This injection guide is for carers of people who are prescribed Triptorelin as part of their gender affirming medical treatment.

This information will help you learn how to administer an intramuscular injection of Triptorelin to the person for whom Triptorelin is prescribed.

An intramuscular injection is an injection that is given into the muscle.

A healthcare professional will show you how to give the injection. You can use the information in this resource to remember how to do it at the person's home.

Important Information

Do not attempt to administer the injection until you have had proper training by a healthcare professional.

• Before commencing, check the expiry date of the Triptorelin. 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. 
• Syringes, needles, and vials 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, syringes, and vials must not be mixed with household rubbish.
• For detailed information on Triptorelin please refer to the Patient Information Leaflet which 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, tingliing 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 Triptorelin, discontinue the Triptorelin and seek medical help immediately by calling the Emergency Services or attending the Emergency Department at your hospital.
• After administering Triptorelin, 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 Triptorelin?

Triptorelin (Decapeptyl) is a medication 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.

Triptorelin also has other uses outside gender affirming healthcare, including treatment of precocious puberty and endometriosis.

How do I get Triptorelin?

Triptorelin must be prescribed by a qualified healthcare professional.

What dose of Triptorelin is used?

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

How is Triptorelin administered?

Triptorelin is administered as an intramuscular injection (into the muscle) by a trained person.

Triptorelin must be administered into the gluteus maximus muscle as follows:

• Measure this site carefully, because an injection given in the wrong place could hit a nerve or blood vessel.
• Uncover one buttock. Imagine a line from the bottom of the buttock to the top of the hip bone. Imagine another line from the top of the crack of the buttock to the side of the hip. These two lines form a box divided into four quarters.
• The needle should be placed in the upper outer quarter of the buttock, below the curved bone.

You will need the following for the injection:

• The glass vial of Triptorelin 11.25mg powder.
• The glass ampoule of solvent (water) for dissolving the powder.
• A syringe.
• A needle for dissolving the Triptorelin and drawing the dissolved Triptorelin into the syringe.
• A needle for injecting the Triptorelin.
• Gloves for personal safety.
• An alcohol wipe for skin preparation.
• Cotton wool or gauze.
• A sharps bin to dispose of the needle after injection.

How to Inject Triptorelin

1. Preparation

1.1. Wash your hands thoroughly with soap and water.

1.2 Put on gloves for personal safety.

1.3 Gather your supplies, including the vial of Triptorelin powder, the ampoule of water, the syringe, the first needle for drawing up the water and dissolving the Triptorelin, the second needle for injecting the Triptorelin, an alcohol wipe, cotton wool or gauze, and a sharps bin.

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

Do not use if the medication is not Triptorelin, is of the incorrect dose, has passed the expiry date, or the integrity of the packaging is compromised.

2. Drawing up the water

2.1 Attach the first needle to the syringe, ensuring that the cap stays on the needle at all times. Put the empty syringe and needle down.

2.2 Pick up the ampoule of water and flick the top firmly to ensure that all the liquid is in the main part of the ampoule. 

2.3 Snap the top off the ampoule by firmly grasping between finger and thumb and pushing away from the dot on the neck of the vial.

2.4 Remove the needle cap and place the needle into the ampoule so that the needle tip rests against the bottom of the ampoule. 

2.5 Pull back the plunger slowly to draw the water into the syringe, ensuring that none is left in the ampoule.

2.6 Bring the syringe back out of the ampoule.

2.7 Dispose of the ampoule and the ampoule top in the sharps bin.

2.8 Check for air bubbles in the syringe by holding it upright with the needle pointing up. Firmly tap the syringe with your finger until the bubbles rise to the top of the syringe.

2.9 Slowly push the plunger up to force the air bubbles out of the syringe.

2.10 Put the syringe and needle down.

3. Dissolving the Triptorelin

3.1 Remove the plastic cap from the top of the Triptorelin.

3.2 Pick up the syringe with your dominant hand. Insert the needle into the rubber top of the vial. Do not touch or bend the needle.

3.3 Depress the plunger all the way to push the water into the vial.

3.4 Remove the needle and syringe and put them down.

3.5 Hold the vial between your right and left palms and gently roll for thirty seconds to dissolve the remaining powder. Do not shake the vial.

3.6 Hold the vial up to eye height and check that all the powder has dissolved.

3.7 Reinsert the needle into the rubber top of the vial.

3.8 Make sure that the medicine covers the tip of the needle the entire time.

3.9 Pull back the plunger to draw all of the liquid into the syringe. There is likely to be around 2ml of liquid.

3.10 Bring the s yringe back out of the vial and carefully remove the needle.

3.11 Dispose of the needle and the vial in the sharps bin.

3.12 Check for air bubbles in the syringe by holding it upright with the plunger pointing down. Firmly tap the syringe with your finger until the bubbles rise to the top of the syringe.

3.13 Slowly push the plunger up to force the air bubbles out of the syringe.

3.14 After the air has been removed, attach the second needle to the syringe. The injection is now ready to be given.

4. Injecting the Triptorelin

4.1 Clean the skin of the injection site with an alcohol swab. The injection site is the upper outer quarter of the buttock.

4.2 Gently hold the skin around your chosen injection site by forming a V with the fingers of your nondominant hand and placing the heel of this hand on the skin.

4.3 Holding the syringe like a pencil or a dart, completely insert the needle with a quick and firm motion at an angle of 90° to the skin surface.

4.4 Remove your nondominant hand from the skin and use it to hold the barrel of the syringe.

4.5 With your dominant hand, gently pull back the plunger slightly to check for blood. If you see blood, do not proceed with the injection. Remove the needle, discard the syringe, and begin again. If you do not see blood, then it is safe to proceed with the injection.

4.6 Push the plunger to inject the entire contents of the syringe slowly and steadily all the way in.

4.7 When the medication is fully injected, withdraw the needle and syringe.

5. After the injection

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

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

5.3 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 Triptorelin below 25°C. Do not store Triptorelin in the freezer.

Store your Triptorelin 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 (2022). Package Leaflet: Information for the User: Decapeptyl SR 11.25 mg: Powder and Solvent for Suspension for Injection: Triptorelin.
https://www.medicines.org.uk/emc/files/pil.780.pdf