nafarelin, Synarel (cont.)

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Medical and Pharmacy Editor:

FSH and LH also control the onset of puberty in boys and girls. Therefore, administration of nafarelin blocks the puberty-promoting effects of FSH and LH, reducing the development of secondary sexual characteristics (such as pubic hair) and skeletal development in boys and girls with abnormally early puberty (central precocious puberty) due to problems in the brain that result in high levels of FSH and LH. The FDA approved nafarelin in February 1991.



PREPARATIONS: Nasal spray: 200µg/spray

STORAGE: Nafarelin should be stored at room temperature, 15 to 30 C (59 to 86 F).

PRESCRIBED FOR: Nafarelin is prescribed for the management of endometriosis, to relieve pain and shrink endometrial implants. It also is used for managing central precocious puberty.

DOSING: For treatment of endometriosis nafarelin is given as one spray (200 µg) into one nostril in the morning and one spray in the other nostril in the evening for 6 months. The first dose of nafarelin should be taken between the second and fourth day after menstrual bleeding begins. After the first two months of nafarelin treatment, most women can expect a decrease in menstrual flow, and menstruation may stop altogether. For women who continue to experience normal menstrual cycles after two months of treatment, the daily dose may be increased to 800 µg daily.

Central precocious puberty is treated with 1600-1800 µg daily administered as four sprays in alternating nostrils twice daily or three sprays in alternating nostrils three times daily. Thirty seconds should elapse between sprays.

For optimal effectiveness and safety, nafarelin has to be given continuously without interruption. Missing one or more doses can cause vaginal bleeding. Missing successive doses can cause release of an egg from the ovary (ovulation) and result in pregnancy, unless proper contraceptive measures have been followed. Since birth control pills cannot be used with nafarelin, it is important to use non-hormonal methods of contraception (such as a diaphragm with contraceptive jelly, IUD, or condoms) while taking nafarelin.

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