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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]" /><meta name="citation_title" content="Triptorelin" /><meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="citation_date" content="2023/05/28" /><meta name="citation_pmid" content="31644065" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK548756/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Triptorelin" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="DC.Date" content="2023/05/28" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK548756/" /><meta name="description" content="Triptorelin is a gonadotropin releasing hormone (GnRH) agonist that is a potent inhibitor of the synthesis of testosterone (in men) and estrogen (in women) and is used to treat advanced prostate cancer. Triptorelin is associated with a low rate of transient serum enzyme elevations during therapy, but has not been linked convincingly to cases of clinically apparent acute liver injury." /><meta name="og:title" content="Triptorelin" /><meta name="og:type" content="book" /><meta name="og:description" content="Triptorelin is a gonadotropin releasing hormone (GnRH) agonist that is a potent inhibitor of the synthesis of testosterone (in men) and estrogen (in women) and is used to treat advanced prostate cancer. Triptorelin is associated with a low rate of transient serum enzyme elevations during therapy, but has not been linked convincingly to cases of clinically apparent acute liver injury." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK548756/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/livertox/Triptorelin/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK548756/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All Drug Records" href="/books/n/livertox/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" alt="Cover of LiverTox" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK548756_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK548756_dtls__"><div>Bethesda (MD): <a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>; 2012-.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/livertox/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Triprolidine/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/Trisalicylate/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK548756_"><span class="title" itemprop="name">Triptorelin</span></h1><p class="small">Last Update: <span itemprop="dateModified">May 28, 2023</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="Triptorelin.OVERVIEW"><h2 id="_Triptorelin_OVERVIEW_">OVERVIEW</h2><div id="Triptorelin.Introduction"><h3>Introduction</h3><p>Triptorelin is a gonadotropin releasing hormone (GnRH) agonist that is a potent inhibitor of the synthesis of testosterone (in men) and estrogen (in women) and is used to treat advanced prostate cancer. Triptorelin is associated with a low rate of transient serum enzyme elevations during therapy, but has not been linked convincingly to cases of clinically apparent acute liver injury.</p></div><div id="Triptorelin.Background"><h3>Background</h3><p>Triptorelin (trip" toe rel' in) is a decapeptide analogue of gonadotropin releasing hormone (GnRH) that acts on the pituitary to cause the synthesis and release of luteinizing hormone (LH) and follicle stimulating hormone (FSH), two gonadotropins that act on the male testes to stimulate the production of testosterone and on the female ovaries to induce synthesis of estrogen. Triptorelin and other GnRH agonists cause an initial surge of gonadotropin release, but then lead to down-regulation of their synthesis and secretion which results in a decline in testosterone and estrogen production. Triptorelin, alone or in combination with other antiandrogens, has been found to be palliative in advanced prostate cancer and as effective as surgical castration. Triptorelin was approved for use in the United States for prostate cancer in 2000 and is still widely used, being considered a first line treatment of this hormone responsive malignancy. The GnRH agonists have also been used off label for precocious puberty, infertility, and as a part of gender affirming therapy. Triptorelin is available generically and under the brand name Trelstar in an injectable suspension for intramuscular depot administration every 4 weeks (3.75 mg), 12 weeks (11.25 mg) or 24 weeks (22.5 mg). Triptorelin and the other GnRH analogues cause a profound hypogonadism ("chemical castration") and its common side effects are typical of androgen deprivation, including hot flashes, loss of libido, erectile dysfunction, depression, nausea, diarrhea, weight gain and fluid retention. Rare, but potentially severe adverse events can include immediate hypersensitivity reactions, pituitary apoplexy and, with long term use, weight gain, metabolic changes, diabetes and osteoporosis.</p></div><div id="Triptorelin.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Long term triptorelin is associated with serum enzyme elevations in 2% to 5% of patients, although the elevations are rarely above three times the upper limit of normal (<1%). The enzyme elevations are usually mild, asymptomatic and resolve even without dose modification or drug discontinuation. Triptorelin has not been linked convincingly to cases of acute, clinically apparent liver injury with jaundice.</p><p><a class="def" href="/books/n/livertox/glossary/def-item/glossary.likelihood-score/">Likelihood score</a>: E (unlikely cause of clinically apparent liver injury).</p></div><div id="Triptorelin.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The cause of the minor serum enzyme elevations that can occur during triptorelin therapy is unknown. Triptorelin is a decapeptide similar to GnRH and is metabolized locally in tissue and not by the hepatic cytochrome P450 system. Some serum enzyme elevations may be caused by nonalcoholic fatty liver arising because of weight gain or metabolic changes caused by the androgen deprivation state induced by the GnRH agonist.