Leuprolide

INTRODUCTION

Indications

Injection, depot, or implant: Advanced prostate cancer in patients who are unable to tolerate orchiectomy or estrogen therapy (may be used in combination with flutamide or bicalutamide): Management of central precocious puberty (CPP). 3.75-mg depot only: Endometriosis: Uterine fibroids (with iron therapy).

Action

A synthetic analogue of luteinizing hormone–releasing hormone (LHRH). Initially causes a transient increase in testosterone; however, with continuous administration, testosterone levels are decreased. Reduces gonadotropins, testosterone, and estradiol. Therapeutic Effects: Decreased testosterone levels and resultant decrease in spread of prostate cancer. Reduction of pain/lesions in endometriosis. Decreased growth of fibroids. Delayed puberty.

Adverse Reactions/Side Effects

CNS: dizziness, headache, syncope; depot—drowsiness, personality disorder. SC—anxiety, lethargy, memory disorder, mood swings. EENT: blurred vision; SC— hearing disorder. Resp: hemoptysis; depot—epistaxis, throat nodules; SC—cough, pleural rub, pulmonary fibrosis, pulmonary infiltrate. CV: MI, PULMONARY EMBOLI, angina, arrhythmias; depot—vasodilation; SC— transient ischemic attack/stroke. GI: anorexia, diarrhea, dysphagia, nausea, vomiting; depot—gingivitis; SC—GI BLEEDING, hepatic dysfunction, peptic ulcer, rectal polyps, taste disorders. GU: decreased testicular size, dysuria, incontinence, testicular pain; depot—cervix disorder; SC—bladder spasm, penile swelling, prostate pain, urinary obstruction. Derm: depot—hair growth, rash; SC—dry skin, hair loss, pigmentation, skin cancer, skin lesions. Endo: breast swelling, breast tenderness, diabetes. F and E: hypercalcemia, lower extremity edema. Local: burning, itching, swelling at injection site. Metab: depot—hyperuricemia, increased bone density. MS: fibromyalgia, transient increase in bone pain (prostate cancer only); SC—ankylosing spondylitis, joint pain, pelvic fibrosis, temporal bone pain. Neuro: SC—peripheral neuropathy. Misc: hot flashes, chills, decreased libido, fever; depot—body odor, epistaxis.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• See immediate medical assistance if symptoms of MI develop, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea.

• Assess pulmonary function periodically by measuring lung volumes, breath sounds, and respiratory rate (See Appendices I, J, K). Notify physician immediately if patient experiences signs of pulmonary fibrosis (dry cough, dyspnea, shortness of breath, cyanosis) or pulmonary embolism (sudden shortness of breath, chest pain, cough, bloody sputum).

• Watch for signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician immediately.

• Monitor and report signs of TIA or stroke, including sudden severe headache, confusion, nausea, vomiting, and increasing neurologic loss (paralysis, numbness, speech problems, visual disturbances).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness ...