GnRH analogue
Nafarelin
Brand names: Synarel
Adult dose
Dose: 200 micrograms intranasally BD (one nostril AM, other PM); start day 2 of cycle
Route: Intranasal
Frequency: BD
Clinical pearls
- Endometriosis, fibroids, IVF
- 6-month treatment limit; consider add-back HRT for ≥6 months
Contraindications
- Pregnancy
- Undiagnosed vaginal bleeding
- Hormone-dependent tumour
- Hypersensitivity
Side effects
- Hot flushes
- Vaginal dryness
- Bone loss (limit 6 months)
- Headache
- Mood change
- Initial flare
Monitoring
- DEXA in long-term use
Reference: BNF; NICE NG73; https://bnf.nice.org.uk/drugs/nafarelin/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Spinal Anaesthesia Hypotension Management · AAGBI; ASA
- Pre-Eclampsia / Eclampsia in ED · NICE NG133; RCOG Green-top 10A
- Suspected Ectopic Pregnancy · NICE NG126; RCOG Green-top 21
- Polycystic Ovary Syndrome (PCOS) · International PCOS Guideline 2023; NICE CKS
- Pre-eclampsia Management · NICE NG133 2019
- Ectopic Pregnancy · NICE CG154 / RCOG GTG 21