</p></div><div id="Triptorelin.Outcome_and_Management"><h3>Outcome and Management</h3><p>The serum enzyme elevations during triptorelin therapy rarely require dose modification or drug discontinuation and should instead lead to investigation of other possible causes of liver injury. There is no evidence to indicate that there is cross sensitivity to liver injury among the various GnRH analogues.</p><p>Drug Class: <a href="/books/n/livertox/AntineoplasticAgents/">Antineoplastic Agents</a>, <a href="/books/n/livertox/GnRHAnalogues/">GnRH Analogues</a></p><p>Other Drugs in the Subclass, GnRH Analogues: <a href="/books/n/livertox/Degarelix/">Degarelix</a>, <a href="/books/n/livertox/Goserelin/">Goserelin</a>, <a href="/books/n/livertox/Histrelin/">Histrelin</a>, <a href="/books/n/livertox/Leuprolide/">Leuprolide</a>, <a href="/books/n/livertox/Relugolix/">Relugolix</a></p></div></div><div id="Triptorelin.PRODUCT_INFORMATION"><h2 id="_Triptorelin_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Triptorelin – Generic, Trelstar®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Antineoplastic Agents</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Triptorelin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div><div id="Triptorelin.CHEMICAL_FORMULA_AND_STRUCTU"><h2 id="_Triptorelin_CHEMICAL_FORMULA_AND_STRUCTU_">CHEMICAL FORMULA AND STRUCTURE</h2><div id="Triptorelin.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548756/table/Triptorelin.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Triptorelin.Tc_lrgtbl__"><table><thead><tr><th id="hd_h_Triptorelin.Tc_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_h_Triptorelin.Tc_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NO.</th><th id="hd_h_Triptorelin.Tc_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Triptorelin.Tc_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Triptorelin.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Triptorelin</td><td headers="hd_h_Triptorelin.Tc_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135003636" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">57773-63-4</a>
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</td><td headers="hd_h_Triptorelin.Tc_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C64-H82-N18-O13</td><td headers="hd_h_Triptorelin.Tc_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135003636" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=135003636" alt="image 135003636 in the ncbi pubchem database" /></a>
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</td></tr></tbody></table></div></div></div><div id="Triptorelin.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Triptorelin_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 28 May 2023</p><p>Abbreviations: FSH, follicle stimulating hormone; GnRH, gonadotropin releasing hormone; LH, luteinizing hormone; PSA, prostate specific antigen.</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Triptorelin.REF.zimmerman.1999">Zimmerman HJ. Hepatotoxic effects of oncotherapeutic and immunosuppressive agents. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 699.<div><i>(Expert review of hepatotoxicity published in 1999; the GnRH analogues such as triptorelin are not discussed).</i></div></div></li><li><div class="bk_ref" id="Triptorelin.REF.chitturi.2013">Chitturi S, Farrell GC. Estrogen receptor antagonists. Adverse effects of hormones and hormone antagonists on the liver. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 610-2.<div><i>(Review of hepatotoxicity of hormonal products; does not discuss the GnRH agonists such as triptorelin).</i></div></div></li><li><div class="bk_ref" id="Triptorelin.REF.levin.2018">Levin ER, Vitek WS, Hammes SR. Estrogens, progestins, and the female reproductive tract. In, Brunton LL, Halal-Dandan R, Knollman BC, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 803-31.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Triptorelin.REF.snyder.2018">Snyder PJ. Androgens and the male reproductive tract. In, Brunton LL, Halal-Dandan R, Knollman BC, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 833-43.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Triptorelin.REF.isaacs.2018">Isaacs C, Wellstein A, Riegel AT. Hormones and related agents in the therapy of cancer. In, Brunton LL, Halal-Dandan R, Knollman BC, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 1237-47.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Triptorelin.REF6">Triptorelin pamoate (Trelstar). <span><span class="ref-journal">Med Lett Drugs Ther. </span>2002;<span class="ref-vol">44</span>(1132):51–2.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12058149" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12058149</span></a>]<div>
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<i>(Concise review of the mechanism of action, efficacy, safety and costs of triptorelin for prostate cancer shortly after its approval in the US; mentions that adverse effects are similar to those of goserelin; does not mention ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.heyns.2003.226">Heyns CF, Simonin MP, Grosgurin P, Schall R, Porchet HC., South African Triptorelin Study Group. Comparative efficacy of triptorelin pamoate and leuprolide acetate in men with advanced prostate cancer. <span><span class="ref-journal">BJU Int. </span>2003;<span class="ref-vol">92</span>:226–31.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12887472" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12887472</span></a>]<div>
