Warnings & Precautions
Warnings and Precautions
ELIGARD® 7.5 mg, 22.5 mg, and 30 mg, like other GnRH agonists, causes a transient increase in serum concentrations of testosterone during the first week of treatment.
ELIGARD 45 mg causes a transient increase in serum concentrations of testosterone during the first two weeks of treatment.
Transient increase in serum levels of testosterone during treatment may result in worsening of symptoms or onset of new signs and symptoms during the first few weeks of treatment, including:
- Bone pain
- Bladder outlet obstruction
Monitor patients at risk closely and manage as appropriate.
Cases of ureteral obstruction and/or spinal cord compression, which may contribute to paralysis with or without fatal complications, have been observed in the palliative treatment of advanced prostate cancer using GnRH agonists.
Patients with metastatic vertebral lesions and/or with urinary tract obstruction should be closely observed during the first few weeks of therapy. If spinal cord compression or ureteral obstruction develops, standard treatment of these complications should be instituted.
Response to ELIGARD should be monitored by periodic measurement of serum concentrations of testosterone and prostate specific antigen.
In the majority of patients, testosterone levels increased above Baseline during the first week, declining thereafter to Baseline levels or below by the end of the second or third week. Castrate levels were generally reached within two to four weeks.
Castrate testosterone levels
Castrate testosterone levels were maintained for the duration of the treatment with ELIGARD 7.5 mg. No increases to above the castrate level occurred in any of the patients. Castrate levels were generally maintained for the duration of treatment with ELIGARD 22.5 mg.
Once castrate levels were achieved with ELIGARD 30 mg, most (86/89) patients remained suppressed throughout the study.
Once castrate levels were achieved with ELIGARD 45 mg, only one patient (< 1%) experienced a breakthrough, with testosterone levels > 50 ng/dL.
Results of testosterone determinations are dependent on assay methodology.
It is advisable to be aware of the type and precision of the assay methodology to make appropriate clinical and therapeutic decisions.
Drug/Laboratory test interactions
Therapy with leuprolide acetate results in suppression of the pituitary-gonadal system. Results of diagnostic tests of pituitary gonadotropic and gonadal functions conducted during and after leuprolide therapy may be affected.
Hyperglycemia and diabetes
Hyperglycemia and an increased risk of developing diabetes have been reported in men receiving GnRH agonists. Hyperglycemia may represent development of diabetes mellitus or worsening of glycemic control in patients with diabetes. Monitor blood glucose and/or glycosylated hemoglobin (HbA1c) periodically in patients receiving a GnRH agonist and manage with current practice for treatment of hyperglycemia or diabetes.
Increased risk of developing myocardial infarction, sudden cardiac death and stroke has been reported in association with use of GnRH agonists in men. The risk appears low based on the reported odds ratios, and should be evaluated carefully along with cardiovascular risk factors when determining a treatment for patients with prostate cancer. Patients receiving a GnRH agonist should be monitored for symptoms and signs suggestive of development of cardiovascular disease and be managed according to current clinical practice.
Effect on QT/QTc interval
Androgen deprivation therapy may prolong the QT/QTc interval. Providers should consider whether the benefits of androgen deprivation therapy outweigh the potential risks in patients with congenital long QT syndrome, congestive heart failure, frequent electrolyte abnormalities, and in patients taking drugs known to prolong the QT interval. Electrolyte abnormalities should be corrected. Consider periodic monitoring of electrocardiograms and electrolytes.
May cause fetal harm.
Based on findings in animal studies and mechanism of action, leuprolide acetate may cause fetal harm when administered to a pregnant woman.
In animal developmental and reproductive studies, major fetal abnormalities were observed after administration of leuprolide acetate throughout gestation in rats.
Advise pregnant patients and females of reproductive potential of the potential risk to the fetus [see Specific Populations].
Postmarketing reports of convulsions have been observed in patients on leuprolide acetate therapy. These included patients with a history of:
- Cerebrovascular disorders
- Central nervous system anomalies
and in patients on concomitant medications that have been associated with convulsions such as bupropion and SSRIs.
Convulsions have also been reported in patients in the absence of any of the conditions mentioned above.
Patients receiving a GnRH agonist who experience convulsion should be managed according to current clinical practice.