Lupron (Leuprolide) Dosing Recommendations
Fertility Preservation in Lupus Nephritis
For women with lupus nephritis receiving intravenous cyclophosphamide who desire future childbearing, leuprolide should be administered as a gonadotropin-releasing hormone agonist to preserve ovarian function. 1
Specific Dosing Regimen
- Standard dose: 1 mg (0.2 mL) administered as a single daily subcutaneous injection 2
- Rotate injection sites periodically to minimize local reactions 2
- Timing is critical: leuprolide must be dosed in relation to cyclophosphamide exposure, limiting its practical use with oral cyclophosphamide regimens 1
Clinical Context for Use
- Leuprolide is specifically recommended for patients receiving low-dose intravenous cyclophosphamide (total dose 3g over 3 months) or the NIH/Euro-Lupus IV cyclophosphamide regimens 1
- This represents a Practice Point in the 2024 KDIGO guidelines as an adjunctive measure to minimize premature ovarian failure risk 1
- Alternative fertility preservation options include sperm/oocyte cryopreservation, though these carry higher costs and risks including hormonal exposure and treatment delays 1
Important Caveats
- Mycophenolate-based regimens are now preferred first-line for patients at high risk of infertility (those with moderate-to-high prior cyclophosphamide exposure), potentially eliminating the need for leuprolide altogether 1
- The evidence supporting leuprolide for fertility preservation in lupus nephritis is based on expert consensus rather than randomized trials specific to this population 1
- Leuprolide works by inducing temporary medical castration through pituitary desensitization, suppressing gonadotropins and sex hormones 3
Monitoring Requirements
- Verify ovarian suppression has occurred (estradiol <40 pg/mL, FSH 23-116 mU/mL) within 3 months of initiating therapy 4
- Continue daily injections throughout the entire cyclophosphamide treatment course 1
- Inspect solution for discoloration and particulate matter before each injection 2
Alternative Depot Formulations (Non-Lupus Indications)
While not indicated for lupus nephritis fertility preservation, other leuprolide depot formulations exist for different conditions:
- 7.5 mg monthly IM/SC depot for prostate cancer and endometriosis 3, 5
- 22.5 mg every 3 months IM depot for prostate cancer 5, 4
- 30 mg every 4 months IM depot for advanced prostate cancer 5
- 3.75-15 mg monthly depot for central precocious puberty 6
These depot formulations are not appropriate for fertility preservation during cyclophosphamide therapy, which requires the daily 1 mg subcutaneous formulation for precise timing with chemotherapy cycles 1, 2.