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Eligard 22.5mg (swollen ankles and feet)

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Posted 3/16/2023 4:45 PM (GMT 0)
I am an 84 year old male and 16 year old prostate cancer survivor diagnosed with a Gleason of 3/4, I took Lupron off and on but was recently switched to the generic Eligard 22.5mg 4 weeks ago. Experiencing 14 side effects (much worse than Lupron) but by far the worst is swelling in ankles and feet. Despite using compression boots, PEMF equipment, elevation of the legs and 10 mg of
torsimide diuretic, the swelling persists. Has anyone experienced such persistent swelling from this drug? Because of the many side effects, my oncologist is going to switch me to Firmagon in two months but for now the damage is done. Does anyone have a solution to the feet and leg swelling? Not only is it painful but I can't wear my shoes or sneakers. Thanks in advance for replies.
Posted 3/16/2023 4:53 PM (GMT 0)
Youkilis,
Sorry about the lousy SEs. Why the switch away from Lupron? I wonder if the newer pill form of ADT, Orgovyx, might be a good option.
Posted 3/16/2023 5:42 PM (GMT 0)
Thanks for your reply. Eligard is the generic of Lupron and is much cheaper. Therefore, insurance companies only cover Eligard unless a special dispensation is granted. My oncologist is recommending a switch to Firmagon. It is rated as more effective with lesser side effects. I have confirmed this with a good friend who is a retired urologist. He told me he used Firmagon on his patients with good results and limited side effects. The downside is it requires monthly shots. Hopefully, he's right! In the meantime I am one month into this 3 month Eligard treatment so I can only hope that the side effects will lessen.. The swollen ankles and feet are a killer!
Posted 3/16/2023 6:08 PM (GMT 0)
Sending supportive thoughts your way, Youkilis!

It's encouraging to MANY of us here that you are a 16-year prostate cancer SURVIVOR.

That being said, I'm sorry for the side effects that you are experiencing, after a switch to ELIGARD.

With it being a multi-month dose, the side effects may linger, unfortunately.

I wonder if there's a doctor that can offer ideas to mitigate the side effects you are experiencing?

I'm sorry for the pain and discomfort you are experiencing. Hopefully, you have an old comfortable pair of slippers you can wear!

I switched from LUPRON to FIRMAGON, and then later to ZOLADEX. I had no issues transitioning from one form of ADT to the next.

The reason for this was that LUPRON and FIRMAGON did not fully suppress my testosterone, which created "spikes and flares" in my PSA.

FIRMAGON also left me with painful site injection reactions which stung like a hornet's sting for a few days and left painful welts on my abdomen. So we all can experience side effects from various medications or treatments.

For me, ZOLADEX worked the magic.

It's good to know there are various forms of ADT.

Hopefully, your side effects will lessen. I hope there's a doctor that could also address this, in the meantime, and get you some relief.

With my best ~
CYCLONE ~ # Iowa State University
Posted 3/17/2023 2:34 AM (GMT 0)
Hi Cyclone, Thanks for your thoughtful reply. I am aware of the nasty after effects of the Firmagon shot and it has to be given monthly. What can you tell me about Zoladex regarding side effects. Is it given monthly? One of my problems with handling these drugs is my advanced age. Lupron side effects were very manageable for me ten years ago and now they are very intense; even the 7.5mg one monthly shot. The side effects of Eligard 22.5mg are much worse than a comparable shot of Lupron. I will ask both my urologist and my oncologist if Zoladex would be a good option for me. After 16 years, my pc is still in the box so I feel blessed. However, my PSA doubling time is starting to increase. Thanks in advance for your reply. Youkilis
Posted 3/17/2023 2:45 AM (GMT 0)

Youkilis said...
Hi Cyclone, Thanks for your thoughtful reply. I am aware of the nasty after effects of the Firmagon shot and it has to be given monthly. What can you tell me about Zoladex regarding side effects. Is it given monthly? One of my problems with handling these drugs is my advanced age. Lupron side effects were very manageable for me ten years ago and now they are very intense; even the 7.5mg one monthly shot. The side effects of Eligard 22.5mg are much worse than a comparable shot of Lupron. I will ask both my urologist and my oncologist if Zoladex would be a good option for me. After 16 years, my pc is still in the box so I feel blessed. However, my PSA doubling time is starting to increase. Thanks in advance for your reply. Youkilis

tell that damn doctor to do his job and get you back on lupron! good luck man!
Posted 3/17/2023 2:53 AM (GMT 0)
Hello, Youkilis ~

I'm mindful of your situation.

