Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.
If you were prescribed this medicine, other products containing Triptorelin pamoate may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.
for
The active ingredient in Decapeptyl SR 11.25 mg is triptorelin. Triptorelin belongs to a group of medicines called gonadotropin releasing hormone (GnRH) agonists. Triptorelin is similar to the gonadotropin releasing hormone which occurs naturally in your body. In men, triptorelin lowers the levels of the hormone testosterone. In women, it reduces oestrogen levels. Decapeptyl SR 11.25 mg has three different uses. It is used in men, women and children to treat completely different conditions. Decapeptyl SR is available in two other strengths: Decapeptyl SR 3 mg is used once a month and Decapeptyl SR 22.5 mg is used once every 6 months. Not all dose strengths are approved for all indications. Ask your doctor if you would like to discuss changing your treatment. This leaflet gives information for all three uses of Decapeptyl SR 11.25 mg. Please read all the sections that are about you and your condition. MEN In men, Decapeptyl SR 11.25 mg is used to treat prostate cancer. WOMEN In women, Decapeptyl SR 11.25 mg is used to treat Endometriosis – a condition in which the tissue that normally lines the uterus (endometrium) grows in other places.
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CHILDREN In children, Decapeptyl SR 11.25 mg is used to treat puberty that occurs at a very young age, i.e. before 8 years in girls and 10 years in boys (Central Precocious Puberty). This is called 'early puberty' in the rest of this leaflet.
2.
e Decapeptyl SR 11.25 mg
MEN Do not use Decapeptyl SR 11.25 mg:
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•
• • • • •
If you have an enlargement (benign tumour) of the pituitary gland that you were unaware of, this may be discovered during treatment. Symptoms include sudden headache, problems with eyesight and paralysis of the eye muscles. After surgical castration triptorelin does not induce any further decrease in serum testosterone levels. Diagnostic tests of pituitary gonadal function or sex organs conducted during treatment or after discontinuation of therapy with Decapeptyl SR 11.25 mg may be misleading. Testosterone decreasing agents may cause changes in ECG associated with heart rhythm abnormalities (QT prolongation). Tell your doctor if you have back pain, weakness, numbness or tingling in your legs. Treatment with GnRH analogues including Decapeptyl SR 11.25mg might increase the risk of anaemia (defined as a decrease in the count of red blood cells).
Your doctor may give you another drug to help you feel better during this time. Other medicines and Decapeptyl SR 11.25 mg: Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Decapeptyl SR 11.25 mg might interfere with some medicines used to treat heart rhythm problems (e.g. quinidine, procainamide, amiodarone and sotalol) or might increase the risk of heart rhythm problems when used with some other drugs (e.g. methadone (used for pain relief and part of drug addiction detoxification), moxifloxacin (an antibiotic), antipsychotics used for serious mental illnesses). Drugs which increase the level of a hormone called prolactin may react with Decapeptyl SR 11.25 mg. Many different kinds of drugs may increase prolactin levels. Driving and using machines: You may feel dizzy, tired or have problems with your sight such as blurred vision. These are possible side effects of treatment or from the underlying disease. If you experience any of these side effects, you should not drive or use machines. Decapeptyl SR 11.25 mg contains sodium This medicine contains less than 1 mmol (23 mg) sodium per dose, that is to say essentially 'sodium-free '. This medicine contains 2 mg of polysorbate 80 in each vial. Polysorbates may cause allergic reactions. Tell your doctor if you or your child have any know allergies. WOMEN Do not use Decapeptyl SR 11.25 mg:
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• •
• •
• • •
• • •
after the treatment was discontinued. Suicidal thoughts have been mostly reported in patients with a previous history of depression. If you are taking Decapeptyl SR 11.25 mg and subsequently develop depressed mood, worsening depression, or suicidal thoughts inform your doctor as soon as possible. Your doctor may want to monitor your depression during treatment. If you are using medicines for delaying your normal blood clotting, you may experience bruising at the site of the intramuscular injection. In adults, triptorelin may cause thinning of the bones (osteoporosis) with an increased risk of bone fractures. You should therefore tell your doctor if you have any of the below risk factors as he/she might give you bisphosphonate (drugs used to treat wark bones) to treat bone loss. Risk factors may include: o If you or any of your close family have thinning of the bones. o If you drink excessive amounts of alcohol, and/or smoke heavily. o If you take medicines over a long period of time that may cause thinning of the bones, for example medicines for epilepsy or steroids (such as hydrocortisone or prednisolone). If any convulsions occur, inform immediately your doctor. There have been reports of convulsions in patients receiving triptorelin or similar medicines. These occurred in patients with or without medical history of epilepsy. When you first start treatment with Decapeptyl SR 11.25 mg it actually increases the level of your hormones for a short time. This means that you may feel worse to begin with (see section 4 'Possible side effects' for more information). After a short time the amount of hormone will drop and your symptoms will get better. Tell your doctor if you have diabetes. Tell your doctor if you have any heart conditions. If you have an enlargement (benign tumour) of the pituitary gland that you were unaware of, this may be discovered during treatment. Symptoms include sudden headache, problems with eyesight and paralysis of the eye muscles. You may have some vaginal bleeding in the first month of treatment. After that your periods normally stop. Tell your doctor if you have bleeding after the first month of treatment. Your periods should start approximately 5 months after the last injection.
