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GnRH Agonist — Androgen Deprivation Therapy Pregnancy: Not applicable — male indication; women of childbearing potential: avoid

Leuprorelin Acetate

Brand names: Prostap, Eligard

Adult dose

Dose: 3.75 mg SC/IM monthly; 11.25 mg every 3 months; 22.5 mg every 6 months
Route: Subcutaneous / Intramuscular injection
Frequency: Monthly, 3-monthly, or 6-monthly depending on formulation
Max: As per formulation
Depot formulation. Initial testosterone flare occurs in first 2-3 weeks — co-prescribe anti-androgen (bicalutamide) for at least 4 weeks to cover flare, especially in patients with metastatic disease near spinal cord

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: SC / IM
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Used under specialist supervision for precocious puberty

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Used under specialist supervision for precocious puberty

Clinical pearls

  • Testosterone flare on initiation can precipitate spinal cord compression in patients with vertebral metastases — mandatory anti-androgen cover with bicalutamide for at least 4 weeks
  • Long-term ADT causes bone mineral density loss — DEXA scan at baseline; prescribe calcium, vitamin D, and consider bisphosphonate (zoledronic acid) or denosumab
  • Castration-resistant prostate cancer (CRPC) defined as progression despite castrate testosterone levels (under 50 ng/dL) — continue ADT even in CRPC per NICE NG131
  • Cardiovascular monitoring essential — ADT associated with metabolic syndrome, diabetes, and increased cardiovascular events
  • QTc prolongation: screen for concurrent QT-prolonging medications

Contraindications

  • Hypersensitivity to GnRH or GnRH analogues
  • Undiagnosed vaginal bleeding

Side effects

  • Hot flushes (very common)
  • Erectile dysfunction and loss of libido
  • Gynaecomastia
  • Osteoporosis (long-term — bone mineral density loss)
  • Fatigue
  • Metabolic syndrome
  • Mood disturbance and depression
  • QT prolongation (class effect)
  • Testosterone flare (initial surge)

Interactions

  • QT-prolonging drugs (additive risk)
  • Antidiabetics (testosterone suppression affects insulin sensitivity — monitor glucose)

Monitoring

  • Testosterone level (confirm castration: under 50 ng/dL)
  • PSA (response monitoring)
  • Bone mineral density (DEXA annually)
  • Fasting glucose and lipids
  • QTc (ECG before and during treatment)
  • Blood pressure

Reference: BNFc; BNF 90; NICE NG131 (Prostate Cancer); EAU Prostate Cancer Guidelines 2024. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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