Degarelix

How it works

It binds GnRH receptors in the pituitary directly and reversibly, rapidly suppressing luteinising hormone and testosterone without the initial surge seen with GnRH agonists.

Prescribing in practice

• Unlike GnRH agonists it does not cause an initial testosterone flare, so no antiandrogen cover is required, but injection-site reactions are common.
• Hot flushes, weight gain and other consequences of androgen deprivation occur and long-term bone and metabolic health should be considered.
• Caution is advised in patients with QT-interval prolongation or relevant cardiovascular disease.

Monitoring

Monitor testosterone and prostate-specific antigen response, with attention to injection-site reactions and cardiovascular and bone health on long-term therapy.

Counselling the patient

• Injection-site redness, swelling or pain is common, especially after the first dose, and usually settles.
• Hot flushes and tiredness are expected effects of lowering testosterone.
• Keep regular appointments so your treatment response can be checked.

Evidence & guidelines

A pivotal randomised trial showed degarelix achieved faster testosterone suppression than leuprorelin while avoiding the testosterone surge.