Goserelin Acetate (Zoladex®)

How to Take Goserelin Acetate

Goserelin acetate is given as a subcutaneous (SQ, under the skin) implant injection every 4 weeks. There is also a long-acting formulation (called a depot ), which is given by SQ injection, every 12 weeks at a higher dose.

Possible Side Effects of Goserelin Acetate

There are many things you can do to manage the side effects of goserelin acetate. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Hot Flashes

There are a few things you can do to help with hot flashes. Several medications have been shown to help with symptoms, including clonidine (a blood pressure medication), low doses of certain antidepressants (such as venlafaxine and fluoxetine), and gabapentin. Talk to your healthcare team about these prescription products to determine if they are right for you.

Non-medical recommendations include:

• Keep well-hydrated with eight glasses of water daily.
• Drink ice water or apply an ice pack at the onset of a hot flash.
• Wear cotton or lightweight, breathable fabrics and dress in layers so you can adjust as needed.
• Exercise regularly.
• Try practicing meditation or relaxation exercises to manage stress, which can be a trigger.
• Avoid triggers such as warm rooms, spicy foods, caffeinated beverages, and alcohol.

Injection Site Irritation

This medication can cause irritation and injury at the site of injection, including pain, bruising, or bleeding. Contact your care provider if you develop abdominal pain, abdominal distension, shortness of breath, dizziness, or if you are difficult to arouse.

Weakening of the Bones (Osteoporosis)

Decreased hormones may increase your risk for bone thinning (osteoporosis). You may be advised to take calcium and vitamin D supplements to help prevent bone loss. Weight-bearing exercise and a healthy diet rich in calcium and vitamin D can help protect your bone health. You may have a bone density scan (DEXA scan) to assess your bone health. If your provider determines that you are at high risk of developing osteoporosis, they may recommend additional treatment with a type of medication called a bisphosphonate to help strengthen the bones.

Muscle or Joint Pain/Aches

This medication can be associated with joint or muscle aches and pains. If it is bothersome, it may be treated with medications. Be sure to discuss which pain relievers you can safely take with your oncology team, as these are not without their own side effects. Non-medical therapies, such as acupuncture, yoga, gentle stretching and exercise may also help reduce this side effect.

Peripheral Edema

This medication can cause edema, which is swelling due to an accumulation of fluid. This typically occurs in the lower extremities (feet, legs and ankles) or hands. Report any swelling you experience to your healthcare provider.

Vaginal Dryness

For those born with a vagina, vaginal dryness and related painful intercourse are the more common side effects of cancer therapy in women. Vaginal lubricants and moisturizers (longer lasting form of moisturizers) can help with these concerns. Talk to your healthcare team for more suggestions on managing this side effect.

Important but Less Common Side Effects

• Initial Tumor Flare: When starting goserelin acetate, the body has a temporary increase in hormone levels. This "flare" can lead to a temporary increase in the tumor size, causing symptoms to worsen. Your healthcare team can tell you what to look for in your particular case and what to do about it.
• High Blood Sugar: This medication can cause elevated blood sugar levels in patients with and without diabetes. Your oncology care team will monitor your blood sugar. If you develop increased thirst, urination, hunger, blurry vision, headaches, or your breath smells like fruit, notify your healthcare team. Diabetics should monitor their blood sugar closely and report elevations to the healthcare team.
• Heart Problems: This medication can cause slow or abnormal heartbeats or an abnormal heart rhythm called QT prolongation. Goserelin acetate can also cause or worsen pre-existing heart problems, including congestive heart failure, restrictive cardiomyopathy, decreased heart function, and heart attack. Notify your healthcare provider if you have sudden weight gain or swelling in the ankles or legs. If you develop chest pain or pressure, pain in the left arm, back, or jaw, sweating, shortness of breath, clammy skin, nausea, dizziness, or lightheadedness, call 911 or go to the nearest emergency room.
• Allergic Reactions: In some cases, patients can have an allergic reaction to this medication. Signs of a reaction can include: shortness of breath or difficulty breathing, chest pain, rash, flushing or itching, or a decrease in blood pressure. If you notice any changes in how you feel during or after the injection, let your nurse know immediately.

Sexual and Reproductive Changes

 This medication may affect your reproductive system, resulting in the menstrual cycle or sperm production becoming irregular or stopping permanently. In addition, the desire for sex may decrease during treatment. You may want to consider sperm banking or egg harvesting if you wish to have a child in the future. Discuss these options with your oncology team.

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Non-hormonal methods of birth control (condoms, spermicide, diaphragm, Paraguard, IUD) are necessary during treatment and for at least 12 weeks after treatment.