are lupron and Zoladex the same efficacy-wise ?
zoladex vs lupron ?: are lupron and... - Advanced Prostate...
zoladex vs lupron ?
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Tinkudi
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In the world of ADT, both Lupron ("Leuprorelin") and Zoladex ("Goserelin") are in the same category as GnRH agonists. I cannot say anything about a comparison between these two meds.
More interesting is a comparison of any GnRH agonist with the category of GnRH antagonists. Most commonly used is the injectable Firmagon ("Degarelix"), for the new oral Orgovyx ("Relugolix").
Firmagon will be prescribed at the beginning of one's treatment after diagnosis if there is immediate risk - in my case to my spinal cord. After a while I was encouraged to move to the so-called "more convenient" and probably more commonly prescribed Lupron, but decided to stay with Firmagon.
Although all these choices are GnRH-related ADT, there is some evidence that the antagonists may have a better cardiovascular risk profile than agonists.
sciencedirect.com/science/a...
What has been your experience getting firmagon ? Does it pain much ?
Summary: I have no pain now after 2 years of Firmagon ADT injections every 28 days. I have a day of tiredness now. At the beginning it was a little worse but not too bad.
My experience with Firmagon also known as Degarelix seems to be typical from the side effects reported. I have fatigue but then I'm also taking Abiraterone. And I get very tired for 24 hours now. At the beginning I had a 2° fever for 24 hours and slept for 16 hours. But now I am over 2 years now and I don't get a fever anymore I just get tired for about 24 hours and sleep maybe 12 hours. And then I start to feel fine on the second day and life goes on.
A lot of people highlight pain at the injection site and a red lump etc. This is something I experienced at the beginning. I also experienced inconsistent injections from one month to the next. And after doing a lot of reading about this I was able to arrange to always have the same nurse. This nurse is a specialist in this kind of injections. And I don't get any red bump any more and I don't have bad symptoms.
The correct preparation of the med is very important in about 20 steps long. I hear some people do it themselves but not very many. So my last 6 months' experience with the same excellent nurse is that the injection is no problem and I don't have the problems at the site. And then I conclude that quality assurance on nursing injection for Firmagon is very important.
At the beginning I would take a hydromorphone pill. And in addition to the fever which at the very beginning extended to 2 days, I also had shivers and was very cold. But I haven't taken hydromorphone for a long time. And I never have shivers anymore. And I have never had hot flashes.
Thank you for detailed explanation 😊
Why does one get such a high fever due to it - did the doctor explain ?
What is a hydromorphone tablet for
At the beginning the hydromorphone took the edge off the sight pain and the shivers and fever.
Why does Firmagon give fever ?
I have no idea.
Is it after every injection ?
It was common, but it's mostly gone away now. Tall Allen seems to be suggesting that one gets used to it after a while. This is aside from any question of injection competency.
Did you mean - it was common ?
Yes.
Dad has a fear of getting injected on the bum as he has an abscess from an injection he got there many years back which went wrong. He says he prefers stomach injection - Would you have any preference between Zoladex or Firmagon ? Relugolix, sadly oncologists here don’t seem very familiar with
Firmagon is monthly, so is less convenient. And injection site reactions are common, especially for the first 2 months.
My view is that injection site reactions are likely because of incompetence or lack of skill. I have only my experience and my reading but I had many injections where the nurse said they had never done it before but someone had explained how to do it. Etc etc etc
so when you had a trained nurse doing it , was it better ?
Yes. But also one who does this kind of injection all the time. Or any kind of medication injection including for example for mental health issues.
With Firmagon, the first 2 injections are higher dose and injection site reactions are very common.
Understood - in my case I had only one double injection of 2 x 80 mg doses to kick things off. And and then every subsequent 28 days just a single injection. And at least for the first 6 months I had a fever of 2° C and slept mostly for 2 days.
For the first year I took a hydromorphone pill or two. During the two days post injection I would have severe shivers and feel extremely cold. And paradoxically sweaty.
And per your implication though, this declined over time. But then I started to notice the inconsistency in the injections skills and the resulting site reactions and whether I felt sick afterwards or not. Now after 2 years, and I believe at least partly due to consistent injection practices, my symptoms are hardly noticeable.
And along the way I never had hot flashes at all.
I think the first dose is 120 into 2. Not 80 into 2
Do you know if the Firmagon injection causes fever in most people who take it ,like JohnInTheMiddle says, it does to him? Are the injection site reactions mild ?
Relugolix as comparatively new, very expensive, and often not on approved formularies yet. Also there's an additional risk and that is that it is metabolized very quickly and it's a bad idea to miss a day. On the other hand it's oral and it's a GnRH antagonist.
