Perioperative Management of Eligard (Leuprolide) for General Anesthesia
Eligard (leuprolide) does not need to be held prior to general anesthesia. 1
Rationale for Continuing Eligard
- Leuprolide acetate (Eligard) is a gonadotropin-releasing hormone (GnRH) agonist that does not have properties that would increase perioperative risk or interact with anesthetic agents 2
- Leuprolide maintains steady serum concentrations after administration and does not require discontinuation before surgical procedures 3
- Unlike medications that affect coagulation, gastric emptying, or hemodynamics, leuprolide does not have pharmacological properties that would necessitate discontinuation before surgery 1
Clinical Considerations
- Leuprolide is commonly used for advanced prostate cancer treatment and works by suppressing testosterone levels to castrate range (≤50 ng/dL) 4
- The medication is available as a depot formulation that maintains steady drug levels for extended periods (12 weeks for the 22.5 mg formulation) 4
- Even delaying a scheduled injection by up to 2 weeks does not affect testosterone suppression, indicating the stability of its therapeutic effect 4
Perioperative Management Approach
- The Society for Perioperative Assessment and Quality Improvement (SPAQI) does not list leuprolide among medications that need to be discontinued before surgery 5
- Unlike medications that affect serotonin levels, blood glucose, or coagulation, leuprolide is not mentioned in perioperative guidelines as requiring discontinuation 5
- The decision to continue medications perioperatively should be based on withdrawal potential, disease progression risk if therapy is interrupted, and potential for drug interactions with anesthesia 1
Important Distinctions from Other Medications
- Unlike GLP-1 receptor agonists (e.g., semaglutide, dulaglutide) which delay gastric emptying and increase aspiration risk, leuprolide does not affect gastric motility and does not require discontinuation 5, 6
- Unlike anticoagulants or antiplatelet agents that increase bleeding risk and require specific timing for discontinuation, leuprolide does not affect coagulation parameters 5
- Unlike medications that require tapering to prevent withdrawal symptoms, abrupt discontinuation of leuprolide is not associated with acute withdrawal effects 7
Common Pitfalls to Avoid
- Do not confuse leuprolide with medications that require perioperative discontinuation such as anticoagulants, antiplatelet agents, or GLP-1 receptor agonists 5
- Do not unnecessarily discontinue leuprolide before surgery, as interruption of therapy could potentially allow disease progression without providing any anesthetic benefit 1
- Avoid assuming that all injectable or depot medications require discontinuation before surgery; each medication should be evaluated based on its pharmacological properties and potential for interaction with anesthetics 7