Firmagon / degarelix -- a LHRH antagonist you may find frightening - may not .. ..

[Sam-theMan]

Shame to waste this one. It was a response on another list to someone
asking about this new product. With my pretty extensive experience
over the last 15 years I have managed to pick up something useful on
many topics. Why this one never got through the so called 'Moderator'
on the Listserv concerned is beyond me, truly. Anyhow, like I said,
shame to waste a good post, so here it is. Note similar working of
Firmagon with DES, they are compatible (again, you may find this
useful, you may not .. ). Oh god, I hope it doesn't come out all
mangled. Too late ..



Now, I don't want to frighten you but .. .

Pain induced by Firmagon/degarelix injection is just the way it is I
am afraid. The predecessor to this LHRH-antagonist (it was known as
Plenaxis/abarelix) was even worse by all accounts. Firmagon/degarelix
injection reaction wears off in time I am told. The injection causes a
reaction similar to an insect bite. You may find something like
loratedine (anti-allergic / anti-hay fever) or a topical analgesic
helpful. However, you may as well get used to the idea that this
product will cause some discomfort. I think if it works for you then
the trade-off is acceptable. It is when the stuff does not work, and
hurts like hell into the bargain - then it becomes a laughing matter.
[ No good crying, no-one takes any notice #:-]

Suggestion: Prior to injection, it is important to monitor the
reconstitution, and follow the instructions to the word. [ You are
provided with bottles of sterilised water, degarelix powder for
reconstitution, needles and syringes. Sticking in the needle is the
least of your problems with this stuff. ] Take regular bloods PSA / T
/ LH/FSH to see how your body responds - especially so if you are used
to taking LHRH-agonist. I stopped degarelix in early 2010 because my
PSA would not go below a certain value I regarded as unacceptable. I
returned to other means of suppressing T in my IHT cycles. It worked,
and the suggestion by my doc that degarelix 'proved' I had become CRPC
was false. I think previous batches of LHRH-agonist I had been using
plus prophylactic AA were generics & sub-standard. [ There is an issue
here for men who may be borderline CRPC. Monitor blood regularly, and
as Henk Scholten used to say, don't provide the beast with an easy
target. Keep your meds on the move. ]

Hitherto, I have done all my own injections. As an 'informed patient'
- like diabetics and others who self inject - have some flexibility,
although one never quite knows where one is with doctors. They like to
reign you in now and then just to show you who is boss. Basically, NHS
staff do not have the time or resources to sit around waiting for the
powder + water to 'reconstitute' in a satisfactory way, and follow the
instructions to "Repeat with a fresh supply of this product" if
anything goes wrong.[ At several hundred$$ a shot they are not likely
to keep spares around are they ? ] If you have any doubts about the
injection contact me and (as an informed patient) I will advise as
best as I can.

I still have lumps on my belly from the earlier degarelix injections,
lumps where the bolus formed too quickly. The reconstituted liquid
binds with subcutaneous fat to form a slow release matrix. When I
touch the lumps accidentally there is still a sensation, just like an
insect sting. If the injection is done exactly right, you have a good
chance of dispersing the liquid along an 'interface' between layers of
fat tissue before the liquid solidifies. That kind of 'sheet' will NOT
still give a sensation after several months so I do not think it is
arguable that said method of delivery is incorrect. A tightly formed
bolus on the other hand has much less surface area for the active
agent to disperse away from, and may give a substandard dose over a
much longer period. The whole thing seems very much determined by
ambient temperature, and body mass of the individual concerned.

The background literature has all kinds of dispersal equations for
different injection concentrations. I am surprised the pilot studies
took such a short time to mature beforen the FDA OK'd this stuff. [
Perhaps it is because it is so similar to abarelix ... ]. It is
expensive too, and because of the need to start off with a double-dose
discourages the practice of intermittent therapy. Having said all
that, I found the European Branch of the company supplying Firmagon
(CEO & staff) very helpful. I contacted them directly regarding one
batch of their product which failed to reconstitute in over 30 minutes
(should take no longer than 10 mins). My hunch was that the batch had
been stored at high temperature in a wharehouse over the long hot
summer of 2009, when in fact it should have been kept refrigerated /
cooled - at least to < 25'C. I received the replacement shot the next
day through my pharmacist. No quibbling.

Now, if degarelix works for you it is a good alternative to
LHRH-agonist, and you need to use alternatives to prevent 'drug
resistance'*. Like other LHRH-antagonists you do not get an up-front
surge of LH/FSH >> T but you do get that old PC-SPES-like problem of
withdrawal LH/FSH 'bounce' with prolonged low T due to the suppressive
effect on Sertoli cells. I think a 1 month zoladex / lupron at the end
of a degarelix cycle may do the trick, it seemed to work for me. 15
years into the game now and almost as many IHT cycles. Oh boy what fun
- but at least I beat the initial prognosis of 18months - 2 years :-]
Hope this has been of some use to you - an u enjoy d rambl.

Sam

*'drug resistance': WRT zoladex, lupron, DES, degarelix this is
confused by doctors with CRPC.





--

Free PDF download [0]; for background see [1]; and for an update on
current thinking see [2]:

http://poetryfromtheprostrateyears.com/ISBN.9780954993511/

0. ProstateCancer.pdf
1. Guide.html
2. calreticulin.connection.html

'Scuse the typos - they still creep in here and there when I am in a
rush !!

[Ann]

Hi Sam and All, Very helpful post., Sam. Many thanks!

John is now on Degarelix. Like Leo, he was on Q+ for years and then PSA was creeping up in spite of having good batches.  Tried Casodex as a monotherapy but PSA shot up. Then Lupron failed as well as Flutamide.

So we are glad of the drop in PSA although we wish it were more. And wondering what next PSA will show.

I am wondering about your comment about using Degarelix with DES. How do they work together? We have some.

Here are recent PSAs etc. 

Dec 19 - 162 at LifeLabs

Dec 11 - started Avodart

Dec 7 - 1st Degarelix injection (T had crept up to 2...)

Nov 15/12 - 241  

Nov 11 - began prednisone 

FYI: LIfeLabs changed their testing system and in new system, PSA results are 10% higher. The test on Oct 11/12 was done under new system. 

Oct 11/12 - 133.0  

Sep 18/12 - 110

Aug 30/12 - 83.2   

Injection was given at PC clinic at hospital...presumably they know what they are doing. Sore for 2-3 days. 

Any thoughts?

Ann

PS: FYI: cancer is considered "locally advanced". No symptoms except fatigue.

Sent from my iPhone

On 2011-06-23, at 11:21 PM, Sam-theMan <georgias...@gmail.com> wrote:

Note similar working of

Firmagon with DES, they are compatible (again, you may find this

useful, you may not .

[PDT:581] Firmagon / degarelix -- a LHRH antagonist you may find frightening - may not .. ..