Nafarelin (patient information)

# Why is this medication prescribed
Nafarelin is a hormone used to treat symptoms of endometriosis such as pelvic pain, menstrual cramps, and painful intercourse. Nafarelin also is used to treat central precocious puberty (early puberty) in young boys and girls.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

# How should this medicine be used
Nafarelin comes as a nasal spray. To use it, first clear your nasal passages by gently blowing your nose. Then insert the sprayer into a nostril. Sniff as you squeeze the sprayer once. To prevent mucus from entering the sprayer, release your grip after you remove the sprayer from your nose. Gently sniff two or three more times.
For treating endometriosis, initially nafarelin is used twice a day: one spray in one nostril in the morning and one spray in the other nostril in the evening. Nafarelin should be started between the second and fourth days of your menstrual period. Nafarelin should not be used for longer than 6 months to treat endometriosis.
For treating precocious puberty, initially nafarelin is used once a day as two sprays in each nostril each morning, for a total of four sprays each morning.
Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Nafarelin initially worsens symptoms before improving them. Use nafarelin exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor. Do not stop using nafarelin without talking to your doctor.

# What special precautions should I follow
Before using nafarelin
- tell your doctor and pharmacist if you are allergic to nafarelin, gonadotropin-releasing hormones, or any other drugs.
- tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially anticonvulsants to treat seizures or epilepsy, nasal decongestants, steroids, and vitamins.
- tell your doctor if you have or have ever had osteoporosis or a family history of osteoporosis; ovarian cysts, ovarian tumors, or ovarian cancer; chronic rhinitis (runny nose); or a history of depression.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. It is important to use a non-hormonal means of contraception (birth control) while using nafarelin (e.g., condom or diaphragm). If you become pregnant while using nafarelin, call your doctor immediately.

# What should I do if I forget a dose
Use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.
If doses are missed, you may experience breakthrough menstrual bleeding. Do not be alarmed, but inform your doctor.

# Side effects

## Mild side effects
Nafarelin may cause side effects. Usually these symptoms are temporary, lasting only until your body adjusts to the medication. Tell your doctor if any of these symptoms are severe or do not go away:
- acne
- breast enlargement
- vaginal bleeding (menstruation should stop with this medication)
- mood swings
- increase in pubic hair
- body odor
- seborrhea (skin irritation)
- nasal irritation
- headache
- hot flashes
- insomnia
- change in weight
- vaginal dryness or vaginal discharge
- change in sex drive
- oily skin
- muscle aches
- rhinitis (runny nose)
- depression

## Severe side effects
If you experience any of the following symptoms, call your doctor immediately:
- stomach pain not related to menstruation
- shortness of breath or difficulty breathing
- chest pain
- rash
- severe itching
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# What storage conditions are needed for this medicine
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

# What other information should I know
If you must use a nasal decongestant, wait at least 2 hours after using the nafarelin spray.
Avoid sneezing or blowing your nose during or immediately after using nafarelin. This decreases nafarelin's effectiveness.
Keep all appointments with your doctor and the laboratory.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Synarel