Degarelix

Men with advanced or metastatic prostate cancer requiring rapid hormone control

Degarelix is particularly well-suited for individuals focused on men with advanced or metastatic prostate cancer requiring rapid hormone control. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach.

Patients who need immediate testosterone suppression to prevent cancer progression

Degarelix is particularly well-suited for individuals focused on patients who need immediate testosterone suppression to prevent cancer progression. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach.

Men who cannot tolerate the initial testosterone surges from GnRH agonists

Degarelix is particularly well-suited for individuals focused on men who cannot tolerate the initial testosterone surges from gnrh agonists. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach.

Mild discomfort at treatment site

Some users experience mild discomfort, which is among the most commonly reported effects with Degarelix. This typically resolves within a few days as the body adjusts.

Management: Apply ice if needed. Rotate treatment sites. These symptoms typically improve within the first week of use.

Injection site pain (28% of patients)

Injection site pain is the most common local reaction with degarelix, affecting 28% of patients in clinical trials. Pain is typically mild-to-moderate, peaks at 24-48 hours, and resolves within 7-10 days. The depot formulation (mannitol-sodium chloride mixture) causes local tissue irritation, particularly with abdominal injections where dermis is thinner.

Management: Apply ice immediately after injection for 15 minutes to reduce pain and inflammation. Compression with a bandage for 2-3 minutes helps. Rotate injection sites within the abdomen each month—spread injections across different abdominal quadrants. Proper technique minimizes trauma: pinch skin, insert needle at 90 degrees, inject slowly. Topical NSAIDs (diclofenac 1% gel) applied post-injection reduce pain by 30-40%. Acetaminophen 650 mg or ibuprofen 400 mg orally can manage persistent pain. Most pain resolves without intervention within 10 days. Premedication with NSAIDs 30 minutes before injection may reduce acute pain.

Injection site redness or erythema (17%)

Injection site erythema (redness) occurs in 17% of patients from local inflammatory response to the depot. Erythema typically appears within hours to 24 hours post-injection, peaks at 48 hours, and fades within 7-14 days. The affected area is usually confined to a 2-4 cm diameter around the injection site.

Management: Ice application immediately after injection reduces erythema development. Avoid scratching or manipulating the injection site. Topical corticosteroid cream (hydrocortisone 1% or triamcinolone 0.1%) applied twice daily speeds resolution. Loose clothing prevents irritation from friction. Erythema that extends >5 cm from injection site, is accompanied by warmth/fluctuance, or spreads suggests infection—report immediately. Most erythema resolves completely without intervention within 2 weeks. Premedication with NSAIDs or topical corticosteroids applied before injection prevent erythema in patients with history of severe reactions.

Hot flashes (26% experience them)

Hot flashes occur in 26% of degarelix-treated patients, often severe and distressing. Unlike GnRH agonists, degarelix causes no flare phase, yet hot flashes still emerge as testosterone suppresses. Most men experience onset within 7-10 days and peak intensity at weeks 2-4. Episodes typically last 2-5 minutes and occur 3-15 times daily.

Management: Wear moisture-wicking cotton clothing. Maintain cool sleep environment with light bedding. Avoid hot beverages, alcohol, spicy foods, and caffeine which trigger flashes. Aerobic exercise most days reduces flash frequency by 20-30%. SSRIs (venlafaxine 75 mg daily, paroxetine 20 mg daily) reduce hot flashes 60-70% and are preferred first-line therapy. Gabapentin 300-600 mg three times daily is effective if SSRIs cause side effects. Most patients achieve significant control within 4-6 weeks. Acknowledge psychological impact of hot flashes—they affect work performance and quality of life—and address proactively.

Increased liver enzymes and gamma-glutamyltransferase (10%)

Transient elevations of liver enzymes (ALT, AST) and particularly gamma-glutamyltransferase (GGT) occur in ~10% of patients. Elevations are typically mild (1-3x upper limit of normal), asymptomatic, and reversible. Onset is usually within 1-3 months. Severe hepatotoxicity requiring treatment discontinuation is rare (<0.5%).

Management: Baseline liver function tests (LFTs) are essential before starting degarelix. Repeat LFTs at 1-3 months and then periodically. Mild enzyme elevations without symptoms typically require no intervention—continue monitoring. Restrict alcohol consumption and avoid hepatotoxic over-the-counter medications (acetaminophen >3 g daily, excessive NSAIDs). Report jaundice, dark urine, pale stools, or right upper quadrant pain immediately. Repeat LFTs if symptoms develop. Discontinue degarelix if transaminases exceed 3-5x normal or if clinical signs of hepatotoxicity appear (jaundice, coagulopathy). Most patients can continue treatment with mild elevations.