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<i>(Among 284 men with prostate cancer treated with triptorelin or leuprolide in 9 monthly injections, both beneficial and adverse effects were similar and "there were no substantial changes in laboratory data"; ALT levels were not specifically mentioned).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.carel.2006.119">Carel JC, Blumberg J, Seymour C, Adamsbaum C, Lahlou N. Triptorelin 3-month CPP Study Group. Three-month sustained release triptorelin (11.25 mg) in the treatment of central precocious puberty. <span><span class="ref-journal">Eur J Endocrinol. </span>2006;<span class="ref-vol">154</span>:119–24.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16382000" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16382000</span></a>]<div>
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<i>(Among 64 children [54 girls] with central precocious puberty treated with triptorelin acetate depot injections every 3 months for 1 year, pubertal regression occurred in most subjects and adverse events were generally mild and self-limited; no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.lundstr_m.2009.757">Lundström EA, Rencken RK, van Wyk JH, Coetzee LJ, Bahlmann JC, Reif S, Strasheim EA, et al. Triptorelin 6-month formulation in the management of patients with locally advanced and metastatic prostate cancer: an open-label, non-comparative, multicentre, phase III study. <span><span class="ref-journal">Clin Drug Investig. </span>2009;<span class="ref-vol">29</span>:757–65.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19888782" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19888782</span></a>]<div>
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<i>(Among 120 patients given triptorelin in 6-month formulation [22.5 mg] for one year, the most common side effects were hot flashes [72%], erectile dysfunction [10%] and injection site reactions [7%], and one patient had a rise in ALT levels [peak=60 U/L] on day 337).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.rabaglio.2010.874">Rabaglio M, Ruepp B., Soft/Text/Perche Steering Committee. Death due to liver failure during endocrine therapy for premenopausal breast cancer. <span><span class="ref-journal">Acta Oncol. </span>2010;<span class="ref-vol">49</span>:874–6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20482225" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20482225</span></a>]<div>
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<i>(Among 4500 women enrolled in an international trial of endocrine therapy of premenopausal breast cancer comparing tamoxifen and exemestane combined with ovarian suppression often with triptorelin, 2 developed liver failure: 50 year old on endocrine therapy for two years developed suspected acute alcoholic hepatitis and died 1 month later [bilirubin 23.2 mg/dL, ALT 182 U/L, AST 294 U/L, GGT 2623 U/L, Alk P 382 U/L]; 36 year old woman on endocrine therapy including tamoxifen for 3 years developed nonspecific symptoms and hepatomegaly and died suddenly, autopsy showing cirrhosis with steatosis, possibly due to or exacerbated by tamoxifen; in neither case could triptorelin be convincingly implicated).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.crawford.2011.201">Crawford ED, Phillips JM. Six-month gonadotropin releasing hormone (GnRH) agonist depots provide efficacy, safety, convenience, and comfort. <span><span class="ref-journal">Cancer Manag Res. </span>2011;<span class="ref-vol">3</span>:201–9.</span> [<a href="/pmc/articles/PMC3154964/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3154964</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21847353" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21847353</span></a>]<div>
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<i>(Review of results on two GnRH agonist depot formulations for advanced prostate cancer that allow for every 6-month administration [leuprolide and triptorelin], both of which provide sustained testosterone suppression and have adverse side effects similar to other GnRH agonist formulations; mentions a single episode of minor asymptomatic ALT [60 U/L] and AST [65 U/L] elevations in a patient receiving triptorelin [Ludström 2009]).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.del_mastro.2011.269">Del Mastro L, Boni L, Michelotti A, Gamucci T, Olmeo N, Gori S, Giordano M, et al. Effect of the gonadotropin-releasing hormone analogue triptorelin on the occurrence of chemotherapy-induced early menopause in premenopausal women with breast cancer: a randomized trial. <span><span class="ref-journal">JAMA. </span>2011;<span class="ref-vol">306</span>:269–76.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21771987" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21771987</span></a>]<div>
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<i>(Among 181 premenopausal women with breast cancer treated with chemotherapy alone or combined with triptorelin [for 6 months], early onset of menopause was less common with triptorelin therapy [9% vs 26%] and adverse events were similar in the two groups; no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.boccongibod.2011.127">Boccon-Gibod L, van der Meulen E, Persson BE. An update on the use of gonadotropin-releasing hormone antagonists in prostate cancer. <span><span class="ref-journal">Ther Adv Urol. </span>2011;<span class="ref-vol">3</span>:127–40.</span> [<a href="/pmc/articles/PMC3159401/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3159401</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21904569" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21904569</span></a>]<div>
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<i>(GnRH antagonists such as degarelix have similar efficacy to GnRH agonists in therapy of prostate cancer but have a more rapid onset of action and do not cause the initial testosterone surge that occurs with the agonists, which can be particularly troublesome in patients with a large tumor burden).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.van_poppel.2012.594">Van Poppel H, Klotz L. Gonadotropin-releasing hormone: an update review of the antagonists versus agonists. <span><span class="ref-journal">Int J Urol. </span>2012;<span class="ref-vol">19</span>:594–601.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22416801" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22416801</span></a>]<div>
