goserelin acetate: clinical use

Prescribing considerations

• Assess cardiovascular disease, QT risk and concurrent QT-prolonging medicines.
• Review osteoporosis risks, depression history, hypertension, diabetes risk, low body mass and anticoagulant treatment.
• Anticipate initial tumour or hormone flare; men at risk of spinal cord compression or ureteric obstruction require particular care.
• Confirm adequate ovarian suppression before aromatase-inhibitor treatment.
• Restrict assisted-reproduction use to appropriately experienced specialist services.

Contraindications and cautions

• Hypersensitivity to goserelin or an excipient.
• Pregnancy.
• Breastfeeding.

Monitoring

• Mood and emergence or worsening of depression.
• Blood pressure and, where appropriate, blood glucose.
• Bone health according to baseline risk and treatment context.
• New urinary obstruction, neurological symptoms or worsening bone pain in prostate cancer.
• Oestradiol and FSH when confirmation of ovarian suppression is clinically required.
• Injection-site symptoms suggesting abdominal bleeding or vascular injury.

Clinical pharmacology

Goserelin is a synthetic GnRH agonist. Continuous exposure suppresses pituitary luteinising-hormone secretion after an initial stimulatory phase, producing reversible suppression of testosterone or oestradiol. Systemic release is maintained by a biodegradable lactide/glycolide implant.

Formulation and product differences

• Both selected products are pre-filled subcutaneous implants for the anterior abdominal wall.
• The selected standard-release presentation includes prostate cancer, breast cancer, benign gynaecological and assisted-reproduction indications.
• The selected longer-acting presentation is licensed for specified prostate cancer settings and oestrogen-receptor-positive breast cancer.
• The polymer composition differs between the selected presentations.

Implant

Route: Implant

Strengths: 3.6 mg