Issues for surgery

Risk of QT-interval prolongation if continued (see Interactions with common anaesthetic agents and Interactions with other common medicines used in the perioperative period).

Advice in the perioperative period

Elective surgery 

Continue.

Emergency surgery

Continue.

Patients with ureteric obstruction

If patient is admitted with spinal cord compression or renal impairment due to ureteric obstruction consideration should be given to the continued use of leuprorelin – see Further information.

Post-operative advice

Restart post-operatively when dose next due if clinically indicated.

For patients who have undergone prostate or gynaecological surgery

Review continued need for leuprorelin post-operatively.

Interactions with common anaesthetic agents

Use of leuprorelin can cause QT-interval prolongation secondary to androgen deprivation. Co-administration with other medicines known to prolong the QT-interval must be based on careful assessment of the potential risks and benefits for each patient.

Anaesthetic agents that may be used in the perioperative period that are known to, or predicted to, prolong the QT-interval include: -

desflurane, isoflurane, sevoflurane*
thiopental (theoretical)**

*monitor ECG if concurrent use unavoidable; if risk factors for QT-prolongation are also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia) use greater caution

**monitor ECG with concurrent use if risk factors for QT-prolongation are also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia).

Interactions with other common medicines used in the perioperative period

QT-interval prolongation

Medicines that may be used in the perioperative period that are known to prolong the QT-interval include: -

ciprofloxacin**
clarithromycin**
domperidone – avoid
droperidol**
erythromycin (particularly intravenous)**
granisetron**
haloperidol*
loperamide**
ondansetron**

**monitor ECG with concurrent use if risk factors for QT-interval prolongation also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia)

Hypokalaemia

Corticosteroids can cause hypokalaemia, which may be additive with concomitant use of leuprorelin (potentially increasing the risk of torsade de pointes). Monitor potassium concentrations closely.

Further information

Gynaecological Surgery

Ideally, leuprorelin should be commenced prior to surgery related to fibroids or endometriosis with maximal time to achieve suppression of symptoms or shrinkage of fibroids.

Ureteric obstruction / spinal cord compression

In patients with advanced prostate / endometrial cancer, tumor ‘flare’ during the initial weeks of leuprorelin treatment can worsen ureteric obstruction or spinal cord compression.

References

Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 26th May 2025]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 26/05/2025]
Summary of Product Characteristics – Prostap® (leuprorelin) 3 DCS 11.25 mg Powder and Solvent for Prolonged-release Suspension for Injection in Prefilled Syringe. Takeda UK Ltd. Accessed via www.medicines.org.uk 26/05/2025 [date of revision of the text June 2024]
Summary of Product Characteristics – Prostap® (leuprorelin) SR DCS 3.75 mg Powder and Solvent for Prolonged-release Suspension for Injection in Pre-filled Syringe. Takeda UK Ltd. Accessed via www.medicines.org.uk 26/05/2025 [date of revision of text June 2024]

Leuprorelin