Posology: Adults: One 3.6 mg depot of Zoladex injected subcutaneously into the anterior abdominal wall every 28 days. No dosage adjustment is necessary for patients with renal or hepatic impairment, or in older people.
Endometriosis should be treated for a period of six months only, since at present there are no clinical data for longer treatment periods. Repeat courses should not be given due to concern about loss of bone mineral density. In patients receiving Zoladex for the treatment of endometriosis, the addition of hormone replacement therapy (a daily oestrogenic agent and a progestogenic agent) has been shown to reduce bone mineral density loss and vasomotor symptoms.
For use in endometrial thinning; four or eight weeks of treatment. The second depot may be required for the patient with a large uterus or to allow flexible surgical timing.
For women who are anaemic as a result of uterine fibroids: Zoladex 3.6 mg depot with supplementary iron may be administered for up to three months before surgery.
Assisted reproduction: Zoladex 3.6 mg is administered to downregulate the pituitary gland, as defined by serum oestradiol levels similar to those observed in the early follicular phase (approximately 150 pmol/l). This will usually take between 7 and 21 days.
When downregulation is achieved, superovulation (controlled ovarian stimulation) with gonadotrophin is commenced. The downregulation achieved with a depot agonist is more consistent suggesting that, in some cases, there may be an increased requirement for gonadotrophin. At the appropriate stage of follicular development, gonadotrophin is stopped and human chorionic gonadotrophin (hCG) is administered to induce ovulation. Treatment monitoring, oocyte retrieval and fertilisation techniques are performed according to the normal practice of the individual clinic.
Paediatric Population: Zoladex is not indicated for use in children.
Method of administration: For correct administration of Zoladex, see Patient Counselling Information.
The instruction card has to be read prior to administration.
Caution is needed when administering Zoladex into anterior abdominal wall due to the proximity of underlying inferior epigastric artery and its branches.
Extra care to be given to patients with a low BMI or who are receiving anticoagulation medication (see Precautions.)
Care should be taken to ensure injection is given subcutaneously, using the technique described in the instruction card. Do not penetrate into a blood vessel, muscle or peritoneum.
In the event of the need to surgically remove a Zoladex implant, it may be localised by ultrasound.
For special precautions for disposal and other handling see Special precautions for disposal and other handling under Cautions for Usage.