AbarelixComplete Dosing & Administration Guide

Mild discomfort at treatment site

Some users experience mild discomfort, which is among the most commonly reported effects with Abarelix. 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.

Hot flashes and sweating

Hot flashes and sweating affect approximately 40-50% of men on GnRH antagonists like abarelix. These occur due to rapid testosterone suppression and hypothalamic dysregulation. Episodes typically last 2-5 minutes and can occur multiple times daily, especially in the first 2-3 months of treatment.

Management: Wear moisture-wicking clothing. Avoid hot beverages, alcohol, and spicy foods which trigger flashes. Use fans or air conditioning. Maintain cool sleeping conditions. Regular aerobic exercise can reduce frequency. Venlafaxine (75 mg daily) or other SSRIs are often prescribed and can reduce hot flashes by 60-70%. Most patients adjust within 6-12 weeks as the body acclimates to low testosterone.

Decreased libido and sexual dysfunction

Sexual dysfunction is nearly universal (90%+ of men) on GnRH antagonists as testosterone suppresses to near-castration levels. Decreased libido, erectile dysfunction, and reduced ejaculate volume are expected consequences of intentional testosterone suppression for prostate cancer treatment. These effects are reversible upon treatment discontinuation.

Management: Discuss sexual health openly with your oncologist—this is an expected part of hormone therapy. Phosphodiesterase-5 inhibitors (sildenafil, tadalafil) may help erectile dysfunction. Penile rehabilitation programs are sometimes recommended. Intimate communication with partners about expectations and alternatives is important. Most sexual function recovers gradually 6-12 months after treatment ends if appropriate.

Increased liver enzymes

Elevated liver enzymes (ALT, AST, GGT) occur in approximately 5-10% of abarelix-treated patients, usually mild and asymptomatic. Elevations typically appear within the first 1-3 months and often resolve spontaneously despite continued treatment. Severe hepatotoxicity is rare.

Management: Baseline liver function tests are essential before starting treatment. Monitor liver function every 3-6 months during treatment. Mild elevations (1-3x upper limit of normal) usually require no intervention. Reduce alcohol consumption and avoid hepatotoxic supplements. Report jaundice, dark urine, or right upper quadrant pain immediately. Treatment discontinuation is rare unless enzymes exceed 5x normal or clinical signs of liver injury appear.

Injection site reactions (pain, redness, swelling)

Injection site reactions occur in 10-20% of patients, typically mild and localized. Redness and swelling usually peak within 24-48 hours and resolve within 7-10 days. Pain ranges from minimal to moderate. Abscesses are rare (<1%). Multiple depot formulations in the same area can increase risk.

Management: Apply ice for 15 minutes immediately after injection and intermittently for 24 hours to reduce inflammation. Rotate injection sites systematically—vary the abdomen location for each subsequent injection. Use proper injection technique: clean skin thoroughly, allow alcohol to dry completely, use a 90-degree angle for needle insertion. Topical hydrocortisone cream or NSAIDs (ibuprofen 400 mg) can manage mild inflammation. Report any signs of infection (increasing warmth, spreading redness, pus) immediately.

Abdominal pain and gastrointestinal symptoms

GI symptoms (nausea, abdominal discomfort, changes in bowel habits) affect 15-25% of patients, usually mild-to-moderate. These may result from the injection itself, hormonal changes, or individual sensitivity. Most symptoms emerge in the first 2 weeks and improve as the body adapts.

Management: Eat small, frequent meals and avoid heavy, fatty, or greasy foods. Stay well-hydrated. Ginger supplements or ginger tea can help with nausea. Avoid eating immediately before or after injection—wait 1-2 hours. Over-the-counter antacids (calcium carbonate) or H2 blockers (famotidine) can help. Probiotic supplements may support GI health. If constipation develops, increase fiber intake and stay active. Report any severe, persistent abdominal pain or vomiting immediately.

Headache and dizziness

Headaches and dizziness occur in approximately 10-15% of patients and typically emerge in the first 1-2 weeks of treatment. Dizziness may relate to blood pressure fluctuations or rapid metabolic changes from hormone suppression. Most episodes are mild to moderate.

Management: Ensure adequate hydration—dehydration exacerbates dizziness. Rise slowly from lying or sitting positions to prevent orthostatic hypotension. Monitor blood pressure regularly, especially if dizziness is severe. Mild headaches often respond to acetaminophen or ibuprofen. Reduce caffeine intake, as this can worsen headaches. Rest in a cool, dark room during episodes. Report severe or persistent headaches, vision changes, or syncope immediately, as these warrant medical evaluation.

Weight changes

Weight gain of 2-5 kg (average 3-4 kg) occurs in 30-40% of abarelix-treated men, primarily from increased adipose tissue deposition. Testosterone suppression reduces basal metabolic rate by 10-15%, decreases muscle mass, and alters fat distribution. Weight changes typically stabilize after 3-6 months.

Management: Implement regular aerobic exercise (150+ minutes weekly) and resistance training to preserve muscle mass and maintain metabolic rate. Maintain consistent caloric intake—increased hunger is common but doesn't require eating more. Focus on high-protein diet (1.2-1.6 g/kg) to protect muscle. Monitor weight weekly. Mediterranean or DASH diets are often recommended. Discuss with a dietitian if weight gain exceeds 5 kg, as this may affect comorbidities like diabetes or hypertension.

Gynecomastia (breast tissue enlargement)

Gynecomastia (breast tissue growth) occurs in 5-15% of men on long-term GnRH antagonist therapy, typically appearing after 3-6 months of treatment. Low testosterone shifts the androgen-to-estrogen balance, and peripheral aromatization of residual androgens to estrogen becomes relatively more significant. Breast tissue tenderness often accompanies enlargement.

Management: Baseline breast imaging (ultrasound or mammography if >50 years old) is recommended to exclude malignancy. Topical NSAIDs (diclofenac) may reduce tenderness. Tamoxifen (10-20 mg daily) or anastrozole can prevent or reduce gynecomastia if started early. Gynecomastia typically regresses partially after treatment discontinuation, but may persist in some patients. Discuss surgical options with your oncologist if gynecomastia becomes cosmetically or functionally bothersome.

Bone density loss with long-term use

Androgen deprivation therapy causes significant bone loss, with hip and spine BMD declining 2-3% per year during treatment. Fracture risk increases substantially—vertebral compression fractures can occur in 10-20% of men on prolonged GnRH therapy. Older men and those with pre-existing osteopenia face highest risk. This is one of the most clinically significant toxicities of long-term GnRH antagonism.

Management: Baseline DXA (bone density) scan is essential before starting therapy and should be repeated annually. Ensure adequate calcium (1200 mg/day) and vitamin D (1000-2000 IU daily, target 25-OH vitamin D >30 ng/mL). Weight-bearing exercise (walking, resistance training) 30 minutes most days protects bone. Bisphosphonates (alendronate, zoledronic acid) should be considered, especially if T-score <-1.0. Denosumab (RANKL inhibitor) is an alternative if bisphosphonates are contraindicated. Limit alcohol and avoid smoking. Monitor for new back pain or height loss, which may indicate compression fractures.