Goserelin

Goserelin
Systematic (IUPAC) name
N-(21-((1H-indol-3-yl)methyl)-1,1-diamino-12-(tert-butoxymethyl)-6-(2-(2-carbamoylhydrazinecarbonyl)cyclopentanecarbonyl)-15-(4-hydroxybenzyl)-18-(hydroxymethyl)-25-(1H-imidazol-5-yl)-9-isobutyl-8,11,14,17,20,23-hexaoxo-2,7,10,13,16,19,22-heptaazapentacos-1-en-24-yl)-5-oxopyrrolidine-2-carboxamide
Clinical data
Trade names Zoladex
AHFS/Drugs.com monograph
MedlinePlus a601002
Pregnancy cat. D (3.6mg) / X (10.8mg) (USA)
Legal status ℞ Prescription only
Routes implant
Pharmacokinetic data
Protein binding 27.3%
Half-life 4-5 hours
Excretion renal
Identifiers
CAS number 65807-02-5 Y
ATC code L02AE03
PubChem CID 5311128
DrugBank BTD00113
ChemSpider 4470656 Y
UNII 0F65R8P09N Y
KEGG D04405 Y
ChEMBL CHEMBL1201247 N
Synonyms D-Ser(But)6Azgly10LHRH
Chemical data
Formula C59H84N18O14 
Mol. mass 1269.410 g/mol
 N(what is this?)  (verify)

Goserelin acetate (Zoladex, AstraZeneca[1]) is an injectable gonadotropin releasing hormone superagonist (GnRH agonist), also known as a luteinizing hormone releasing hormone (LHRH) agonist. Structurally, it is a decapeptide. Goserelin acetate is used to suppress production of the sex hormones (testosterone and oestrogen), particularly in the treatment of breast and prostate cancer.

Goserelin acetate stimulates the production of the sex hormones testosterone and oestrogen in a non-pulsatile (non-physiological) manner. This causes the disruption of the endogenous hormonal feedback systems, resulting in the down-regulation of testosterone and oestrogen production.

Zoladex approved by the U.S. Food and Drug Administration in 1989[2] for treatment of prostate cancer.

Contents

Pharmacokinetics

Goserelin is a synthetic analogue of a naturally occurring luteinising-hormone releasing hormone (LHRH). Bioavailability is almost complete. Goserelin is poorly protein bound and has a serum elimination half-life of two to four hours in patients with normal renal function. The half-life increases with patients with impaired renal function. There is no significant change in pharmacokinetics in subjects with hepatic failure. After administration, peak serum concentrations are reached in about two hours. It rapidly binds to the LHRH receptor cells in the pituitary gland thus leading to an initial increase in production of luteinizing hormone and thus leading to an initial increase in the production of corresponding sex hormones. This initial flare may be treated by co-prescribing/co-administering Casodex (Bicalutamide) or similar medication. Eventually, after a period of about 14–21 days, production of LH is greatly reduced due to receptor downregulation, and sex hormones are generally reduced to castrate levels.[3]

Indications

Goserelin Acetate is used to treat hormone-sensitive cancers of the breast (in pre- and peri- menopausal women) and prostate, and some benign gynaecological disorders (endometriosis, uterine fibroids and endometrial thinning). In addition, goserelin is used in assisted reproduction and in the treatment of precocious puberty. It is available as a 1-month depot and a long-acting 3-month depot.

Side effects

Goserelin Acetate may cause a temporary increase in bone pain and symptoms of prostatic cancer during the first few weeks of treatment. This is known as the tumour flare effect, and is the result of an initial increase in luteinizing hormone production, before the receptors are desensitised and hormonal production is inhibited. The symptoms will disappear, with hormonal inhibition. It is therefore advisable to co-treat with an antiandrogen during the first 2-3 weeks of Gosrelin treatment, particularly in patients with pre-existing bone symptoms. Goserelin may cause bone pain, hot flushes, headache, stomach upset, depression, difficulty urinating (isolated cases), weight gain, swelling and tenderness of breasts (infrequent), decreased erections and reduced sexual desire. Bone pain can be managed symptomatically, and decreased libido can be treated by Levitra (Vardenafil) or other similar oral therapies.

Memory loss may be severe and may not return to normal levels.[4][5]

References

  1. ^ AstraZeneca official Zoladex site
  2. ^ FDA Approval for Zoladex 3.6 mg
  3. ^ Kotake, Toshihiko, Michiyuki Usami et al. (August 1999). "Goserelin Acetate with or without Antiandrogen or Estrogen in the Treatment of Patients with Advanced Prostate Cancer: a Multicenter, Randomized, Controlled Trial in Japan". Japanese Journal of Clin. Oncol. 29 (11): 562–570. doi:10.1093/jjco/29.11.562. ISSN 1465-3621. PMID 10678560. http://jjco.oxfordjournals.org/cgi/content/full/29/11/562. Retrieved 2007-02-26. 
  4. ^ Newton CR, Yuzpe AA, Timmon IS, Slota MD. Memory complaints: a side effect of continued exposure to gonadotropin-releasing hormone agonists (GnRHa). Paper presented at: Conjoint Annual Meetings of the American Fertility Society and the Canadian Fertility and Andrology Society; October 11–14, 1993; Montreal, Canada.
  5. ^ Friedman AJ, Juneau-Norcross M, Rein MS. Adverse effects of leuprolide acetate depot treatment. Fertil Steril. 1993;59(2):448-450.)

External links

Gonadotropins and GnRH (G03G)
Gonadotropin
preparations
Agonist
Antigonadotropin
GnRH
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