SHARED CARE GUIDELINE GOSERELIN (ZOLADEX 3.6mg and ZOLADEX LA 10.

8mg)
Introduction Indication: Zoladex is a gonadorelin analogue indicated in the management of prostate cancer suitable for hormonal manipulation. Dosage, administration & duration: Zoladex 3.6 mg depot injected subcutaneously (SC) into the anterior abdominal wall every 28 days. Or Zoladex LA 10.8 mg depot injected SC into the anterior abdominal wall every 12 weeks. Therapy should be continuous, even if patient is in remission. Initial prescribing : The first Zoladex injection will be given in the Uro-oncology clinic. An anti-androgen (eg cyproterone acetate 300mg daily in 23 divided doses or flutamide 250mg tds or bicalutamide 50mg od.) will also be prescribed. This should be taken 3 days before and continued for 2-3 weeks following the first injection, to cover testosterone flare. Monitoring undertaken: Baseline FBC & U&Es, including LFTs & prostate-specific antigen (PSA). Clinical response to therapy, eg. bone pain and performance status. Radiology and radioisotopes (CT scans of abdomen and pelvis and bone scans may be performed). Frequency of hospital review: Variable depending upon symptoms; usually 3-monthly for first year and 6-monthly thereafter. Contact details: See Consultant or Hospital specialist letter for details. Contact details will be provided to patients in diaries. Prescribing Long term prescribing and arrange administration of Zoladex. Monitoring Monitor for adverse effects of drug therapy. U&Es and FBC every 6 months. Contact the hospital specialist if potassium or serum creatinine (unless known to have chronic renal failure) are significantly raised. PSA every 3 months. Refer to hospital specialist if patient has symptoms, or if PSA doubles or if there are 2 consecutive increases in PSA or if PSA >20g/L Refer promptly to hospital specialist when any loss of clinical efficacy occurs or disease progression suspected or if intolerance to therapy occurs.

Hospital specialist responsibilities

GP responsibilities

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Product information

Side effects: * Common Hot flushes, sweating, impotence, decreased libido. Breast swelling and tenderness has been noted infrequently. Initially prostate cancer patients may experience a temporary increase in bone pain. Occasional local reactions include mild bruising at injection site. Rare Adverse events which have been reported include hypersensitivity reactions, arthralgia, skin rashes, changes in blood pressure. These changes are usually transient. Important drug interactions: * There are no documented drug interactions in the BNF or SPC. Licensed status: POM Availability From community pharmacies Preparation and storage: 3.6mg or 10.8mg implant in Safe-system syringe applicator to be stored at room temperature. Dispose of used syringe in sharps bin. Basic NHS cost per month: 3.6mg @ 84.14; 10.8mg 3-monthly @ 267.48 Hospital specialist to GP: Write to inform the GP when therapy has been initiated, supply a copy of the Shared Care Guideline and request agreement to shared care. Inform the GP of baseline test results and intended duration of treatment. Continue to prescribe & monitor the patient until GP has confirmed date for transfer of care. Advise the GP of any medication changes. Information given to patient: Patients will be provided with appropriate information including commercially available leaflets, eg. A Patients Guide to Prostate Cancer and a diary including contact telephone numbers. GP to Hospital specialist: Reply to request for shared care as soon as practicable. Contact the hospital specialist as soon as possible if concerns over prescribing, treatment efficacy, and intolerance or disease progression. Inform hospital specialist of relevant changes in concomitant medication.

Communication

Authorship & date prepared

Mr P Weston & Mr K Sundaram, Consultant Urologists and Anne Fonseca, Principal Pharmacist Medicines Information, The Mid Yorkshire Hospitals NHS Trust. Sept 2005 Sept 2007 Review date * This information is not inclusive of all prescribing information and potential adverse effects. Please refer to the SPC (www.emc.medicines.org.uk) or current BNF for further prescribing information.