avoid areas that may be compressed or rubbed (e.g., belt or waistband area).
• If a syringe is required, use insulin syringes.
• Alternate injection sites periodically.

Brand-specific injection information:

• Intramuscular Lupron Depot injections: Administer within 2 hours of preparation as a single injection into the gluteal area, outer thigh, or upper arm. 
• Subcutaneous leuprolide acetate injections: Inject into areas on the arm, thigh, or abdomen. 
• Subcutaneous Eligard injections: Administer within 30 minutes of preparation to an area with adequate tissue like the upper or mid-abdomen or upper buttocks area. 
• Subcutaneous Fensolvi injections: Fensolvi should be administered by a health care professional as a single subcutaneous injection into the abdomen, upper buttocks, or other location with adequate tissue. 

Missed Dose

This medicine must be given on a fixed schedule. If you miss a dose, contact your physician for further instructions immediately. 

Storage

Store injections in their original containers to protect from light. Store in the refrigerator and do not shake. Allow injection to sit at room temperature for 30 minutes prior to administration. Different formulations have a specified timeframe when they should be administered after reconstitution. It is best to administer injections immediately after reconstitution. Different formulations may have different storage requirements. Read and follow the patient instructions that come with your specific medication.

What To Avoid While Taking Lupron

While taking Lupron therapy, you must follow some precautions. Always tell your physician about any medications you are already taking. Do not take any drug or medicine (even herbals, vitamins, or over-the-counter medications) without prior consent from your physician or pharmacist. They may have some significant interactions with leuprolide.

Pregnancy and Lupron

Pregnancy status must be checked prior to starting Lupron therapy in women of childbearing age. Lupron may impair fertility; however, this condition is reversible after discontinuation. Despite the fact that Lupron usually inhibits ovulation and stops menstruation, contraception is not guaranteed, and therefore, a nonhormonal contraceptive should be utilized throughout therapy. If pregnant, Lupron should be discontinued immediately. It is safest to avoid breastfeeding during Lupron therapy. 

Side Effects

As with any other medication, you may encounter many side effects while taking Lupron. A few things to remember are:

• You may not have all the side effects listed below. Many people may experience little to no side effects.
• The severity of side effects may vary from person to person, so don’t compare your side effects with other people’s experiences.
• Most of the side effects will improve when therapy is discontinued.
• These side effects are easily manageable most of the time, either by readjusting the dose of Lupron or using additional medications to treat the symptoms. Consult with your physician or pharmacist to explore available options.
• Do not hide any symptoms; if you feel any discomfort, do not hesitate to tell your physician or pharmacist about it.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions. 

Some of the more serious side effects of Lupron are listed below:

Allergic Reaction/Hypersensitivity

There have been cases reported of patients with allergic reactions to the Lupron injection or any of its components. In addition, worsening asthma has been reported in patients with a history of asthma, sinusitis, or allergies. Signs of an allergic reaction can include rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; tightness in the chest or throat; wheezing; difficulty breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat. If you are experiencing any of these symptoms, seek emergency medical attention immediately. 

Cardiac Complications

Although uncommon, there is an increased risk for heart attack or stroke in patients with prostate cancer receiving GnRH agonists. Lupron can increase the interval between when the heart contracts and relaxes, potentially increasing the risk for cardiac complications. 

Decreased Bone Density

Decreased bone density may be common when using Lupron for 6 months or longer. Patients with chronic alcohol or tobacco use, strong family history of osteoporosis, and those taking chronic medications that may decrease bone mineral density are at a higher risk for experiencing decreased bone density, which may eventually lead to bone fractures or falls.

Endometriosis, Vaginal Bleeding

After the first dose of leuprolide, endometriosis symptoms may worsen before being relieved. Female children treated for premature puberty may experience menses or spotting during the first weeks of treatment or after each dose. If bleeding continues after the second month, contact your physician immediately. 

Blood Sugar Impairment

Men receiving GnRH agonists are at a higher risk for hyperglycemia (high blood glucose), diabetes, or worsening glucose control.

Pituitary Apoplexy

Although it is rare, a condition called pituitary apoplexy may arise with Lupron use. This is a condition caused by bleeding inside the pituitary gland of the brain. This may occur anywhere from 1 hour to usually 2 weeks after Lupron use. Seek immediate medical attention if you experience a sudden headache, vomiting, vision loss, or visual or mental status changes like confusion, disorientation, or strange behaviors.

Psychiatric Events

Psychiatric events are possible with Lupron use. Symptoms can include emotional instability, irritability, impatience, depression, anger, and aggression. Patients with a history of psychiatric illness are at a much higher risk for experiencing these symptoms. Contact your physician if you are experiencing any of these symptoms. 

Seizures

It is possible that Lupron therapy may increase the risk of seizures in all patients. Patients receiving concomitant medications that may lower the seizure threshold (e.g., certain antidepressants) may be at a higher risk. If seizures occur, contact your physician immediately on how to manage them. 

Spinal Cord Compression

When used for prostate cancer, Lupron may cause spinal cord compression, especially during the first few weeks of therapy. Contact your physician if you are experiencing any of the following symptoms of spinal compression: pain/stiffness of neck or back, trouble with hand coordination, cramping, numbness, painful sensations, or weakness of the hands, arms, or legs. 

Urinary Tract Obstruction

When used for prostate cancer, Lupron may cause urinary tract obstruction, especially during the first few weeks of therapy. Contact your physician if you are experiencing any of the following symptoms: frequent urination, constant feeling of a full bladder, difficulty urinating, or painful urination.

Tumor Flare

When used for prostate cancer, Lupron may cause a temporary increase in testosterone (a male hormone), resulting in a condition called a tumor flare. Symptoms of tumor flare include bone pain, blood in urine, or inability or difficulty urinating. This may occur during the first few weeks of therapy in patients with prostate cancer. Consult with your physician on ways to reduce these symptoms. 

Other common side effects may include:

• Headache
• Dizziness or weakness
• Lack of appetite
• Upset stomach or vomiting
• Trouble sleeping
• Injection-site reaction (pain, redness, or swelling)
• Back, muscle, or joint pain
• Flu or cold-like symptoms
• Acne
• Mood changes
• Hot flashes/night sweats
• Vaginal bleeding or discharge

Monitoring

Due to its many side effects, monitoring is an important part of managing Lupron therapy. 

• Testosterone and other hormone levels should be periodically monitored at the doctor’s office.
• Bone mineral density should also be checked periodically.
• Pregnancy status should be checked prior to and during therapy.
• Patient should be monitored for the potential development of psychiatric symptoms.
• Blood glucose and diabetes status should be regularly monitored.

FAQs

Is Lupron a chemo agent?

Chemo drugs are those that are used in the management of various cancers. Lupron is used to treat the symptoms associated with prostate cancer by decreasing the amount of certain hormones in the body.  Therefore, Lupron is a chemo agent. 

How should Lupron be taken?

Lupron is only available as a solution for intramuscular or subcutaneous injections into the muscle under the skin. Lupron injections can be given every day, once a month, or once every several months, depending on the condition treated. Most of the time, it is administered by a health care provider but can be self-administered as well. 

Is Lupron a hormone?

Lupron is not a hormone; rather, it affects the hormones in the body. Estrogen is a hormone found in females that causes cells in the uterus to grow. By reducing estrogen in the body, Lupron will stop ovulation and menstrual bleeding, which can help relieve endometriosis. Testosterone, on the other hand, is a hormone found in males and is also suppressed with Lupron use, reducing symptoms of prostate cancer.