Goserelin
 Zoladex

Fatigue | Weight gain | Hot flushes | Libido | Exercise | Bone health | Sleep | Anti-oxidants

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Your doctor has recommended a medication called Zoladex as treatment for your illness. This page provides extra information about your medicine, summarises possible side effects and tips to alleviate them.

What is Zoladex?  Goserelin contained within a slow release pellet given which is given as a subcutaneous (under the skin) injection around the area of the abdomen. The active chemical is released into the blood stream at a constant level over a one or three month period depending on the strength used (3.6mg for one month, 10.5 mg for three months).  Zoladex  belongs to group of medicines called "LHRH blockers" and have the effect of reducing the bodies hormones which are made in the testes in men and ovaries in women. They are used to treat female patients with. Breast cancer and male patients with prostate cancer.

How does Zoladex work? Some tumours such as breast & prostate cancer are stimulated by the bodies own hormones. In men the hormone is called testosterone (from the testes) and in women it's oestrogen from the ovaries. Stopping the bodies hormones reaching the cancer can cause many cells to stop growing and some  shrivel up and die completely (self destruct - apoptosis). Usually not all the cells shrivel up and die so although the whole tumour can shrink hormones alone do not completed irradiate the tumour. One way to low the hormone levels in the body is to surgically remove the ovaries or testis. Some drug therapies chemically do the same thing by blocking the signal from the brain to the ovaries or testis - these include goserelin (Zoladex), More specifically Zoladex blocks production of two hormones called Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH). Zoladex blocks their production and hence is sometimes called a LHRH blocker

How will I and the doctor know it is working?  This depends why you have been given zoladex.. If before radiotherapy for prostate cancer then the PSA will drop in value. If you are given it for disease in the bones or elsewhere you should start to feel better either from a symptom related to your cancer, something which can be felt on examination (e.g. your prostate) or something seen on a scan. If you have been given zoladex as a precaution after radical radiotherapy you won't really know if it has helped as it is given to improve your risks.

Possible side effects. All medications have side effects. These can effect some people more than others. It its hard to predict the level and type of side effect for each individual, you may experience none, all, or only a few of these. You may also have a rare side effect not listed here - If you have any other side effects, please report them to your clinic. If side effects are severe, you may have to stop taking the drug and a different hormonal drug may be prescribed.

• Flushes and sweats. Similar to menopausal flushes in women. Often they gradually lessen over the first few months but some people continue to have them for as long as they take Zoladex. There are a number of ways to help reduce or control hot flushes and sweats. Some people find it helpful to avoid or cut down on tea, coffee, nicotine and alcohol. Evening primrose oil has been reported to be helpful in reducing sweats but it does not work for all people and it is  expensive. There are also a lot of calories in Evening Primrose Oil so it may be fattening. When Zoladex is stopped hot flushes can get worse before they get better. (coping with hot flushes)
  
• Sex drive (libido). Zoladex in men has a significant impact on sex drive. In most cases it impairs the ability to have erections
  
• Lethargy. It is common to have mild lethargy with Zoladex - it is most severe at the beginning but can wear off over time (daily light exercise will help this). 
  
• Nausea and indigestion.  Feelings of mild sickness (nausea)  can occur rarely but usually wears off after a few weeks.  
  
• Weight gain. This is sometimes due to water retention but at other times a consequence of a eating more either due to a increased appetite or mild nausea - "to settle the stomach" . Again regular light exercise will help and eating less ( See coping with weight gain.)
  
• Breast swelling (gynaecomastia). Occasionally in men the breast can become tender and enlarge (this can be prevented by a low dose of radiotherapy to the nipples as soon as it start). 
  
• Bone density loss (osteoporosis) If Zoladex continues for a long time it can begin to affect the hardness of the bones risking osteoporosis and fracture. It is important to do as much exercise as possible, get regular light sun exposure and eat foods with an adequate calcium level. (see advice for bone hardening)

Less common side effects include:-

• Allergic reactions – this may include skin rashes
• Temporary thinning of the hair
• Headaches – some people affected by migraine have noticed a worsening of severity

There is no interaction between Zoladex  and moderate amounts of alcohol. Zoladex does not usually affect your ability to drive.  Some people find that when they start Zoladex that with the first treatment they experience a temporary increase in bone pain. This is due to the Zoladex causing a surge in FSH and LH levels, which initially creates an increase in the production of testosterone or oestrogen. To prevent this, additional oral medication is normally given for the first two weeks (usually either  Tamoxifen (women),  Casodex, Flutamide or Cyproterone acetate (men). These drugs are usually not required to cover subsequent injections.

Who gives the injection? It is now most convenient for the patient that the General Practitioner continue prescribing Zoladex in the long term. This is called shared care. The injection itself is usually given by the district practice nurse. A full description of this type of management can be found in the NHS Management Executive Letter EL(91) 127(1/11/91). The consultant is responsible for the decision to start and stop Zoladex and monitoring the patient regularly. The GP is responsible for ensuring the drug is given on time and reporting any adverse events to the consultant. If you have been told to arrange repeat prescription from the GP show this information page to the receptionist when making the appointment so she knows when to make the appointment and for what reason. The following table may be helpful to remind all parties how long the Zoladex should be given and when:-

Further information: Your doctors and specialist  nurses are in an ideal position to give information relevant to your situation. Macmillan has a help line and a prize winning video available in English UK ethnic languages explaining Radiotherapy & Chemotherapy. Cancernet.co.uk is a complete cancer information resource written by an experienced team of doctors, health professionals and patients. It will help you make informed decisions and guide you through the cancer journey including information about: Optimum treatment of specific cancers:  e.g.Breast | Prostate | Bowel.   Common treatments:  Chemotherapy | Radiotherapy | Hormones | Biological agents | Complementary.  Lifestyle and cancer: Books based on the facts | Exercise | Diet | Smoking | Sunbathing | Alcohol. Tip to help with the symptoms of cancer and side effects of treatments. Financial issues: Traveling and cancer | Travel insurance | Links to support groups | Books | Videos | Glossary | About us | Disclaimer | Tests for cancer | Clinical trials | What is cancer | How to avoid cancer