Goserelinâ•… 747
or hard. Do not rub injection site.
Discard any unused portion.
Goserelin
go′seh-rel-in
Zoladex, Zoladex LA
CATEGORY AND SCHEDULE
Pregnancy Risk Category: D
(advanced breast cancer), X
(endometriosis, endometrial
thinning)
Classification: Hormones/
hormone modifiers, gonadotropin-
releasing hormone analogs
MECHANISM OF ACTION
A gonadotropin-releasing hormone
analog and antineoplastic agent that
stimulates the release of luteinizing
hormone (LH) and follicle-
stimulating hormone (FSH) from the
anterior pituitary gland. Therapeutic
Effect: In females, reduces estrogen
levels, produces a reduction in
ovarian size and function, a reduction
in uterine and mammary gland size,
and regression of sex-hormone-
responsive tumors. In men, it
produces decreased testosterone
levels, pharmacologic castration, and
decreases the growth of abnormal
prostate tissue.
AVAILABILITY
Implant: 3.6 mg (monthly).
Implant: 10.8 mg (every 3 mo).
INDICATIONS AND DOSAGES
‣ Prostatic cancer
IMPLANT
Adult males. 3.6 mg every 28 days or
10.8 mg q12wk subcutaneously into
upper abdominal wall.
‣ Breast cancer, endometriosis
IMPLANT
Adult females. 3.6 mg every 28 days
subcutaneously into upper abdominal
wall. Do not use 10.8-mg implant in
females.
OFF-LABEL USES
Uterine fibroids, endometrial
thinning before ablation procedure.
CONTRAINDICATIONS
Pregnancy; hypersensitivity to G
goserelin products, luteinizing
hormone-releasing hormone (LHRH),
or LHRH analogs; breastfeeding.
INTERACTIONS
Drug, Herbal, and Food
None known.
DIAGNOSTIC TEST EFFECTS
In men, causes transient increases in
serum levels of testosterone at
treatment initiation. May increase
blood sugar, liver enzymes, or blood
lipids.
SIDE EFFECTS
Frequent
Headache (60%), hot flashes (55%),
depression (54%), diaphoresis
(45%), sexual dysfunction (21%),
decreased erection (18%), lower
urinary tract symptoms (13%).
Occasional (5%-10%)
Pain, lethargy, dizziness, insomnia,
anorexia, nausea, rash, upper
respiratory tract infection, hirsutism,
abdominal pain, acne, vaginitis,
peripheral edema.
Rare
Pruritus.
SERIOUS REACTIONS
• Arrhythmias, congestive heart
failure, and hypertension occur rarely.
• Ureteral obstruction and spinal cord
compression have been observed.
An immediate orchiectomy may be
necessary if these conditions occur.
 748â•… Granisetron
• Deep vein thrombosis has been
reported. May increase risk of MI,
sudden cardiac death, or stroke.
• Decreased bone mineral density,
osteoporosis with long-term use,
fractures.
• New onset or worsened diabetes.
PRECAUTIONS & CONSIDERATIONS
In men at particular risk of
G developing ureteral obstruction or
spinal cord compression, monitor
closely. Use with caution in patients
with existing diabetes mellitus or
cardiovascular risk factors.
Goserelin crosses the placenta
and may cause fetal harm. Women
who are or may be pregnant should
not use this drug. Pregnancy status
should be determined before
beginning therapy. Women should use
nonhormonal contraceptive measures
during therapy. It is unknown whether
goserelin is excreted in breast milk.
The safety and efficacy of goserelin
have not been established in children.
No age-related precautions have been
noted in elderly patients.
Women should notify the physician
if regular menstruation persists or if
they become pregnant. Breakthrough
bleeding may occur if a goserelin
dose is missed. Signs and symptoms
of worsening of prostatic cancer,
especially in the first month, should
be monitored in men. Decreased
bone mineral density secondary to
this medication may be irreversible.
Storage
Store at room temperature in original
packaging and do not remove from
foil pouch until time of use.
Administration
! Confirm implant dosage against
patient prescription before insertion.
Inspect for damage before opening.
If the package is damaged, do not
use the syringe. Remove the sterile
syringe from the package immediately
before use. Check that implant is
visible in the translucent chamber.
Place patient in a comfortable
position with the upper part of the
body slightly raised. Prepare area of
the anterior abdominal wall below the
navel with alcohol. Grasp the safety
tab and pull away from the syringe
and discard. Remove needle cover. Do
not remove air bubbles as this may
displace the implant.
Using aseptic technique, pinch
up the skin area for subcutaneous
implant. With the bevel of the needle
up, insert at a 30-45° angle to the
skin in one continuous motion until
the protective sleeve touches the skin;
take care not to penetrate muscle.
! If the needle penetrates a large
vessel, blood will be seen instantly
in the syringe chamber. If a vessel
is penetrated, withdraw the needle
and inject with a new syringe at a
different site.
To administer the implant and
activate the protective sleeve, grasp
the barrel at the finger grip and
depress plunger until it cannot
depress any further. When the
sleeve “clicks,” it will automatically
begin to slide to cover the needle.
Withdraw the needle and allow
protective sleeve to cover it. Dispose
of in an approved receptacle.
In case of the need to surgically
remove the implant, it may be
localized by ultrasound.
Granisetron
gra-ni′se-tron
Kytril, Sancuso Kytril
CATEGORY AND SCHEDULE
Pregnancy Risk Category: B
Classification: Antiemetics/
antivertigo, serotonin receptor
antagonists