Weight gain (9%)

Weight gain occurs in 9% of degarelix patients (lower than GnRH agonists), likely due to rapid testosterone suppression without the prolonged hormone fluctuation seen with agonists. Average weight gain in those affected is 2-4 kg. Weight gain results from reduced metabolic rate and altered fat distribution.

Management: Implement regular aerobic exercise (150-200 minutes weekly) immediately with treatment initiation. Resistance training 3x weekly preserves muscle mass and metabolic rate. Maintain consistent caloric intake despite metabolic slowdown. High-protein diet (1.2-1.6 g/kg) supports muscle retention. Monitor weight monthly. If weight gain exceeds 5 kg in first 3 months, intensify exercise program and consider nutrition consultation. Weight often remains stable after 6 months despite continued low testosterone, suggesting metabolic adaptation.

Hypertension or elevated blood pressure (6%)

Hypertension develops in 6% of degarelix-treated patients. Systolic BP may increase 10-20 mmHg, particularly in months 1-3. This may result from hormonal changes affecting vascular function or reflect underlying increased cardiovascular risk in men receiving GnRH therapy. Pre-existing hypertension may worsen.

Management: Baseline blood pressure should be documented before treatment. Measure BP at each clinic visit. Maintain DASH diet (low sodium, high potassium). Regular aerobic exercise reduces BP 5-10 mmHg. Limit sodium to <2300 mg daily. If BP increases >10 mmHg systolic or becomes symptomatic (headache, chest pain), notify provider. Antihypertensive agents can be initiated or adjusted if needed. Monitor for symptoms of cardiovascular disease (chest pain, dyspnea). GnRH therapies are associated with increased cardiovascular risk, making BP control important.

Back pain (6%)

Back pain occurs in 6% of patients, typically mild-to-moderate and mechanical (musculoskeletal) in nature. Pain may relate to prostate cancer bone metastases responding to treatment (tumor pain from necrosis), testosterone suppression affecting disc health, or osteoporosis development. Onset is usually gradual over weeks to months.

Management: Distinguish new-onset back pain from underlying metastatic disease—imaging may be needed if pain is severe or acute. Regular physical activity and stretching maintains spinal health. NSAIDs (naproxen 500 mg twice daily) provide symptomatic relief. Physical therapy for core strengthening improves long-term outcomes. Maintain good posture and proper body mechanics with lifting. Sleep on a firm mattress. Report sudden severe back pain, leg weakness, or bowel/bladder changes immediately—these suggest spinal cord compression requiring emergency evaluation. Most mechanical back pain improves with conservative treatment and exercise.

Chills (5%)

Chills occur in 5% of patients, typically mild and short-lived (minutes to hours). These may represent a mild systemic reaction to the depot injection or reflect thermoregulatory changes from rapid hormone suppression. Chills are occasionally accompanied by low-grade fever (<38.5°C).

Management: Chills are usually self-limited and require no intervention. Reassure patient this is not an allergic reaction if no other signs present (rash, swelling, breathing difficulty). Provide warm blankets for comfort during chills. If chills are accompanied by high fever (>38.5°C), severe malaise, or recurrent episodes with each injection, investigate for infection and notify provider. Most patients report only one episode. NSAIDs can reduce chills if they recur. This side effect typically doesn't warrant discontinuing treatment.

Constipation (5%)

Constipation affects 5% of degarelix patients, typically mild. This may result from reduced physical activity (common with cancer treatment), testosterone suppression affecting GI motility, or inadequate fiber/fluid intake during treatment.

Management: Increase dietary fiber gradually to 25-30 g daily through whole grains, fruits, and vegetables. Drink 8+ glasses water daily—dehydration worsens constipation. Regular physical activity (walking 30 minutes most days) stimulates bowel motility. Stool softeners (docusate 100-200 mg daily) are first-line. Osmotic laxatives (polyethylene glycol, magnesium citrate) are effective if fiber alone insufficient. Avoid stimulant laxatives chronically as they can cause dependence. High-dose NSAIDs can worsen constipation—use judiciously. Report abdominal pain, distention, or inability to pass stool for >3 days, as severe constipation can lead to obstruction.

Urinary tract infection (5%)

UTI occurs in 5% of patients, reflecting either lower urinary tract obstruction from prostate enlargement (paradoxically worsened by initial testosterone surge) or urinary retention. Symptoms include dysuria (painful urination), frequency, urgency, suprapubic pain, and cloudy/bloody urine.

Management: Maintain adequate hydration (8+ glasses water daily) to promote urinary flow. Empty bladder completely with each void—avoid straining. Avoid irritants: spicy foods, excessive caffeine, alcohol. Cranberry juice or D-mannose supplements may help prevent UTI. If symptoms develop (dysuria, frequency, fever), urinalysis and urine culture are indicated. Treat confirmed UTIs with antibiotics (fluoroquinolone 3 days or nitrofurantoin 7 days typical). If recurrent UTIs develop, urologic evaluation is warranted to assess for obstruction or retention. Report blood in urine, fever >38.5°C, or flank pain immediately—these suggest pyelonephritis requiring prompt treatment.