You must use some form of contraception other than the 'pill' while you are having treatment and until you start your next period. Your doctor may suggest using a barrier method of contraception such as a condom or diaphragm (cap). Other medicines and Decapeptyl SR 11.25 mg: Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Drugs which increase the level of a hormone called prolactin may react with Decapeptyl SR 11.25 mg. Many different kinds of drugs may increase prolactin levels. Pregnancy and breast-feeding: Do not take Decapeptyl SR 11.25 mg if you are pregnant or breast-feeding. Driving and using machines: You may feel dizzy, tired or have problems with your sight such as blurred vision. These are possible side effects of treatment or from the underlying disease. If you experience any of these side effects, you should not drive or use machines.
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Decapeptyl SR 11.25 mg contains sodium This medicine contains less than 1 mmol (23 mg) sodium per dose, that is to say essentially 'sodium-free '. This medicine contains 2 mg of polysorbate 80 in each vial. Polysorbates may cause allergic reactions. Tell your doctor if you or your child have any know allergies. CHILDREN Do not use Decapeptyl SR 11.25 mg:
• • • • • • •
•
•
If your child suffers from a bad or recurrent headache, problems with eyesight and ringing or buzzing in the ears, contact a doctor immediately (see section 4). Girls who have an early puberty may have some vaginal bleeding in the first month of treatment. In girls, menstrual bleeding will start on average one year after stopping treatment. Early puberty caused by other diseases should be ruled out by your doctor. Tell your doctor if you have diabetes. Tell your doctor if you have any heart conditions. If you have an enlargement (benign tumour) of the pituitary gland that you were unaware of, this may be discovered during treatment. Symptoms include sudden headache, problems with eyesight and paralysis of the eye muscles. A pathology of the hip may occur after stopping treatment (slipped capital femoral epiphysis of the hip). It results in stiffness of the hip, a limp and / or severe pain in the groin radiating to the thigh. If this occurs, you should consult your doctor. If any convulsions occur, inform immediately your doctor. There have been reports of convulsions in patients receiving triptorelin or similar medicines. These occurred in patients with or without medical history of epilepsy.
Other medicines and Decapeptyl SR 11.25 mg: Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Drugs which increase the level of a hormone called prolactin may react with Decapeptyl SR 11.25 mg. Many different kinds of drugs may increase prolactin levels. Decapeptyl SR 11.25 mg contains sodium
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This medicine contains less than 1 mmol (23 mg) sodium per dose, that is to say essentially 'sodium-free '. This medicine contains 2 mg of polysorbate 80 in each vial. Polysorbates may cause allergic reactions. Tell your doctor if you or your child have any know allergies. 3.
Decapeptyl SR 11.25 mg
MEN Decapeptyl SR 11.25 mg will be injected into a muscle, usually your bottom, by a doctor or nurse. On this leaflet there are instructions for them that explain how to prepare the injection. You will normally receive an injection once every 3 months. Also read 'Other medicines and Decapeptyl SR 11.25 mg' in section 2. If you are given more Decapeptyl SR 11.25 mg than you should If you are given too much Decapeptyl SR 11.25 mg you may experience additional or more severe side effects (see section 4 'Possible side effects'). If you forget to take a dose of Decapeptyl SR 11.25 mg As soon as you realise that you have missed an injection you should tell your doctor. You will then be given your next injection. If you stop receiving Decapeptyl SR 11.25 mg If you stop receiving your Decapeptyl SR 11.25 mg injection before your doctor tells you to then your symptoms are likely to return. If you have any further questions on the use of this product, ask your doctor or pharmacist. WOMEN Decapeptyl SR 11.25 mg will be injected into a muscle, usually your bottom, by a doctor or nurse. On this leaflet there are instructions for them that explain how to prepare the injection. You will normally receive two injections, the second one three months after the first. Each injection will be given in the first five days of your period. Also read 'Other medicines and Decapeptyl SR 11.25 mg' in section 2. If you are given more Decapeptyl SR 11.25 mg than you should If you are given too much Decapeptyl SR 11.25 mg you may experience additional or more severe side effects (see section 4 'Possible side effects'). If you forget to take a dose of Decapeptyl SR 11.25 mg As soon as you realise that you have missed an injection you should tell your doctor. You will then be given your next injection. If you stop receiving Decapeptyl SR 11.25 mg
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If you stop receiving your Decapeptyl SR 11.25 mg injection before your doctor tells you to then your symptoms are likely to return. If you have any further questions on the use of this product, ask your doctor or pharmacist. CHILDREN Decapeptyl SR 11.25 mg will be injected into a muscle, usually your bottom, by a doctor or nurse. On this leaflet there are instructions for them that explain how to prepare the injection. You will normally receive an injection once every 3 months. Your doctor will decide when treatment should be stopped (normally when you are about 12-13 if you are a girl and about 13-14 if you are a boy). Also read 'Other medicines and Decapeptyl SR 11.25 mg' in section 2. If you are given more Decapeptyl SR 11.25 mg than you should If you are given too much Decapeptyl SR 11.25 mg you may experience additional or more severe side effects (see section 4 'Possible side effects'). If you forget to take a dose of Decapeptyl SR 11.25 mg As soon as you realise that you have missed an injection you should tell your doctor. You will then be given your next injection. If you stop receiving Decapeptyl SR 11.25 mg If you stop receiving your Decapeptyl SR 11.25 mg injection before your doctor tells you to then your symptoms are likely to return. If you have any further questions on the use of this product, ask your doctor or pharmacist.
4.
