goserelin (Rx)

Brand and Other Names:Zoladex, Zoladex LA
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

implant

  • 3.6mg
  • 10.8mg

Prostate Cancer

Monthly implant: 3.6 mg SC q28days

3-months implant: 10.8 mg SC q12week

Treat long-term

Place in upper abdominal wall

Breast Cancer

3.6 mg implant SC q28days

Treat long-term

Place in upper abdominal wall

Endometriosis

3.6 mg implant SC q28days

Treat for 6 months

Place in upper abdominal wall

Endometrial Thinning

3.8 mg SC q28days for 1 or 2 doses

Renal Impairment

Dose adjustment not necessary

Hepatic Impairment

Dose adjustment not necessary

Safety and efficacy not established

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Interactions

Interaction Checker

and goserelin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (30)

            • amiodarone

              goserelin increases toxicity of amiodarone by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • anagrelide

              goserelin increases toxicity of anagrelide by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • arsenic trioxide

              goserelin increases toxicity of arsenic trioxide by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • artemether

              goserelin increases toxicity of artemether by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • artemether/lumefantrine

              goserelin increases toxicity of artemether/lumefantrine by QTc interval. Contraindicated.

            • citalopram

              goserelin increases toxicity of citalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • disopyramide

              goserelin increases toxicity of disopyramide by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • dofetilide

              goserelin increases toxicity of dofetilide by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • dronedarone

              goserelin increases toxicity of dronedarone by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • eliglustat

              goserelin increases toxicity of eliglustat by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • escitalopram

              goserelin increases toxicity of escitalopram by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • fluoxetine

              goserelin increases toxicity of fluoxetine by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • ibutilide

              goserelin increases toxicity of ibutilide by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • iloperidone

              goserelin increases toxicity of iloperidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • lopinavir

              goserelin increases toxicity of lopinavir by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • lumefantrine

              goserelin increases toxicity of lumefantrine by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • mifepristone

              goserelin increases toxicity of mifepristone by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • nilotinib

              goserelin increases toxicity of nilotinib by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • paliperidone

              goserelin increases toxicity of paliperidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • pimozide

              goserelin increases toxicity of pimozide by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • procainamide

              goserelin increases toxicity of procainamide by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • quetiapine

              goserelin increases toxicity of quetiapine by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • quinidine

              goserelin increases toxicity of quinidine by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • sotalol

              goserelin increases toxicity of sotalol by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • tetrabenazine

              goserelin increases toxicity of tetrabenazine by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • thioridazine

              goserelin increases toxicity of thioridazine by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • toremifene

              goserelin increases toxicity of toremifene by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • vandetanib

              goserelin increases toxicity of vandetanib by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • vemurafenib

              goserelin increases toxicity of vemurafenib by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            • ziprasidone

              goserelin increases toxicity of ziprasidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.

            Serious - Use Alternative (23)

            • amisulpride

              amisulpride and goserelin both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

            • asenapine

              asenapine and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • asenapine transdermal

              asenapine transdermal and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • buprenorphine

              buprenorphine and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • buprenorphine buccal

              buprenorphine buccal and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • buprenorphine subdermal implant

              buprenorphine subdermal implant and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • buprenorphine transdermal

              buprenorphine transdermal and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • buprenorphine, long-acting injection

              buprenorphine, long-acting injection and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • desflurane

              desflurane and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • encorafenib

              encorafenib and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • entrectinib

              goserelin and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole and goserelin both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

            • glasdegib

              goserelin and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

            • inotuzumab

              inotuzumab and goserelin both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

            • isoflurane

              isoflurane and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • lefamulin

              lefamulin and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • lithium

              lithium and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • olanzapine

              olanzapine and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • oxaliplatin

              oxaliplatin and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • panobinostat

              goserelin and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

            • pitolisant

              goserelin and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • sevoflurane

              sevoflurane and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • siponimod

              siponimod and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            Monitor Closely (80)

            • albuterol

              albuterol and goserelin both increase QTc interval. Use Caution/Monitor.

            • alfuzosin

              goserelin and alfuzosin both increase QTc interval. Use Caution/Monitor.

            • apomorphine

              goserelin increases toxicity of apomorphine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • arformoterol

              goserelin increases toxicity of arformoterol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • aripiprazole

              aripiprazole and goserelin both increase QTc interval. Use Caution/Monitor.

            • atomoxetine

              atomoxetine and goserelin both increase QTc interval. Use Caution/Monitor.

            • azithromycin

              goserelin increases toxicity of azithromycin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • bedaquiline

              goserelin increases toxicity of bedaquiline by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • bosutinib

              bosutinib and goserelin both increase QTc interval. Use Caution/Monitor.

            • capecitabine

              capecitabine and goserelin both increase QTc interval. Use Caution/Monitor.

