This injection guide is for people who are prescribed leuprorelin (Prostap) as part of their gender affirming medical treatment. This information will help you learn how to give yourself a subcutaneous injection of leuprorelin.

A subcutaneous injection is an injection that's given under your skin.

A healthcare professional will show you how to give yourself the injection. This guide is to help you remember how to do it at home.

Important Information

• Before commencing, check the expiry date of the leuprorelin. Do not use the medication if it has expired.
• Always use a new needle and carefully examine the liquid to make sure it is clear. Do not use it if the liquid is discoloured or contains any lumps or large particles in it. If you suspect that the liquid has been contaminated, do not use it.
• Always use the specific dose that has been prescribed to you.
• Syringes and needles are for single use only and should be handled with care. Store them safely and dispose of them safely in a special sharps bin. Needles and syringes must not be mixed with household rubbish.
• For detailed information on leuprorelin please refer to the Patient Information Leaflet available here.

Warnings and precautions

• Some people can have unexpected allergic reactions to certain medications. Anaphylaxis is a serious allergic reaction that manifests as difficulty breathing, wheezing, swelling around the face, tingling of the lips and throat, and a choking sensation within minutes of administering the medication. This requires immediate medical treatment. If you experience any of these symptoms after administering leuprorelin, discontinue the leuprorelin and seek medical help immediately by calling the Emergency Services or attending the Emergency Department at your hospital.
• After administering leuprorelin, you may experience a reaction at the injection site, such as pain, a nodule, a rash or discolouration during the injection of the medicine or during the hours following the injection. If you observe a severe reaction at the injection site, seek medical attention.

What is Leuprorelin?

Leuprorelin (Prostap) is a medication that is known as a gonadotropin releasing hormone analogue (GnRHa). It is used to suppress puberty in adolescents as part of their gender affirming medical treatment. It is also used to suppress sex hormone production in adults who are receiving gender affirming hormone treatment.

Leuprorelin also has other uses outside of gender affirming healthcare, including treatment of breast cancer, prostate cancer and endometriosis. 

How do I get Leuprorelin?

Leuprorelin must be prescribed by a qualified healthcare professional.

What dose of Leuprorelin is used?

You will need to administer leuprorelin at the specific dose that is prescribed to you. The usual dose of leuprorelin is 11.25mg every 12 weeks, but different people may require different dose frequencies depending on their specific needs.

How is Leuprorelin administered?

Leuprorelin (Prostap) can be administered as an intramuscular injection (into the muscle), or as a subcutaneous injection (under the skin). The intramuscular injection can only be administered by a trained healthcare professional. Hence, for self-administration, we would like you to administer the injection via the subcutaneous route.

There are specific areas of the body that are suitable for giving subcutaneous injections. As a general rule, these areas are those with a substantial amount of fat below the skin. These include the abdomen, thighs, and buttocks. When injecting regularly, it is important to change injection sites regularly to limit the risks of pain, irritation, and lipodystrophy (clumping or loss of fat under the skin).

The leuprorelin (Prostap) injection pack comes as a prefilled syringe with two components, which will need to be reconstituted for injection:

• Powder: 1.2mg leuprorelin acetate.
• Liquid: a sterile solvent containing 5mg carmellose sodium, 50mg mannitol (E421), 1mg polysorbate 80, acetic acid, and water.

In addition to the above, you will need the following:

• An aclochol wipe for skin preparation.
• Cotton wool or gauze.
• A sharps bin to dispose of the needle after injection.

How to inject Leuprorelin

1. Preparation 

1.1 Wash your hands thoroughly with soap and water.

1.2 Gather your supplies, including the leuprorelin (Prostap) injection pack, an alcohol wipe, coton wool or gauze, and a sharps bin.

1.3 Check the medication name, dose, expiry date, and integrity of the packaging.

2. Dissolving the Leuprorelin

2.1 Screw the plunger rod into the stopper at the base of the syringe until the stopper begins to turn.

2.2 Check that the needle is tight by twisting the needle cap clockwise. Do not overtighten.

2.3 Holding the syringe upright, slowly push the plunger up until the middle stopper is at the blue line in the middle of the syringe barrel. This will release the solvent into the powder.

2.4 Keeping the syringe upright, gently tap the syringe to allow the solvent and the powder to mix. This will form a uniform suspension that is milky in appearance. Avoid hard tapping to prevent bubbles from forming. 

2.5 Remove the needle cap and push the plunger up further to expel the air from the syringe. 

3. Injecting the Leuprorelin

3.1 Clean the skin of the chosen injection site with an alcohol swab.

3.2 Gently pinch the skin of your chosen injection site with your thumb and forefinger.

3.3 Holding the syringe like a pencil or a dart, insert the needle into the raised skin so it is at an angle of between 30° and 90° to the skin surface. 

3.4 While continuing to hold the skin, push the plunger to inject the entire contents of the syringe slowly and steadily all the way in.

3.5 When the medication is completely injected, withdraw the needle and syringe. Immediately activate the safety device by pushing the arrow forward with the thumb or finger until the safety device is fully extended and a click is heard or felt.

4. After the Injection

4.1 Dispose of the syringe and needle in the sharps bin immediately. The syringe and needle must not be placed in the household rubbish.

4.2 Gently place a piece of cotton wool or gauze over the injection site for a few seconds. This will help seal the punctured tissure and prevent any leakage. Do not rub the injection site after injection.

4.3 Record all details of the injection in the injection diary or using other means. It is recommended that you note where you injected, the dose injected, the date and time of injection, and any injection reactions.

Storage

• Store your leuprorelin below 25°C. Do not store leuprorelin in the refrigerator or freezer.
• Store your leuprorelin in the original package in order to protect the medication from light.
• Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. This will help to protect the environment.

References

Electronic Medicines Compendium (2023). Health Professionals’ User Leaflet: Prostap 3 DCS. https://www.medicines.org.uk/emc/files/usermanual.4651.pdf

Electronic Medicines Compendium (2023). Package Leaflet: Information for the User: Prostap 3 DCS. https://www.medicines.org.uk/emc/files/pil.4651.pdf

Health Products Regulatory Authority (2021). Package Leaflet: Information for the User: Prostap 3 DCS. https://www.hpra.ie/img/uploaded/swedocuments/b268ec7ca175-46cb-8be4-6ef7e95a602f.pdf

Manchester University NHS Foundation Trust (2022). Self-Administration of GnRH Agonist Injections @ Home. https://mft.nhs.uk/app/uploads/sites/4/2019/11/TIAG-22-22-PatientLeaflet-GNRH-@-home-self-administration.pdf