Diagnosed in my 40s, my medical team has helped me immensely. I am a teacher, and have continued working full-time, since being diagnosed in 2013.

To be honest, ZOLADEX isn't mentioned as often.

However, having been on LUPRON, then FIRMAGON, and then ZOLADEX - I found ZOLADEX was the most tolerable.

It's basically an injectable tiny "pellet" - injected into one's abdomen. A tiny little numbing shot of LIDOCAINE is given first. Then the ZOLADEX "pellet" is injected - no pain or tenderness afterwards!

It is a once-a-month injection. A 3-month dose is available, but my oncologist felt fatigue might result.

I stay active and have a good energy flow.

Best of all, for my case, ZOLADEX flatlined my testosterone, which has helped control my PSA far better than LUPRON or FIRMAGON did. For whatever reason, ZOLADEX worked best for me.

It was the third form of ADT that my oncologist tried. He was diligent in determining if something would work better than LUPRON and then FIRMAGON.

Testosterone level tests were used to determine which form of ADT worked the best for me.

He assured me that I could always go back to LUPRON. I had everything to gain, and nothing to lose.

So - getting the monthly ZOLODEX injection is simply part of my routine. I have a great oncologist, who looks after me like a brother.

Seeing him monthly is part of my routine now, these past ten years.

It's important to know there are alternate forms of ADT!

Here's hoping you find a form of ADT that works even better for you!

CYCLONE ~ # Iowa State University
Posted 3/17/2023 12:21 PM (GMT 0)
Similar to you, Youkilis. Diagnosed 14 years ago, some months ago switched from lupron to Eligard, some sweelling in feet and ankles. Earlier stopped degarelix after several years due to fainting spells the following day.
Posted 3/18/2023 2:44 AM (GMT 0)
Thanks Cigafred, How long did the swelling in your feet and ankles last? i took a 3 month 22.5mg 3 month shot four weeks ago. The swelling in my feet and ankles started about 1 week after the injection and it is very intense and still with me three weeks later. I am wondering when it will subside. Eligard is like a poison, at least for me. I have 14 side effects and every one of them is awful. The latest one commenced yesterday when my face became covered with a rash. If you could tell me the strength of the Eligard you took and how long the feet and ankle swelling lasted, it would help me a lot. Thanks and good luck.
Posted 3/18/2023 3:19 AM (GMT 0)
Hello, Youkilis ~

It's almost like your body is having an adverse reaction to the ELIGARD injection.

With the swelling - and now the rash - could it be akin to an allergic reaction?

Has your medical team presented any antidotes, in the meantime ~ or solutions for mitigating the side effects?

Benedryl ? Steroids? SOMETHING!

I also wonder if your medical team could reach out to the manufacturers of ELIGARD for some insight?

Just thinking aloud ~ wanting all the best for you ~

CYCLONE ~ # Iowa State University
Posted 3/18/2023 6:27 AM (GMT 0)
YouKillis, discounting any heart problems, the symptoms you speak of is well documented in the literature as a severe allergic reaction. I am not a doctor, but I would take benedryl as cyclone mentioned. However, I would not wait for an appointment. You might be better off going to urgent care just to make sure it doesn’t progress to even more serious problems. I am not trying to be an alarmist, but if you look up the adverse side effects of Eligard online, you are exhibiting many of them. My best wishes.
Jack

Post Edited (Jack64) : 3/18/2023 6:14:42 AM (GMT-8)

Posted 3/18/2023 12:14 PM (GMT 0)
I agree with those who replied since my last response. I think we had different situations in that my swelling is not a big problem, just that my shoes are tighter than before, I am not aware of any fluctuations in the swelling.
Posted 3/18/2023 12:38 PM (GMT 0)
Mindful of the situation our comrade Youkilis is enduring right now, I think it speaks to the issue of our doctors starting with a one-month dose of ADT, at the beginning ~ to gauge its impact and tolerability.

Years ago, when my new oncologist discovered "spikes & flares" in my testosterone, I had to WAIT until that multi-month LUPRON injection expired ~ so that we could try a different form of ADT injection.

My original urologist failed to monitor my testosterone levels, which was creating spikes and flares in my PSA.

This oversight on my original urologist's part resulted in me benching him, and switching all my care - and ADT injections ~ over to my oncologist.