            • ceritinib

              goserelin increases toxicity of ceritinib by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • chloroquine

              goserelin increases toxicity of chloroquine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • chlorpromazine

              goserelin increases toxicity of chlorpromazine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • cholera vaccine

              goserelin decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

            • ciprofloxacin

              goserelin increases toxicity of ciprofloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • clarithromycin

              goserelin increases toxicity of clarithromycin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • clozapine

              goserelin increases toxicity of clozapine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • crizotinib

              goserelin increases toxicity of crizotinib by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • dasatinib

              dasatinib and goserelin both increase QTc interval. Use Caution/Monitor.

            • degarelix

              goserelin increases toxicity of degarelix by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • dengue vaccine

              goserelin decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

            • desipramine

              desipramine and goserelin both increase QTc interval. Use Caution/Monitor.

            • deutetrabenazine

              deutetrabenazine and goserelin both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

            • dolasetron

              goserelin increases toxicity of dolasetron by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • donepezil

              donepezil and goserelin both increase QTc interval. Use Caution/Monitor.

            • doxepin

              doxepin and goserelin both increase QTc interval. Use Caution/Monitor.

            • droperidol

              goserelin increases toxicity of droperidol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • efavirenz

              efavirenz and goserelin both increase QTc interval. Use Caution/Monitor.

            • eribulin

              goserelin increases toxicity of eribulin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • erythromycin base

              goserelin increases toxicity of erythromycin base by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • erythromycin ethylsuccinate

              goserelin increases toxicity of erythromycin ethylsuccinate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • erythromycin lactobionate

              goserelin increases levels of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • erythromycin stearate

              goserelin increases toxicity of erythromycin stearate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • ezogabine

              goserelin increases levels of ezogabine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • fingolimod

              goserelin increases toxicity of fingolimod by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • flecainide

              goserelin increases toxicity of flecainide by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • fluconazole

              goserelin increases toxicity of fluconazole by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • formoterol

              goserelin increases toxicity of formoterol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • fostemsavir

              goserelin and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • gallium Ga 68 PSMA-11

              goserelin will decrease the level or effect of gallium Ga 68 PSMA-11 by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Androgen deprivation therapy and other therapies targeting the androgen pathway may result in changes in the uptake of gallium Ga 68 PSMA-11 in prostate cancer. The effect of ADT on the performance of gallium Ga 68 PSMA-11 is unknown.

            • gemifloxacin

              goserelin increases toxicity of gemifloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • gemtuzumab

              goserelin and gemtuzumab both increase QTc interval. Use Caution/Monitor.

            • gilteritinib

              gilteritinib and goserelin both increase QTc interval. Use Caution/Monitor.

            • granisetron

              granisetron and goserelin both increase QTc interval. Use Caution/Monitor.

            • haloperidol

              goserelin increases toxicity of haloperidol by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • hydroxyzine

              hydroxyzine and goserelin both increase QTc interval. Use Caution/Monitor.

            • indacaterol, inhaled

              goserelin increases toxicity of indacaterol, inhaled by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • itraconazole

              itraconazole and goserelin both increase QTc interval. Use Caution/Monitor.

            • lapatinib

              goserelin increases levels of lapatinib by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • lenvatinib

              goserelin and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

            • levofloxacin

              goserelin increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • metformin

              goserelin decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor.

            • methadone

              goserelin increases toxicity of methadone by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • mirtazapine

              mirtazapine and goserelin both increase QTc interval. Use Caution/Monitor.

            • moxifloxacin

              goserelin increases toxicity of moxifloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • ofloxacin

              goserelin increases toxicity of ofloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • ondansetron

              goserelin increases toxicity of ondansetron by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • osilodrostat

              osilodrostat and goserelin both increase QTc interval. Use Caution/Monitor.

            • osimertinib

              goserelin increases toxicity of osimertinib by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • oxaliplatin

              oxaliplatin will increase the level or effect of goserelin by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

            • pasireotide

              goserelin increases toxicity of pasireotide by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • pazopanib

              goserelin increases toxicity of pazopanib by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • pentamidine

              goserelin increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • perflutren

              goserelin increases toxicity of perflutren by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • primaquine

              primaquine and goserelin both increase QTc interval. Use Caution/Monitor.

            • propafenone

              goserelin increases toxicity of propafenone by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • ranolazine

              goserelin increases toxicity of ranolazine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • romidepsin

              goserelin increases toxicity of romidepsin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • saquinavir

              goserelin increases toxicity of saquinavir by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • sertraline

              sertraline and goserelin both increase QTc interval. Use Caution/Monitor.

            • siponimod

              siponimod and goserelin both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

            • solifenacin

              solifenacin and goserelin both increase QTc interval. Use Caution/Monitor.

            • sorafenib

              goserelin increases toxicity of sorafenib by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • sunitinib

              goserelin increases toxicity of sunitinib by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • tacrolimus

              tacrolimus and goserelin both increase QTc interval. Use Caution/Monitor.