Possible side effects
Like all medicines, Decapeptyl SR 11.25 mg can have side effects although not everybody gets them. In rare cases you may experience a severe allergic reaction (angioedema, anaphylactic reaction). Tell your doctor immediately if you develop symptoms such as swallowing or breathing problems, dizziness, a rash, swelling of your lips, face, throat or tongue. MEN Many of the side effects are expected, due to the change in the level of testosterone in your body. These effects include hot flushes, impotence and decreased libido. Side effects which are very common (may affect more than 1 in 10 people) are hot flushes, weakness, excessive sweating, back pain, pins and needles sensation in the legs, reduced libido and impotence. Side effects which are common (may affect up to 1 in 10 people) are nausea, dry mouth, pain, bruising, redness and swelling at injection site, muscle and bone pain, pain in the arms and legs, oedema (build-up of fluid in the body tissues), lower abdominal pain, high blood pressure, allergic reaction, increase in weight,
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dizziness, headache, loss of libido, depression and mood changes. Side effects which are uncommon (may affect up to 1 in 100 people) are increase of blood platelets, feeling your heartbeat, ringing in the ears, vertigo, blurred vision, pain in abdomen, constipation, diarrhoea, vomiting, drowsiness, severe shivering associated with sweating and a fever, sleepiness, pain, swelling of the ankles, feet or fingers, some blood tests affected (including raised liver function tests), blood pressure increased, weight loss, loss of appetite, increase of appetite, gout (severe pain and swelling in the joints usually in the big toe), diabetes, excessive lipids in the blood, joint pain, muscle cramp, muscle weakness, muscle pain, swelling and tenderness, bone pain, tingling or numbness, inability to sleep, feeling of irritability, development of enlarged breasts in men, breast pain, reduction in testicular size, pain in testicles, difficulty in breathing, acne, hair loss, itching, rash, redness of skin, hives, waking up to pass urine, problems passing urine and nosebleeds. Side effects which are rare (may affect up to 1 in 1,000 people) are red or purple discolorations on the skin, abnormal sensation in the eye, blurring or disturbance in vision, sensation of fullness in the abdomen, flatulence, abnormal sense of taste, chest pain, difficulty in standing, flu-like symptoms, fever, anaphylactic reaction (serious allergic reaction which can cause dizziness or difficulty in breathing, swelling of the face or throat), inflammation of the nose/throat, increased body temperature, stiff joints, joint swelling, musculoskeletal stiffness, osteoarthritis, memory loss, feeling confused, decreased activity, having a feeling of elation, shortness of breath when lying flat, blisters and low blood pressure. During post-marketing surveillance the following side effects have also been reported (their frequency cannot be estimated from the available data): changes in ECG (QT prolongation), serious allergic reaction which can lead to a swelling of the face, the tongue and the neck, dizziness or breathing difficulties (Quincke oedema, anaphylactic shock), convulsions, general discomfort, anxiety, rapid formation of wheals due to swelling of the skin or mucous membranes and urinary incontinence, if there is an existing pituitary tumour there is an increased risk of bleeding to the area, anaemia (decrease in the count of red blood cells). As with other GnRH agonists, an increase in white blood cell count may be found in patients being treated with Decapeptyl SR 11.25 mg. Patients receiving long-term treatment by GnRH analogue in combination with radiation may have more side effects especially gastrointestinal, related to radiotherapy. WOMEN Many of the side effects are expected due to the change in the level of oestrogens in your body. These very common side effects (may affect more than 1 in 10 people) include headache, decreased libido, mood swings, difficulty in sleeping, breast disorder, ovarian hyperstimulation syndrome, pain during or after sexual intercourse, painful periods, genital bleeding, pelvic pain, dryness of the vagina, weakness, excessive sweating, acne, oily skin and hot flushes. Side effects which are common (may affect up to 1 in 10 people) are breast pain, muscle cramps, painful joints, weight gain, feeling sick, depression (long term treatment), nervousness, abdominal pain or discomfort, pain, bruising, redness and swelling at injection site, swelling and tenderness, allergic reaction, pain in the arms and legs, dizziness and swelling of ankles, feet or fingers.
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Side effects which are uncommon (may affect up to 1 in 100 people) are feeling your hearbeat, vertigo, dry eye, blurred vision, bloating, vomiting, dry mouth, flatulence, mouth ulcer, weight decrease, decrease in appetite, water retention, back pain, muscle pain, abnormal taste, loss of sensations, temporary loss of consciousness, memory loss, lack of concentration, tingling or numbness, involuntary muscle movement, mood change, anxiety, disorientation, depression (short term treatment), bleeding after sex, prolapse, irregular period, painful period and heavy period, small cysts (swelling) on the ovaries which can cause pain, discharge from the vagina, difficulty breathing, nosebleed, hair loss, dry skin, excessive bodily hair, brittle nails, itching, hives and skin rash. During post-marketing surveillance the following side effects have also been reported (their frequency cannot be estimated from the available data): general discomfort, increased blood pressure, increased body temperature, serious allergic reaction which can lead to a swelling of the face, the tongue and the neck, dizziness or breathing difficulties (Quincke oedema, anaphylactic shock), convulsions, some blood tests affected (including raised liver function tests), diarrhoea, muscle weakness, confusion, absence of menstrual periods, rapid formation of wheals due to swelling of the skin or mucous membranes, abnormal sensations in the eyes and/or changes in sight, hives, if there is an existing pituitary tumour there is an increased risk of bleeding to the area. In endometriosis treatment, the disorders for which the treatment has been justified (pelvic pain, dysmenorrhea) may be exacerbated at the beginning of the treatment, but should disappear in one to two weeks. This may occur even if the treatment is producing a favorable effect. You should nevertheless immediately notify your doctor of this phenomenon. CHILDREN Side effects which are very common (may affect more than 1 in 10 people) include vaginal bleeding which may occur in girls in the first month of treatment. Side effects which are common (may affect up to 1 in 10 people) include pain in abdomen, pain, bruising, redness and swelling at injection site, headache, hot flushes, weight gain, acne, allergic reactions.
