Triptorelin

INTRODUCTION

Indications

Palliative treatment of advanced prostate cancer when orchiectomy or estrogen administration are contraindicated or unacceptable.

Action

A synthetic analogue of luteinizing hormone–releasing hormone (LHRH); Initially causes a transient ↑ in testosterone; however, with continuous administration, testosterone levels are ↓. Reduces gonadotropins, testosterone, and estradiol. Therapeutic Effects: ↓ testosterone levels and resultant ↓ in spread of prostate cancer.

Adverse Reactions/Side Effects

CNS: dizziness, emotional lability, fatigue, headache, insomnia. CV: hypertension. GI: diarrhea, vomiting. GU: erectile dysfunction, urinary retention, urinary tract infection. Derm: pruritus. Hemat: anemia. Local: injection site pain. MS: musculoskeletal pain. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS AND ANGIOEDEMA.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and anaphylaxis or angioedema, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, raised patches of red or white skin, burning/itching skin, swelling in the face). Notify physician or nursing staff immediately if these reactions occur.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report a sustained increase in blood pressure (hypertension).

• Assess any joint or muscle to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, and bruising, and pale skin. Notify physician immediately if these signs occur.

• Monitor personality or behavioral changes, including emotional instability or difficulty sleeping. Notify physician if these changes become problematic.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor IM injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

Patient/Client-Related Instruction

• Instruct patient to report problems with urination, including urinary retention or signs of a urinary tract infection (blood in the urine, increased nighttime urination, pain and burning during urination).

• Instruct patient or family/caregivers to report other troublesome side effects such as severe or prolonged headache, erectile dysfunction, skin reactions (itching, redness), or GI problems (diarrhea, vomiting).

Pharmacokinetics

Absorption: Well absorbed following IM administration.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

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