# Steps In Becoming One's Own Advocate!

Sharing a first-hand experience ~
CYCLONE ~ # Iowa State University
Posted 3/19/2023 3:22 AM (GMT 0)
To give you guys an update, my face rash has gotten worse; red welts everywhere. Worse yet, my lower legs and ankles turned very warm and red and the pain increased. I contacted my cardiologist and sent her pictures (she's out of town) and was diagnosed with cellulitis. I am on 500mg of Cephalexin (an antibiotic) and regular applications of emuaidMax. Obviously, this is a fairly serious reaction from the 3-month Eligard injection. I spent the day in bed because it was too painful to walk but I am up and around this evening. My experience with Eligard should raise a red flag about this drug! I will post progress reports. PS My son reminded me that I took the same dose of Eligard two years ago and had the same reaction, only to a much lesser extent. However, back then I did not connect the infection with the Eligard.
Posted 3/19/2023 12:52 PM (GMT 0)
It's certainly an unfortunate reaction to a medication that was used to help you.

I hope your side effects fade and dissipate.

However, it was a 3-month dose, so the medication will stay in your system for the foreseeable future.

Each of us have different sensitivities. I sailed through all the recent corona vaccines and subsequent boosters, yet one of my oncology nurses had a severe allergic reaction to her last booster.

I sailed through my first TAXOTERE infusions, some years ago, but went into a full-blown allergic reaction during the second infusion.

My oncologist came RUNNING to my aid, and a Benadryl infusion was iven immediately. From that point forward, I had to have that infusion FIRST before given the chemotherapy infusion.

When I tried FIRMAGON, I had painful site injection reactions that lasted for about a week after each injection, which left painful welts and tender & stinging lumps on my abdomen. I dreaded each month's new injection.

That's when I switched to ZOLADEX - a tiny injectable "pellet" - preceded by a tiny numbing shot of LIDOCAINE. No pain or tenderness afterwards, either!

Have you gone in to see your medical team? I realize that may be difficult, at this point.

My oncologist would want to see me IMMEDIATELY ~ and would tell me to get to the treatment center at once.

I still wonder if an infusion of Benedryl or a prescription for oral steroids might be needed?

Once three months passes, you will qualify for your next dose of ADT.

Obviously, you & your oncologist will need to determine which form of ADT to try next.

Thankfully, other options are there for you, including FIRMAGON, ZOLADEX, and ORGOVYX - the newer oral medication one takes at home.

Your experience makes me think our doctors should always try the one-month dose of ADT first, to gauge patient reaction, before ever offering the multi-month doses. Something for us all to keep in mind.

I will watch for your updates & send my best to you ~

CYCLONE ~ # Iowa State University
Posted 3/19/2023 1:34 PM (GMT 0)
I had some/many of those side effects from Eligard chemotherapy, also from Firmagon and Lupron chemo. Further, I quickly (1 week after first Firmagon injection, and again 1 week after first Lupron) developed shingles despite having had both Zostavax and Shengrix vaccinations.

Once the Eligard killed off my testicles, testosterone wasn't much of an issue, only the cancer and chemo side effects. One of those was pruritis on my arms (big nasty itchy weeping sores that left scars), swelling of my ankles (I assume a lymphatic system malfunction) and itchy bleeding sores all over my calves. Most of those went away a couple of years after I quit getting those chemical injections. Of course, I replaced those with the side effects from Xtandi (enzalutamide) which are worse and more persistent than those from the other chemotherapy drugs.

Goserelin appears to be very similar to leuprolide and shares many of the side effects, though it does appear to be slightly less obnoxious (IMHO due to more frequent lower dosages). All of these chemicals have the ability to severely damage our immune systems as well. My medical team is concerned that this has happened to mine and are currently monitoring that as those side effects have not gone away in the almost 3 years since my last dose of leuprolide + enzalutamide chemo. "It is well - known in the medical community that these drugs can permanently damage the immune system." As per my medical team.

Side note: leuprolide, gozerelin and enzalutamide chemotherapy etc are referred to as "androgen deprivation therapy" or "hormonal therapy" so as not to frighten patients away from taking them. This as the end goal is to get the patient to take them to slow the cancer and the term "chemotherapy" scares a lot of folks. But...

"since Lupron injures both cancerous and normal cells it is a form of chemotherapy". The Medicare copy of the invoice reads "(hormonal) chemotherapy drug....$6000, injection of chemotherapy drug....$100"
An unfortunate 'side effect' of this manipulative tactic is that the profound - and often permanent - side effects of these powerful chemicals comes as a complete surprise to patients that get those side effects.