which are uncommon (may affect up to 1 in 100 people) are blurred vision, vomiting, constipation, nausea, general discomfort, overweight, neck pain, changes in mood, pain in breast, nosebleeds, itching, rash or hives in the skin. Long term trial (up to 4 years) did not bring any new and significant safety concerns. During post-marketing surveillance the following side effects have also been reported (their frequency cannot be estimated from the available data): high blood pressure, abnormal vision, serious allergic reaction which can lead to a swelling of the face, the tongue and the neck, dizziness or breathing difficulties (Quincke oedema, anaphylactic shock), convulsions, some blood tests affected include hormone levels, rapid formation of wheals due to swelling of the skin or mucous membranes, muscle pain, mood disorders, depression, nervousness, Idiopathic intracranial hypertension (increased intracranial pressure around the brain characterised by headache, double vision and other visual symptoms, and ringing or buzzing in the ears). Reporting of side effects
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If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme. Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects, you can help provide more information on the safety of this medicine.
5.
Decapeptyl SR 11.25 mg
Keep this medicine out of the sight and reach of children. Do not use the vial or ampoule after the expiry date printed on the box. This medicine should not be stored above 25°C. The vial and ampoule should be kept in the outer box. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6.
What Decapeptyl SR 11.25 mg contains: The active substance of Decapeptyl SR 11.25 mg is triptorelin. Each vial contains sufficient quantity of triptorelin (as triptorelin pamoate) to ensure that the minimum triptorelin quantity injected is 11.25 mg. The other ingredients are D,L lactide-glycolide copolymer, mannitol, carmellose sodium, polysorbate 80. What Decapeptyl SR 11.25 mg looks like and contents of the pack Each pack contains: 1 clear glass vial with a rubber stopper and an aluminium cap containing the powder 1 glass ampoule containing the suspension vehicle 1 syringe 2 needles. Marketing Authorisation Holder Ipsen Limited, 5th Floor, The Point, 37 North Wharf Road, Paddington, London, W2 1AF, UK. Manufacturer Ipsen Pharma Biotech, Signes, France. This leaflet was last revised in May 2026. Is this leaflet hard to see or read? Please phone +44 (0) 1753 627777 and ask for help.
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The following information is intended for medical or healthcare professionals only: INSTRUCTIONS FOR RECONSTITUTION 1. PREPARATION OF THE PATIENT BEFORE RECONSTITUTION •
Prepare the patient by disinfecting the injection site. This operation needs to be performed first because once reconstituted, the drug should be injected immediately.
2. PREPARATION OF THE INJECTION Two needles are provided in the box :
The presence of bubbles on top of the lyophilisate is a normal appearance of the product. The following steps must be completed in a continuous sequence. 2a
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2c
4. AFTER USE • •
Activation of the safety system using a one-handed technique. Note: Keep your finger behind the tab at all times.
There are two alternatives to activate the safety system: • Method A : push the tab forward with your finger
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or •
Method B : push the sheath to a flat surface
•
In both cases press down with a firm quick motion until a distinct audible click is heard.
•
Visually confirm that the needle is fully engaged under the lock.
•
Used needles, any unused suspension or other waste materials should be disposed of in accordance with local requirements.
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Decapeptyl SR 11.25mg Powder and solvent for suspension for injection comes as oral solution containing 11.25mg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.
The active substance in Decapeptyl SR 11.25mg Powder and solvent for suspension for injection is triptorelin pamoate.
This leaflet reproduces the patient information leaflet approved for Decapeptyl SR 11.25mg Powder and solvent for suspension for injection, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.
Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.
The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.
Treatment of patients with locally advanced, non-metastatic prostate cancer, as an alternative to surgical castration (see section 5.1).
Treatment of metastatic prostate cancer.
As adjuvant treatment to radiotherapy in patients with high-risk localised or locally advanced prostate cancer.
As neoadjuvant treatment prior to radiotherapy in patients with high-risk localised or locally advanced prostate cancer.
As adjuvant treatment to radical prostatectomy in patients with locally advanced prostate cancer at high risk of disease progression.
Treatment of endometriosis.
Treatment of central precocious puberty (onset before 8 years in girls and 10 years in boys).
Prostate cancer
One intramuscular injection should be administered every 3 months.
No dosage adjustment is necessary in the elderly.
Decapeptyl is also available as a 1-month treatment (Decapeptyl SR 3 mg) and as a 6-month treatment (Decapeptyl SR 22.5 mg) for prostate cancer.
In patients treated with GnRH analogues for metastatic prostate cancer, treatment is usually continued upon development of castrate resistant prostate cancer.
Reference should be made to relevant guidelines.
Endometriosis
One intramuscular injection should be administered every 3 months. The treatment must be initiated in the first five days of the menstrual cycle. Treatment duration depends on the initial severity of the endometriosis and the changes observed in the clinical features (functional and anatomical) during treatment. The maximum duration of treatment should be 6 months (two injections).
A further course of treatment with Decapeptyl SR 11.25 mg, or with other GnRH agonists, beyond 6 months should not be undertaken due to concerns about bone density losses. In patients treated with GnRH analogues for endometriosis, the addition of an add-back therapy (ABT - an estrogen and progestogen) has been shown to reduce bone mineral density loss and vasomotor symptoms. Therefore, if appropriate, ABT should be co-administered with GnRH analogue taking into account the risks and benefits of each treatment.
Decapeptyl is also available as a 1-month treatment (Decapeptyl SR 3 mg) for endometriosis.