I am in India and doctors don’t seem to know too much about religolix yet
As the previous posters noted, with Firmagon (Degarelix), it is extremely important for the nurse to know how to inject it properly to minimize the side effects especially at the injection site. It has to be mixed well and injected on a 45 degree angle very slowly, over 30-45 seconds and the needle has to be removed slowly. My husband has started to coach the nurses giving the injection because they are so used to giving lupron, and don’t always give the Firmagon injection since it is less common. We have found that when it is injected correctly, my husband does not have a reaction at the injection site, nor chills. For the times he received the injection from the nurse who injected it too quickly and not at the correct angle, he had pain for several days as well as chills. There are numerous videos online regarding the proper injection of Firmagon.
Fantastic comment Oatmeal!
The hospital nurses I asked here did not seem to know much about Firmagon ! I so want to give that as a first shot to my dad but I fear the nurse will mess it up 😐
do you have a link to a good video I can show the nurse
The Ferring company provides a full PDF with all 20 steps of a proper Firmagon injection, listed in detail. So does the US government.
And if you search for Firmagon injection videos you can find quite a few. There are also I think some articles by people who do their own injections.
There are a number of tricky steps that you have to get right such as not shaking the mixture to create a foam. And the importance taking everything slowly and making sure the mixture is fully clear. And then pinching the skin correctly and the correct angle of the insertion of the needle - this is important to make sure you don't hit blood vessels or muscle.
And as many people point out you must not withdraw the needle quickly but you need to wait for a period of time to properly create the depot.
All these steps are sort of time sensitive - you can't learn in the moment, you should practice ahead of time.
Now of course professional and experienced nurses do similar kinds of thing so should be able to master this. But again, as it has been pointed out by someone else above, having a best practices procedure means no worries about nasty injection related side effects.
So your job now is to find these videos and compare them and to find the instructions so you understand what the videos are talking about.
The other thing you need to concern yourself with is whether you have a double injection the first time that your Dad gets the injection. I can't advise you on this. This is typical though for initial dose loading. And then every other injection afterwards is just a single dose.
I have read up about the pharmacokinetics of Firmagon - about how closely one needs to adhere to the 28 day schedule. Probably don't need to worry if it's a day earlier or a day late. I'm quite concerned to have it exactly every 28 days. I have had some doctors who are very casual about the schedule and they say "don't worry about 5 days". That is a mistake which could give your cancer a temporary advantage to progress.
The whole thing seems simple and indeed it is once you get into the right habit and have a good nurse. But it's taking me a long time to figure this out and it's over 2 years.
A big success! (By the way I might have mentioned we are low carb - the whole insulin and glucose management thing is a big deal - I am of the personal view that this kind of issue drives a lot of vulnerabilities and poor responses to PCa therapies.)
Don't forget that you are choosing Firmagon deliberately as a specific technology for the advantages of that medical technology. And you have to do it every month and now someone will say it's much more convenient with Lupron or whatever every 90 days. But again it's not a question of convenience!
By the way I don't have the time to edit this and make it easier to read. And although I believe Firmagon has so far proved to be the right choice for me, I am not advocating it for anyone. I'm only presenting the information on which I made my choice.
And specifically my choice was to stay on Firmagon, which for emergency medical reasons I had been prescribed at the beginning. And I rejected the enticement to switch to the more convenient 90 day Lupron. The initial choice was not mine.
Thank you so much for explaining. The doctor did give a prescription for 120 mg into 2 as loading dose. I will try to find a nurse who is trained in this.
Sounds like your doctor knows what he or she is doing.
By the way, should your Dad have some unpleasant symptoms at one injection or another, don't give up, unless the medication is just not suitable for your Dad.
Different people have different reactions of course. But if you feel like you have the flu for a day or two and maybe you have slightly painful red lump, there are worse things. And then you'll get over them hopefully.
My wife tells me that I was very low energy for even five or six days after any injection. But that is also gone now too.
If everything works out well and the nurse does the good job and only injects into the fat then hopefully all this discussion will have been worthwhile and your Dad gets a great medication which helps with quality of life and additional years.
And of course in terms of quality of life, and between my Abiraterone and the Firmagon and the resulting zero testosterone of course I have fatigue. And for the record the inevitable loss of the masculine function.
One sees people complaining about this in posts on this forum. It seems a misplaced focus. One gets used to a different way of living. But I'm living! With my lovely wife and our children and one grandchildren already.
Thanks so much. God bless you 😊🙏🏻
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