The choice as to where, exactly, the injection is given appears to be solely at the discretion of the injector. I have got those nasty shots pretty much in all of the sites noted above - belly, side, arm and butt. Each time by a different person who was adamant that they "knew" exactly how to do it right (and the others were all doing it wrong). :applause:
Posted 3/19/2023 3:23 PM (GMT 0)
Sorry to read about your troubles.
My urologist started me off with a one-month dose (of Lupron) and told me he wanted to see how I would handle it. This should really be 'standard protocol'.
Posted 3/19/2023 3:57 PM (GMT 0)
The following from Drugs.com clears up (maybe) the differences between Lupron and Eligard. The active ingredient is identical but the formulations seem to be quite different, which probably explains different reactions to the medications. During the Pandemic when there was a Lupron shortage I had Eligard substituted for Lupron twice. The first injection was administered (incorrectly?) just like Lupron, as far as I could tell. The second time it was give subcutaneously in my upper arm. Both injections burned like hell as the medication went in. Lupron never has.

Medical Answers
Are Lupron Depot and Eligard the same drug?
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Dec 8, 2022.


Official answer
by Drugs.com
Lupron Depot and Eligard are brand names for drugs that both contain the active ingredient leuprolide acetate. Both Lupron Depot and Eligard are prescribed to treat the symptoms of advanced prostate cancer. Lupron Depot is also FDA-approved for the treatment of endometriosis, uterine fibroids, or central precocious puberty (CPP) in children (early puberty).

Leuprolide acetate, the generic name for Lupron Depot and Eligard, is classified as a gonadotropin releasing hormone (GnRH) agonist and is often referred to as hormone therapy. These drugs work by reducing the amount of the hormone in your body called testosterone (in men) or estrogen (in women).

Lupron Depot is given as an intramuscular (IM) injection into the muscle. Eligard is given as a subcutaneous (under the skin) injection. Lupron Depot and Eligard are available as single dose kits that contain a prefilled injection syringe of:

7.5 mg (given every month)
22.5 mg (given every 3 months)
30 mg (given every 4 months)
45 mg (given every 6 months)
Depot formulations, like Lupron Depot and Eligard, continuously release medicine into your body over a certain period of time after injection. This means you may not need to get a shot every day (or even every month). Both medicines supply a continuous release of leuprolide and these injections are only given by a healthcare provider.

For the palliative treatment of prostate cancer:

Lupron Depot is injected into a muscle of your upper arm, upper thigh or buttocks once every month, OR once every 3, 4 or 6 months for the treatment of prostate cancer, based on the dose you need. Lupron Depot should be injected with 2 hours of preparation or it should be discarded.
Eligard is injected subcutaneously (under the skin) in areas such as abdomen (stomach area) once every month, OR once every 3, 4 or 6 months based on the dose you need. Eligard should be injected within 30 minutes of preparation or it should be discarded.
You will receive this injection in your doctor’s office, in a clinic or in the hospital. Leuprolide is not available in a pill form.
Which drugs contain leuprolide?
There are different brand names and package inserts for these products, with different uses and doses. It is important to follow your doctor’s exact dosing instructions and read the patient information for specific use. Ask your doctor or pharmacist if you have questions.

The various package insert information, brand names and approved uses for leuprolide acetate can be found here:

Eligard (FDA-approved use: symptoms of prostate cancer)
Fensolvi (FDA-approved use: central precocious puberty)
Lupron Depot (FDA-approved use: symptoms of prostate cancer)
Lupron Depot 3.75 mg and Lupron Depot 11.25 mg - (FDA-approved use: endometriosis, uterine fibroids)
Lupron-Depot Ped (FDA-approved use: central precocious puberty)
Is there a generic for Lupron Depot?
There is no therapeutically equivalent generic version of Lupron Depot or Eligard commercially available in the U.S. at this time.