Central precocious puberty (before 8 years in girls and 10 years in boys)
One intramuscular injection should be administered every 3 months.
The treatment of children with Decapeptyl SR 11.25 mg should be under the overall supervision of a paediatric endocrinologist or of a paediatrician or endocrinologist with expertise in the treatment of central precocious puberty.
Treatment should be stopped around the physiological age of puberty in boys and girls and should not be continued in girls with a bone maturation of 12 to 13 years. There are limited data available in boys relating to the optimum time to stop treatment based on bone age, however it is advised that treatment is stopped in boys with a bone maturation age of 13-14 years.
Hypersensitivity to GnRH (gonadotropin releasing hormone), its analogues or to any of the excipients listed in section 6.1 (see section 4.8 Undesirable effects).
Pregnancy and lactation.
The use of GnRH agonists may cause a reduction in bone mineral density. In men, preliminary data suggest that the use of a bisphosphonate in combination with a GnRH agonist may reduce bone mineral loss. No specific data is available for patients with established osteoporosis or with risk factors for osteoporosis (e.g. chronic alcohol abuse, smokers, long-term therapy with drugs that reduce bone mineral density, e.g. anticonvulsants or corticosteroids, family history of osteoporosis, malnutrition, e.g. anorexia nervosa). Particular caution is therefore necessary since reduction in bone mineral density is likely to be more detrimental in these patients. Treatment with Decapeptyl SR 11.25 mg should be considered on an individual basis and only be initiated if the benefits of treatment outweigh the risk following a very careful appraisal. Consideration should be given to additional measures in order to counteract loss of bone mineral density.
Rarely, treatment with GnRH agonists may reveal the presence of a previously unknown gonadotroph cell pituitary adenoma. These patients may present with a pituitary apoplexy characterised by sudden headache, vomiting, visual impairment and ophthalmoplegia.
In patients undergoing treatment with GnRH agonists, an increased risk of depression was reported (which may be severe and includes rare case reports of suicidal ideation from post-marketing experience, including reports of positive dechallenge and reversible symptoms, and with the majority of reports occurring in patients with a background history of depression). Patients should be informed accordingly to contact a doctor as soon as possible if worsening depression occurs, and if suicidal ideation develops and treated as appropriate if symptoms occur. Patients with known depression should be monitored closely during therapy.
Convulsions have been reported with GnRH analogues, particularly in women and children. Some of these patients had risk factors for seizures (such as a history of epilepsy, intracranial tumors or co-medication with drugs known to present a risk of seizure reactions). Convulsions have also been reported in patients in the absence of such risk factors.
This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially 'sodium-free'.
This medicine contains 2 mg of polysorbate 80 in each vial. Polysorbates may cause allergic reactions.
In men
Prostate cancer
Initially, Decapeptyl SR 11.25 mg, like other GnRH agonists, causes a transient increase in serum testosterone levels. As a consequence, isolated cases of transient worsening of signs and symptoms of prostate cancer may occasionally develop during the first weeks of treatment. During the initial phase of treatment, consideration should be given to the additional administration of a suitable anti-androgen to counteract the initial rise in serum testosterone levels and the worsening of clinical symptoms.
A small number of patients may experience a temporary worsening of signs and symptoms of their prostate cancer (tumour flare) and temporary increase in cancer related pain (metastatic pain), which can be managed symptomatically.
As with other GnRH agonists, isolated cases of spinal cord compression or urethral obstruction have been observed. If spinal cord compression or renal impairment develops, standard treatment of these complications should be instituted, and in extreme cases an immediate orchidectomy (surgical castration) should be considered. Careful monitoring is indicated during the first weeks of treatment, particularly in patients suffering from vertebral metastasis, at the risk of spinal cord compression, and in patients with urinary tract obstruction.
After surgical castration, Decapeptyl SR 11.25 mg does not induce any further decrease in serum testosterone levels.
Long-term androgen deprivation either by bilateral orchidectomy or administration of GnRH agonists is associated with increased risk of bone loss and may lead to osteoporosis and increased risk of bone fracture.
Androgen deprivation therapy may prolong the QT interval.
In patients with a history of or risk factors for QT prolongation and in patients receiving concomitant medicinal products that might prolong the QT interval (see section 4.5) physicians should assess the benefit risk ratio including the potential for Torsade de pointes prior to initiating Decapeptyl SR 11.25 mg.
In addition, from epidemiological data, it has been observed that patients may experience metabolic changes (e.g. glucose intolerance, fatty liver), and an increased risk of cardiovascular disease during androgen deprivation therapy. However, prospective data did not confirm the link between treatment with GnRH agonists and an increase in cardiovascular mortality. Patients at high risk for metabolic or cardiovascular diseases should be carefully assessed before commencing treatment and their glucose, cholesterol and blood pressure adequately monitored during androgen deprivation therapy.
Metabolic changes may be more severe in these high risk patients. Patients at high risk of metabolic or cardiovascular disease and receiving androgen deprivation therapy should be monitored at appropriate intervals not exceeding 3 months.
Administration of triptorelin in therapeutic doses result in suppression of the pituitary gonadal system. Normal function is usually restored after treatment is discontinued. Diagnostic tests of pituitary gonadal function conducted during treatment and after discontinuation of therapy with GnRH agonists may therefore be misleading.
Due to androgen deprivation, treatment with GnRH analogues can increase the risk of anaemia. This risk should be assessed in treated patients and monitored appropriately.
In women
It should be confirmed that the patient is not pregnant before prescription of triptorelin.