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<i>(Review of androgen deprivation therapy for prostate cancer using GnRH agonists and antagonists stressing the more rapid onset of action and similar if not better safety profile of GnRH antagonists).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.walker.2013.375">Walker LM, Tran S, Robinson JW. Luteinizing hormone--releasing hormone agonists: a quick reference for prevalence rates of potential adverse effects. <span><span class="ref-journal">Clin Genitourin Cancer. </span>2013;<span class="ref-vol">11</span>:375–84.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23891497" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23891497</span></a>]<div>
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<i>(Systematic review of adverse event profile of long-term use of GnRH agonists which mostly relate to hypogonadism: hot flashes, gynecomastia, genital shrinkage, hair loss, osteoporosis, mild anemia, hyperglycemia, increased weight, loss of skeletal muscle mass, emotional lability, depression, loss of sexual desire and erectile dysfunction; no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.ploussard.2013.93">Ploussard G, Mongiat-Artus P. Triptorelin in the management of prostate cancer. <span><span class="ref-journal">Future Oncol. </span>2013;<span class="ref-vol">9</span>:93–102.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23252566" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23252566</span></a>]<div>
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<i>(Review of the efficacy and safety of triptorelin as therapy of prostate cancer focusing upon 1 vs 3 vs 6 monthly formulations; no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.bj_rnsson.2013.1419">Björnsson ES, Bergmann OM, Björnsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. <span><span class="ref-journal">Gastroenterology. </span>2013;<span class="ref-vol">144</span>:1419–25.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23419359" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23419359</span></a>]<div>
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<i>(In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, but none were attributed to triptorelin or any of the GnRH analogues).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.chalasani.2015">Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al.; United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. Gastroenterology 2015; 148: 1340-52.e.7. [<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div><i>(Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, none were attributed to triptorelin or any of the GnRH analogues).</i></div></div></li><li><div class="bk_ref" id="Triptorelin.REF.lambertini.2015.2632">Lambertini M, Boni L, Michelotti A, Gamucci T, Scotto T, Gori S, Giordano M, et al. GIM Study Group. Ovarian suppression with triptorelin during adjuvant breast cancer chemotherapy and long-term ovarian function, pregnancies, and disease-Free survival: a randomized clinical trial. <span><span class="ref-journal">JAMA. </span>2015;<span class="ref-vol">314</span>:2632–40.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26720025" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26720025</span></a>]<div>
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<i>(Among 281 premenopausal women with breast cancer treated with chemotherapy with or without triptorelin [Del Mastro 2011], long term disease-free survival rates were similar while rates of menstrual resumption were slightly higher with triptorelin; no mention of adverse events, ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.zenaty.2016.188">Zenaty D, Blumberg J, Liyanage N, Jacqz-Aigrain E, Lahlou N, Carel JC. Co-Investigators. A 6-month trial of the efficacy and safety of triptorelin pamoate (11.25 mg) every 3 months in children with precocious puberty: a retrospective comparison with triptorelin acetate. <span><span class="ref-journal">Horm Res Paediatr. </span>2016;<span class="ref-vol">86</span>:188–95.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27603324" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27603324</span></a>]<div>
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<i>(Among 37 children with precocious puberty treated with triptorelin pamoate depot injections every 3 months, pubertal regression occurred in most and adverse events were generally mild and self-limited: no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.schagen.2016.1125">Schagen SE, Cohen-Kettenis PT, Delemarre-van de Waal HA, Hannema SE. Efficacy and Safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. <span><span class="ref-journal">J Sex Med. </span>2016;<span class="ref-vol">13</span>:1125–32.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27318023" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27318023</span></a>]<div>
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<i>(Among 49 male-to-female and 67 female-to-male gender dysphoric adolescents treated with triptorelin for at least 6 months, ALT and AST elevations were present in 5% to 10% of subjects at baseline and levels did not change during treatment, however, growth velocity slowed, and lean body mass decreased while fat percentage increased).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.bolton.2018.371">Bolton EM, Lynch TH. Are all gonadotropin-releasing hormone agonists equivalent for the treatment of prostate cancer? A systematic review. <span><span class="ref-journal">BJU Int. </span>2018;<span class="ref-vol">122</span>(3):371–83.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29438592" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29438592</span></a>]<div>