Leuprolide 1 mg/0.2 mL injection strength is available as a generic (non-depot form) for the palliative treatment of prostate cancer or central precocious puberty, but this form must be injected daily.
Posted 3/19/2023 9:36 PM (GMT 0)
I don't think cellulitis and drug reaction are the same thing although some of the symptoms may be similar. Cellulitis is a bacterial infection and can spiral out of control if not treated properly (my wife got it from a bee sting and ended up in a hospital for a couple of days with IV antibiotics,) so stay vigilant and hope the drugs help. Side effects are typically treated with prednisone, antihistamines and so on.
Posted 3/20/2023 4:16 AM (GMT 0)
Hi Mumbo, Yes, the swollen legs and feet are a direct side effect of the Eligard. I have been using a prescription diuretic to reduce the swelling. My skin in the ankle area was dry and slightly cracked as a result of the painful swelling. Bacteria likely entered the cracked skin and bingo, I had a nasty case of cellulitis diagnosed by my doctor. She immediately prescribed 500mg of Cephalexin 500mg taken every six hours and the application of a topical cream called emuaid max. 24 hours later the redness and pain are nearly gone. My guess is all these prostate cancer drugs have nasty side effects and I can tell you from experience that as one ages, the side effects worsen. At age 75, they were tolerable, at 84 they aren't.
Posted 3/21/2023 4:35 AM (GMT 0)
Still struggling but there is improvement in the cellulitis and the swelling of ankles and feet is improving. Obviously, the 3 month Eligard was a huge mistake but I have only myself to blame. Knowing my drug sensitivity, my oncologist wanted to put me on Firmagon but it has a side effect of heart arrhythmia issues. I developed A-Fib from open heart surgery 16 years ago (a common occurrence) and suffered with it off and on for about ten years until I had a successful coronary ablation. So the last thing I want is more arrhythmia problems. Tomorrow, I will post under "new topics" how being diagnosed with prostate cancer saved me from instant death 16 years ago. It is an interesting story.
Posted 3/23/2023 2:08 AM (GMT 0)
Hello, Youkilis ~

I'm glad to hear that side effects are slightly lessening.

I really hope the time it takes for this three-month dosage to wane pass by quickly.

You will want to start planning a change of ADT with your oncologist. Check out insurance coverage and discuss options.

Always remember ~ it took a period of time ~ and trial & error ~ to discover the form of ADT that would help me the most. First LUPRON, then FIRMAGON, and ultimately ZOLADEX ... but the end results were worth it.

Sending you my support ~ stay focused on the future!

CYCLONE ~ # Iowa State University
Posted 3/23/2023 4:48 AM (GMT 0)
Thanks Cyclone! My oncologist wanted to put me on Firmagon this last time because of side effects issues with Lupron and Eligard. (As you know, due to age I guess, I have become very drug sensitive. More than than two years ago a three month shot of Eligard did not bother me that much, now it's like being injected with poison.) I have concerns about Firmagon beyond what you told me and they relate to heart arrhythmia issues. I will most certainly ask him about Zoladex. To bring you up to date, my side effects continue to subside. In fact, today was the first day I could wear sneakers or shoes again. The cephalexin antibiotic cured the cellulitis in three days. Again, thanks for all your insights and help!
Posted 3/25/2023 2:14 PM (GMT 0)
Hello, Youkilis ~

I remember waiting for a multi-month LUPRON injection to "expire" ~ so that my oncologist and I could start trying other forms of ADT that served me better.

I was experiencing spikes and flares in testosterone, creating worrisome spikes in PSA.

The weeks went by, but while waiting ~ my oncologist and I discussed which form of ADT we would try next.

Important to state ~ all subsequent injections were the "one month" dosage, with follow-up lab tests (testosterone and PSA). You can see why I have had monthly lab tests for years and years, until very recently.

You've got some lead time now to discuss options and check on insurance coverage.

FIRMAGON didn't work the magic, as hoped. The injections were a miserable experience for me, but that's just my experience.

ZOLADEX flatlined my testosterone and PSA. I have had no tenderness or soreness since, either.

A wider-gauged needed is used to inject the tiny "pellet" ~ but it's given in my abdomen, and they numb me up with a tiny bit of LIDOCAINE first. It's an easy process, actually. It's worked great for me now ~ for years.

Hope your side effects are lessening, day by day!

CYCLONE ~ # Iowa State University
Posted 3/25/2023 3:14 PM (GMT 0)
Had my one and only experience with cellulitis about 6 years ago. It was in the winter and was brought on by poor sanitation. I was skiing every day and came back home with itchy toes which was not uncommon for me. Used the same sweaty boots every day which probably were just full of microcostic critters.Scratched at them until I broke the skin. Missed taking a shower for a few days which was unusual, blame it on my wife as she was out of town, even though we have 3 bathrooms with showers and a hot tub.
Woke up one morning with left lower leg red and swollen. End of day no improvement so went to ER. Doctor who I knew from skiing said it was cellulitis and put me on IV antibiotics. There were 2 other older guys in ER with the same problem but they were having a lot more serious issues with the cellulitis and had to stay in the hospital. I had to come back the next 3 days for a few hours as I was on an antibiotic drip. Cellulitis cleared up fine.
Doctor said sometimes this condition can be serious enough to cause amputations. I am guessing that it has something to do with a weakened immune system, old age or both as I have had lots of times in the past when skin between toes has been broken with out problems such as on multi day hikes where there is no or poor sanitation.
Give thanks to modern medicine.

Dave
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