The use of GnRH agonists is likely to cause reduction in bone mineral density averaging 1% per month during a six-month treatment period. Every 10% reduction in bone mineral density is linked with about a two to three times increased fracture risk.
No specific data are available for patients with established osteoporosis or with risk factors for osteoporosis (e.g. chronic alcohol abusers, smokers, long-term therapy with drugs that reduce bone mineral density, e.g. anticonvulsants or corticoids, family history of osteoporosis, malnutrition, e.g. anorexia nervosa). Since reduction in bone mineral density is likely to be more detrimental in these patients, treatment with triptorelin should be considered on an individual basis and only be initiated if the benefits of treatment outweigh the risk following a very careful appraisal. Consideration should be given to additional measures in order to counteract loss of bone mineral density.
Endometriosis
GnRH agonist is not recommended for patients under the age of 18 years. Careful attention should be given to adolescent and young women (specially less than 16 years of age) who may not have reached maximum bone density.
In patients treated with GnRH analogues for endometriosis, the addition of ABT (an estrogen and progestogen) has been shown to reduce mineral density loss and vasomotor symptoms (see 'Posology and Method of Administration' section 4.2 for further information).
Used at the recommended dose, Decapeptyl SR 11.25 mg causes constant hypogonadotropic amenorrhoea. If vaginal haemorrhage occurs after the first month, plasma oestradiol levels should be measured and if levels are below 50 pg/mL, possible organic lesions should be investigated.
After withdrawal of treatment, ovarian function resumes and ovulation occurs approximately 5 months after the last injection. A non-hormonal method of contraception should be used throughout treatment including for 3 months after the last injection.
Since menses should stop during Decapeptyl SR 11.25 mg treatment, the patient should be instructed to notify her physician if regular menstruation persists.
In paediatric population
Central precocious puberty
In girls, it should be confirmed that the patient is not pregnant before prescribing triptorelin.
Treatment of children with progressive brain tumours should follow a careful individual appraisal of the risks and benefits.
Pseudo-precocious puberty (gonadal or adrenal tumour or hyperplasia) and gonadotropin-independent precocious puberty (testicular toxicosis, familial Leydig cell hyperplasia) should be precluded.
In girls, initial ovarian stimulation at treatment initiation, followed by the treatment-induced oestrogen withdrawal, may lead, in the first month, to vaginal bleeding of mild or moderate intensity.
After discontinuation of treatment the development of puberty characteristics will occur.
Information with regards to future fertility is still limited. In most girls, regular menses will start on average one year after ending the therapy.
Bone mineral density may decrease during GnRH agonist therapy for central precocious puberty. However, after cessation of treatment subsequent bone mass accrual is preserved and peak bone mass in late adolescence does not seem to be affected by treatment.
Slipped capital femoral epiphysis can be seen after withdrawal of GnRH agonist treatment. The suggested theory is that the low concentrations of oestrogen during treatment with GnRH agonists weaken the epiphysial plate. The increase in growth velocity after stopping the treatment subsequently results in a reduction of the shearing force needed for displacement of the epiphysis.
Idiopathic intracranial hypertension
Idiopathic intracranial hypertension (pseudotumor cerebri) has been reported in paediatric patients receiving triptorelin. Patients should be warned for signs and symptoms of idiopathic intracranial hypertension, including severe or recurrent headache, vision disturbances and tinnitus. If idiopathic intracranial hypertension occurs, discontinuation of triptorelin should be considered.
Drugs which raise prolactin levels should not be prescribed concomitantly as they reduce the level of GnRH receptors in the pituitary.
When Decapeptyl SR 11.25 mg is co-administered with drugs affecting pituitary secretion of gonadotropins, caution should be exercised and it is recommended that the patient's hormonal status be supervised.
Since androgen deprivation treatment may prolong the QT interval, the concomitant use of Decapeptyl SR 11.25 mg with medicinal products known to prolong the QT interval or medicinal products able to induce Torsade de pointes such as class IA (e.g. quinidine, disopyramide) or class III (e.g. amiodarone, sotalol, dofetilide, ibutilide) antiarrhythmic medicinal products, methadone, moxifloxacin, antipsychotics, etc. should be carefully evaluated (see section 4.4).
Pregnancy
Triptorelin should not be used during pregnancy since concurrent use of GnRH agonists is associated with a theoretical risk of abortion or foetal abnormality. Prior to treatment, potentially fertile women should be examined to exclude pregnancy. Non-hormonal methods of contraception should be employed during therapy until menses resume.
Animal studies have not revealed any teratogenic effects. During post-marketing surveillance and in a limited number of pregnant women who were exposed inadvertently to triptorelin, there were no reports of malformation or foetotoxicity attributable to the product. However, as the number of patients is too small to draw conclusions regarding the risk of foetal malformations or foetotoxicity, if a patient becomes pregnant while receiving triptorelin, therapy should be discontinued.
Lactation
Triptorelin is not recommended for use during lactation.
Fertility
There is no clinical evidence to suggest a causal connection between triptorelin and any subsequent abnormalities of oocyte development or pregnancy or outcome.
No studies on the effects on the ability to drive and use machines have been performed. However, the ability to drive and use machines may be impaired should the patient experience dizziness, somnolence and visual disturbances (being possible undesirable effects of treatment), or resulting from the underlying disease.
Clinical trials experience
General tolerance in Men (see section 4.4)
Since patients suffering from locally advanced or metastatic, hormone-dependent prostate cancer are generally old and have other diseases frequently encountered in this aged population, more than 90% of the patients included in clinical trials reported adverse events, and often the causality is difficult to assess. As seen with other GnRH agonist therapies or after surgical castration, the most commonly observed adverse events related to triptorelin treatment were due to its expected pharmacological effects. These effects included hot flushes and decreased libido.
