Drug reference
Administration of gonadorelin analogues produces an initial phase of stimulation; continued administration is followed by down-regulation of gonadotrophin-releasing hormone receptors, thereby reducing the release of gonadotrophins (follicle stimulating hormone and luteinising hormone) which in turn leads to inhibition of androgen and oestrogen production.
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Endometriosis ▶BY INTRANASAL ADMINISTRATION ▶Adult (female): 200 micrograms twice daily for maximum 6 months (do not repeat), one spray in one nostril in the morning, and one spray in the other nostril in the evening (starting on days 2–4 of menstruation). Pituitary desensitisation before induction of ovulation by gonadotrophins for in vitro fertilisation (under expert supervision) ▶BY INTRANASAL ADMINISTRATION ▶Adult: 400 micrograms twice daily, one spray in each nostril, to be started in early follicular phase (day 2) or, after exclusion of pregnancy, in midluteal phase (day 21) and continued until down regulation achieved (usually within 4 weeks) then maintained (usually for 8–12 days) during gonadotrophin administration (stopping gonadotrophin and nafarelin on administration of chorionic gonadotrophin at follicular maturity), discontinue if down-regulation not achieved within 12 weeks
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Undiagnosed vaginal bleeding. use longer than 6 months in the treatment of endometriosis (do not repeat) Endocrine system
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Patients with metabolic bone disease (decrease in bone mineral density can occur)
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▶Common or very common Artificial menopause. breast abnormalities. chest pain. depression. dyspnoea. emotional lability. headaches. hirsutism. hot flush. hypersensitivity. hypertension. hypotension. insomnia. myalgia. oedema. oestrogen deficiency. paraesthesia. rhinitis. seborrhoea. sexual dysfunction. skin reactions. uterine haemorrhage. vulvovaginal dryness. weight changes ▶Uncommon Alopecia. arthralgia. ovarian cyst (may require discontinuation) ▶Frequency not known Ovarian hyperstimulation syndrome. palpitations. vision blurred
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Non-hormonal, barrier methods of contraception should be used during entire treatment period. Pregnancy should be excluded before treatment, the first dose should be given during menstruation or shortly afterwards or use barrier contraception for 1 month beforehand.
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Avoid.
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Avoid.
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Avoid use of nasal decongestants before and for at least 30 minutes after treatment; repeat dose if sneezing occurs during or immediately after administration.
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There can be variation in the licensing of different medicines containing the same drug. Spray CAUTIONARY AND ADVISORY LABELS 10 ▶Synarel (Pfizer Ltd) Nafarelin (as Nafarelin acetate) 200 microgram per 1 dose Synarel 200micrograms/dose nasal spray | 60 dose P £52.43 DT = £52.43
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Patients or carers should be given advice on how to administer nafarelin nasal spray.
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200 micrograms twice daily for
First-line fragment. Read the complete Indications and Dose section above.
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400 micrograms twice daily, one spray in each
First-line fragment. Read the complete Indications and Dose section above.
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