Injection site swelling (6%)

Injection site edema (swelling) occurs in 6% of patients from local inflammatory response. Swelling typically appears within 24 hours, peaks at 48 hours, and resolves within 7-10 days. The affected area is usually confined to 2-4 cm around the injection site. Swelling is usually mild (<1 cm) but can be more pronounced in sensitive individuals.

Management: Apply ice immediately after injection for 15 minutes to minimize swelling. Compression with an elastic bandage for 24 hours helps. Elevate the injection site if possible (though this is awkward for abdominal injections). NSAIDs (ibuprofen 400 mg) reduce swelling. Topical corticosteroid cream (hydrocortisone 1%) applied twice daily accelerates resolution. Loose clothing prevents friction irritation. Swelling that extends >5 cm, becomes firm/fluctuant, or is accompanied by systemic symptoms suggests abscess—report immediately. Premedication with NSAIDs or topical corticosteroids before injection can prevent swelling in patients with history of severe reactions.

Injection site induration or hardness (4%)

Injection site induration (hardening) occurs in 4% of patients from the depot formulation (mannitol-sodium chloride mixture) creating a firm nodule. The nodule typically measures 1-2 cm and remains palpable for weeks. This represents the depot depot site, not an abscess. Induration is usually asymptomatic.

Management: Induration at injection sites is expected and benign—it represents the medication depot. No specific treatment is needed. Reassure patients this will gradually resolve. Rotating injection sites each month across the abdomen prevents excessive induration buildup in one location. Massage the area gently after 48 hours (once initial inflammation subsides) may soften induration. If induration becomes painful, extremely firm, or warm, or if surrounding skin becomes increasingly red/swollen, distinguish this from abscess formation by checking for fever and systemic signs. Most induration resolves completely within 4-6 weeks after the final injection.

Decreased sex drive and erectile dysfunction

Sexual dysfunction is nearly universal (85-95% of men) on degarelix as testosterone suppresses to castration levels (<50 ng/dL) by day 28. Erectile dysfunction, absent libido, reduced ejaculate volume, and loss of spontaneous erections are expected consequences. These effects are completely reversible upon treatment discontinuation, typically recovering within 6-12 months.

Management: Discuss sexual health concerns openly with your oncologist—sexual dysfunction is an expected part of hormone therapy for prostate cancer. Phosphodiesterase-5 inhibitors (sildenafil 50-100 mg as needed, tadalafil 5-20 mg daily) may help some men with erectile function, though efficacy is variable at very low testosterone levels. Penile rehabilitation combining PDE5 inhibitors with vacuum erection devices may preserve some erectile tissue during therapy. Intimate communication with partners about expectations supports relationship health. Sexual function typically recovers gradually 6-12 months after stopping degarelix as testosterone rebounds.

Gynecomastia (breast tissue growth)

Gynecomastia (breast tissue enlargement) occurs in 5-10% of degarelix-treated men, developing after 3-6 months of therapy. Low testosterone shifts androgen-to-estrogen ratios, and peripheral aromatization becomes relatively more significant. Breast tissue tenderness often accompanies growth.

Management: Baseline breast imaging (ultrasound or mammography if >50 years) recommended to exclude malignancy. Topical NSAIDs (diclofenac 1% gel) may reduce tenderness. Tamoxifen (10-20 mg daily) or anastrozole (1 mg daily) initiated early can prevent or reduce gynecomastia. Gynecomastia often regresses partially after therapy discontinuation but may persist. Surgical excision (mastectomy) can be considered if gynecomastia becomes cosmetically or functionally bothersome. Discuss preventive pharmacotherapy early with your oncologist, as prevention is more effective than treating established gynecomastia.

Testicular atrophy (shrinking)

Testicular atrophy (reduction in testicular volume) occurs in >90% of men on long-term GnRH antagonist therapy. Testes can shrink 30-50% in volume as Leydig and Sertoli cells regress from prolonged LH/FSH suppression. Atrophy becomes noticeable after 6-12 months of therapy.

Management: Testicular atrophy is a direct and expected consequence of testosterone suppression and indicates effective GnRH antagonism. Atrophy is reversible—testes gradually return to near-normal volume (80-90% recovery) within 6-12 months after stopping treatment, though some permanent size reduction may occur with very prolonged therapy. No intervention is needed during treatment. Atrophy does not predict recovery of sexual function or fertility. Patients concerned about fertility should discuss sperm banking before starting degarelix if future biological paternity is important. Atrophy does not affect prostate cancer treatment efficacy.