With the exception of immuno-allergic (rare) and injection site (< 5%) reactions, all adverse events are known to be related to testosterone changes.
The following adverse reactions considered as at least possibly related to triptorelin treatment were reported. Most of these events are known to be related to biochemical or surgical castration.
The frequency of the adverse reactions is classified as follows: very common (≥1/10); common (≥1/100 to < 1/10); uncommon (≥1/1000 to < 1/100); rare (≥1/10000 to < 1/1000); not known, (cannot be estimated from the available data).
System Organ Class
Very common
≥ 1/10
Common
≥1/100 - <1/10
Uncommon
≥1/1000 - <1/100
Rare
≥1/10000 - <1/1000
Additional post-marketing AEs
Frequency not known
Infections and infestations
Nasopharyngitis
Blood and lymphatic system disorders
Thrombocytosis
Anaemia
Immune system disorders
Hypersensitivity
Anaphylactic reaction
Anaphylactic shock
Endocrine disorders
Pituitary apoplexy**
Metabolism and nutrition disorders
Anorexia
Diabetes mellitus
Gout
Hyperlipidaemia
Increased appetite
Psychiatric disorders
Libido decreased
Depression*
Loss of libido
Mood change*
Insomnia
Irritability
Confusional state
Decreased activity
Euphoric mood
Anxiety
Nervous system disorders
Paraesthesia in lower limbs
Dizziness
Headache
Paraesthesia
Memory impairment
Convulsions***
Eye disorders
Visual impairment
Abnormal sensation in eye
Visual disturbance
Ear and labyrinth disorders
Tinnitus
Vertigo
Cardiac Disorders
Palpitations
QT prolongation* (see sections 4.4 and 4.5)
Vascular disorders
Hot flush
Hypertension
Hypotension
Respiratory, thoracic and mediastinal disorders
Dyspnoea
Epistaxis
Orthopnoea
Gastrointestinal disorders
Dry mouth
Nausea
Abdominal pain
Constipation
Diarrhoea
Vomiting
Abdominal distension
Dysgeusia
Flatulence
Skin and subcutaneous tissue disorders
Hyperhidrosis
Acne
Alopecia
Erythema
Pruritus
Rash
Urticaria
Blister
Purpura
Angioneurotic oedema
Musculoskeletal and connective tissue disorders
Back pain
Musculoskeletal pain
Pain in extremity
Arthralgia
Bone pain
Muscle cramp
Muscular weakness
Myalgia
Joint stiffness
Joint swelling
Musculoskeletal stiffness
Osteoarthritis
Renal and urinary disorders
Nocturia
Urinary retention
Urinary incontinence
Reproductive system and breast disorders
Erectile dysfunction (including ejaculation failure, ejaculation disorder)
Pelvic pain
Breast pain
Gynaecomastia
Testicular atrophy
Testicular pain
General disorders and administration site conditions
Asthenia
Injection site reaction (including erythema, inflammation and pain)
Oedema
Lethargy
Oedema peripheral
Pain
Rigors
Somnolence
Chest pain
Dysstasia
Influenza like illness
Pyrexia
Malaise
Investigations
Weight increased
Alanine aminotransferase increased
Aspartate aminotransferase increased
Blood creatinine increased
Blood pressure increased
Blood urea increased
Gamma-glutamyl transferase increased
Weight decreased
Blood alkaline phosphatase increased
* This frequency is based on class-effect frequencies common for all GnRH agonists
** Reported following initial administration in patients with pituitary adenoma
*** During post market experience convulsions have been reported in patients receiving GnRH analogues, including triptorelin.
Triptorelin causes a transient increase in circulating testosterone levels within the first week after the initial injection of the sustained release formulation. With this initial increase in circulating testosterone levels, a small percentage of patients (≤ 5%) may experience a temporary worsening of signs and symptoms of their prostate cancer (tumour flare), usually manifested by an increase in urinary symptoms (< 2%) and metastatic pain (5%), which can be managed symptomatically. These symptoms are transient and usually disappear in one to two weeks.
Isolated cases of exacerbation of disease symptoms, either urethral obstruction or spinal cord compression by metastasis have occurred. Therefore, patients with metastatic vertebral lesions and/or with upper or lower urinary tract obstruction should be closely observed during the first few weeks of therapy (see section 4.4).
Patients receiving long-term treatment by GnRH analogue in combination with radiation therapy may have more side effects, mostly gastrointestinal and related to radiotherapy.
The use of GnRH agonists to treat prostate cancer may be associated with increased bone loss and may lead to osteoporosis and increases in the risk of bone fracture.
General tolerance in Women (see section 4.4)
As a consequence of decreased oestrogen levels, the most commonly reported adverse events (expected in 10% of women or more) were headache, libido decreased, sleep disorder, mood changes, dyspareunia, dysmenorrhoea, genital haemorrhage, ovarian hyperstimulation syndrome, ovarian hypertrophy pelvic pain, abdominal pain, vulvovaginal dryness, hyperhidrosis, hot flushes and asthenia.
The following adverse reactions, considered as at least possibly related to triptorelin treatment, were reported. Most of these are known to be related to biochemical or surgical castration.
The frequency of the adverse reactions is classified as follows: very common (≥1/10); common (≥1/100 to < 1/10); uncommon (≥1/1000 to < 1/100); not known (cannot be estimated from the available data).