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<i>(Systematic review of literature on relative efficacy and safety of different GnRH agonists, indicates that there is little evidence of superiority of any of the four, largely because of lack of adequately powered, controlled studies comparing them).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.cornford.2018.173">Cornford P, Jefferson K, Cole O, Gilbody J. Effects of initiating or switching to a six-monthly triptorelin formulation on prostate cancer patient-healthcare interactions and hospital resource use: a real-world, retrospective, non-interventional study. <span><span class="ref-journal">Oncol Ther. </span>2018;<span class="ref-vol">6</span>:173–187.</span> [<a href="/pmc/articles/PMC7359994/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7359994</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32700031" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32700031</span></a>]<div>
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<i>(Among 41 adults with advanced prostate cancer who were switched from every 1 or 3 monthly GnRH regimen to 6 monthly triptorelin, healthcare visits, injections and PSA testing were less as were adverse side effects including fatigue [12% vs 26%], urinary frequency [9% vs 32%], and bone pain [7% vs 14%]; no mention of ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.lambertini.2022.400">Lambertini M, Boni L, Michelotti A, Magnolfi E, Cogoni AA, Mosconi AM, Giordano M, et al. GIM study group. Long-term outcomes with pharmacological ovarian suppression during chemotherapy in premenopausal early breast cancer patients. <span><span class="ref-journal">J Natl Cancer Inst. </span>2022;<span class="ref-vol">114</span>:400–408.</span> [<a href="/pmc/articles/PMC8902441/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8902441</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34850043" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34850043</span></a>]<div>
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<i>(Among 281 women with early onset breast cancer treated with chemotherapy with or without a GnRH analogue to preserve ovarian function, disease-free and overall survival were similar in the two groups and those given the GnRH analogue were slightly more likely to have a successful pregnancy during follow up [6.5% vs 3.2%]; no mention of other adverse events, ALT levels or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Triptorelin.REF.popovic.2022.968485">Popovic J, Geffner ME, Rogol AD, Silverman LA, Kaplowitz PB, Mauras N, Zeitler P, et al. Gonadotropin-releasing hormone analog therapies for children with central precocious puberty in the United States. <span><span class="ref-journal">Front Pediatr. </span>2022;<span class="ref-vol">10</span>:968485. </span> [<a href="/pmc/articles/PMC9577333/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9577333</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36268040" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36268040</span></a>]<div>
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<i>(Review of the 3 GnRH analogues used to treat children with precocious puberty including leuprolide, triptorelin, and histrelin which have different regimens of administration [intramuscular and subcutaneous] and durations of action [1-12 months]; no mention of liver adverse events).</i>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK548756/?report=reader">PubReader</a></li><li><a href="/books/NBK548756/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK548756" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK548756" style="display:none" title="Cite this Page"><div class="bk_tt">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. 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<a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&pubmedfilters=true&term=Triptorelin+AND+Human%5BMH%5D+AND+(drug+induced+liver+injury+OR+jaundice/CI+OR+bile+duct+diseases/CI+OR+liver/DE+OR+liver+diseases/CI)+AND+(%221900/1/1%22%5BEDat%5D:%222999/12/31%22%5BEDat%5D)" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Recent References on Triptorelin: from PubMed.gov</a>
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<a href="https://clinicaltrials.gov/ct2/results?term=Triptorelin" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Trials on Triptorelin: from ClinicalTrials.gov</a>
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xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Histrelin.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31643199" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Gonadotropin Releasing Hormone (GnRH) Analogues.</a><span class="source">[LiverTox: Clinical and Researc...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Gonadotropin Releasing Hormone (GnRH) Analogues.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31643987" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Leuprolide.</a><span class="source">[LiverTox: Clinical and Researc...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Leuprolide.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31644049" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Goserelin.</a><span class="source">[LiverTox: Clinical and Researc...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Goserelin.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/19563062" ref="ordinalpos=1&linkpos=5&log$=relatedarticles&logdbfrom=pubmed">[Effect of gonadotropin-releasing hormone-I agonist and gonadotropin-releasing hormone-II on endometrial carcinoma cell lines with different states of PTEN].</a><span class="source">[Zhonghua Fu Chan Ke Za Zhi. 2009]</span><div class="brieflinkpop offscreen_noflow">[Effect of gonadotropin-releasing hormone-I agonist and gonadotropin-releasing hormone-II on endometrial 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