            • telavancin

              goserelin increases toxicity of telavancin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • trazodone

              goserelin increases toxicity of trazodone by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • valbenazine

              valbenazine and goserelin both increase QTc interval. Use Caution/Monitor.

            • voriconazole

              goserelin increases toxicity of voriconazole by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • vorinostat

              vorinostat and goserelin both increase QTc interval. Use Caution/Monitor.

            Minor (2)

            • maitake

              maitake increases effects of goserelin by pharmacodynamic synergism. Minor/Significance Unknown. Maitake mushroom has anti-tumor effects (animal/in vitro research).

            • taurine

              goserelin decreases levels of taurine by unspecified interaction mechanism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Flushing (46-96%)

            Vaginitis (5-75%)

            Hot flashes (62%)

            Reduced libido (47-61%)

            Mood swings (60%)

            Depression (women 54%)

            Sweating (16-45%)

            Acne (42%)

            Diarrhea (40%)

            Breast atrophy (33%)

            Headache (women 32-75%)

            Seborrhea (26%)

            Tumor flare (23%)

            Sexual dysfunction (21%)

            Peripheral edema (21%)

            Erectile dysfunction (18%)

            Pain (8-17%)

            UTI (13%)

            1-10%

            Nausea (9%)

            Lethargy (8%)

            Rash (6%)

            Chronic obstructive pulmonary disease (5%)

            Congestive heart failure(5%)

            Cerebrovascular accident (1-5%)

            Renal impairment (1-5%)

            Headache (men 1-5%)

            Depression (men 1-5%)

            Immune hypersensitivity reaction (>1%)

            Frequency Not Defined

            Asthenia

            Hypercalcemia

            Cystitis

            Dysmenorrhea

            Hirsutism

            Dyspareunia

            Breast changes

            Implant site reactions

            Bone pain

            Spinal cord compression (rare)

            Postmarketing Reports

            Bone mineral density: Osteoporosis, decreased bone mineral density, bony fracture in men

            Cardiovascular: DVT, PE, MI, stroke, TIA observed in women treated with GnRH agonists

            Ovarian cyst: Ovarian cyst formation and, in combination with gonadotropins, ovarian hyperstimulation syndrome

            Changes in blood pressure: Hypotension and hypertension

            Pituitary apoplexy and tumors: Pituitary apoplexy

            Acne: Usually within 1 month of starting treatment

            Other: Psychotic disorders, convulsions, mood swings

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            Warnings

            Contraindications

            Hypersensitivity to LHRH, LHRH-agonists, any component of product

            Pregnancy (for endometriosis), lactation, undiagnosed abnormal vaginal bleeding

            Cautions

            Manifestations of disease may worsen at beginning of therapy

            Increase in cervical resistance may occur; caution is recommended when dilating the cervix for endometrial ablation

            Avoid pregnancy; premenopausal women should use nonhormonal contraception until >12 wk following end of treatment

            Risk of reduced glucose tolerance in men

            Males at risk of ureteral obstruction or spinal compression

            Risk of pituitary apoplexy (rare)

            Ongoing analysis found that men receiving GnRH agonists for prostate cancer were at a small increased risk for diabetes, heart attack, stroke, and sudden death

            Do not exceed 1 year treatment duration with GnRH angonists in women except when treating breast cancer

            Androgen deprivation therapy may prolong the QT interval; consider risks and benefits

            Hypercalcemia has been reported in patients with bone metastases treated with goserelin; monitor and manage appropriately

            Increased risk of myocardial infarction, sudden cardiac death and stroke reported in association with use of GnRH analogs in men; monitor for cardiovascular disease and manage according to current clinical practice

            Hyperglycemia and an increased risk of developing diabetes have been reported in men receiving GnRH analogs. Monitor blood glucose level and manage according to current clinical practice

            Pregnancy must be excluded for use in benign gynecological conditions

            Transient worsening of tumor symptoms may occur during first few weeks of therapy, which may include ureteral obstruction and spinal cord compression; monitor patients at risk for complications of tumor flare

            Injection site injury and vascular injury including pain, hematoma, hemorrhage and hemorrhagic shock, requiring blood transfusions and surgical intervention, reported; use extra care when administering to patients with low BMI and/or to patients receiving full dose anticoagulation

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            Pregnancy & Lactation

            Pregnancy Category: D (advanced breast cancer); X (endometriosis, endometrial thinning)

            Lactation: excretion in milk unknown; not recommended

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Gonadotropin-releasing hormone (LHRH) analog; chronic stimulation of goserelin results in suppression of LH, FSH serum levels

            Pharmacokinetics

            Half-life: 2-4 hr

            Protein bound: 27%

            Time to peak: 12-15 days (male); 8-22 days (female)

            Vd: 44.1 L (Male); 20.3 L (female)

            Excretion: Urine (90%)

            Absorption

            • 3.6 mg: absorbed slowly during first 8 days, then more rapid continuous release
            • 10.8 mg: peak level within 24 hr, then decline until day 4, then concentrations stabilize
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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.