System Organ Class
Very common
≥ 1/10
Common
≥1/100 - <1/10
Uncommon
≥1/1000 - <1/100
Additional post-marketing AEs
Frequency not known
Immune system disorders
Hypersensitivity
Anaphylactic shock
Endocrine disorders
Pituitary apoplexy***
Metabolism and nutrition disorders
Decreased appetite
Fluid retention
Psychiatric disorders
Libido decreased
Mood disorder
Sleep disorder (including insomnia)
Depression*
Nervousness
Affect lability
Anxiety
Depression**
Disorientation
Confusional state
Nervous system disorders
Headache
Dizziness
Dysgeusia
Hypoesthesia
Syncope
Memory impairment
Disturbance in attention
Paraesthesia
Tremor
Convulsions****
Eye disorders
Dry eye
Visual Impairment
Visual disturbance
Ear and labyrinth disorders
Vertigo
Cardiac Disorders
Palpitations
Vascular disorders
Hot flush
Hypertension
Respiratory, thoracic and mediastinal disorders
Dyspnoea
Epistaxis
Gastrointestinal disorders
Abdominal pain
Abdominal discomfort
Nausea
Abdominal distension
Dry mouth
Flatulence
Mouth ulceration
Vomiting
Diarrhoea
Skin and subcutaneous tissue disorders
Acne
Hyperhidrosis
Seborrhoea
Alopecia
Dry skin
Hirsutism
Onychoclasis
Pruritus
Rash
Angioneurotic oedema
Urticaria
Musculoskeletal and connective tissue disorders
Arthralgia
Muscle spasms
Pain in extremities
Back pain
Myalgia
Muscular weakness
Reproductive system and breast disorders
Breast disorder
Dyspareunia
Genital bleeding (including vaginal bleeding withdrawal bleed)
Ovarian hyperstimulation syndrome
Ovarian hypertrophy
Pelvic pain
Vulvovaginal dryness
Breast pain
Coital bleeding
Cystocele
Menstrual disorder (including dysmenorrhoea, metrorrhagia and menorrhagia)
Ovarian cyst
Vaginal discharge
Amenorrhoea
General disorders and administration site conditions
Asthenia
Injection site reaction (including pain, swelling, erythema and inflammation)
Oedema peripheral
Malaise
Pyrexia
Investigations
Weight increased
Weight decreased
Blood alkaline phosphatase increased
Blood pressure increased
*Long term use: This frequency is based on class-effect frequencies common for all GnRH agonists
** Short term use: This frequency is based on class-effect frequencies common for all GnRH agonists
*** Reported following initial administration in patients with pituitary adenoma
**** During post market experience convulsions have been reported in patients receiving GnRH analogues, including triptorelin.
At the beginning of treatment, the symptoms of endometriosis may be exacerbated during the initial transient increase in plasma oestradiol levels. These symptoms are transient.
Vaginal bleeding including menorrhagia, metrorrhagia may occur in the month following the first injection.
General tolerance in Children (see section 4.4)
The frequency of the adverse reactions is classified as follows: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1000 to < 1/100); not known; (cannot be estimated from the available data).
Vaginal bleeding may occur in the month following the first injection.
System Organ Class
Very common
≥ 1/10
Common
≥1/100 - <1/10
Uncommon
≥1/1000 - <1/100
Additional post-marketing AEs
Frequency not known
Immune system disorders
Hypersensitivity
Anaphylactic shock
Metabolism and Nutrition Disorders
Obesity
Psychiatric disorders
Mood altered
Affect lability
Depression
Nervousness
Nervous system disorders
Headache
Idiopathic intracranial hypertension (pseudotumor cerebri) (see section 4.4)
Convulsions*
Eye disorders
Visual impairment
Visual disturbance
Vascular disorders
Hot flush
Hypertension
Respiratory, thoracic and mediastinal disorders
Epistaxis
Gastrointestinal disorders
Abdominal pain
Vomiting
Constipation
Nausea
Skin and subcutaneous tissue disorders
Acne
Pruritus
Rash
Urticaria
Angioneurotic oedema
Musculoskeletal and connective tissue disorders
Neck pain
Myalgia
Reproductive system and breast disorders
Vaginal bleeding (including vaginal haemorrhage withdrawal bleed, uterine haemorrhage, vaginal discharge, vaginal bleeding including spotting)
Breast pain
General disorders and administration site conditions
Injection site reaction (including injection site pain, injection site erythema and injection site inflammation)
Malaise
Investigations
Weight increased
Blood prolactin increased
Blood pressure increased
* During post market experience convulsions have been reported in patients receiving GnRH analogues, including triptorelin.
Long term tolerance in children population:
• The long-term clinical trial 2-54-52014-159 (NCT00909844) included 35 patients, age ranging from 4 to 10.4 years, who had received treatment (up to 4 years) with triptorelin 11.25 mg. More than half of patients (20 patients: 57.1%) reported at least one adverse event during the study, of which the most frequent were abdominal pain (17.1%), injection site pain (11.4%), headache and hot flush (each 8.6%). Overall, the safety profile was similar as seen in the other CPP studies.
General
Increased lymphocytes count has been reported with patients undergoing GnRH agonist treatment. This secondary lymphocytosis is apparently related to GnRH induced castration and seems to indicate that gonadal hormones are involved in thymic involution.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme. Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
If overdose occurs, symptomatic management is indicated.
Medicines sold in Romania with the same active substance: Cunoscut în România ca
Same active substance. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Romanian medicines in the UK →
Medicines sold in Poland with the same active substance: W Polsce znany jako
Same active substance. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Polish medicines in the UK →
Ask anything about Decapeptyl SR 11.25mg Powder and solvent for suspension for injection. The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.
Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.
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