What should I discuss with my healthcare provider before using nafarelin nasal (Synarel)?

You should not use this medication if you are allergic to nafarelin or similar medicines such as leuprolide (Lupron, Eligard, Viadur), goserelin (Zoladex), histrelin (Vantas), or triptorelin (Trelstar).

• abnormal vaginal bleeding that has not been checked by a doctor; or
• if you are pregnant or breast-feeding.

To make sure you can safely use nafarelin nasal, tell your doctor if you have any of these other conditions:

• diabetes, heart disease, high blood pressure, recent weight gain, high cholesterol (especially in men);
• polycystic ovary disease;
• low bone mineral density;
• a personal or family history of osteoporosis;
• sneezing or a runny nose;
• if you take steroids or seizure medication; or
• if you smoke or drink large amounts of alcohol.

FDA pregnancy category X. This medication can harm an unborn baby or cause birth defects. Do not use nafarelin nasal if you are pregnant. Tell your doctor right away if you become pregnant during treatment.

Use a barrier form of birth control (such as a condom or diaphragm with spermicide). Hormonal contraception (such as birth control pills, injections, implants, skin patches, and vaginal rings) may not be effective enough to prevent pregnancy during your treatment.

It is not known whether nafarelin nasal passes into breast milk or if it could harm a nursing baby. Do not breast-feed while using this medication.

How should I use nafarelin nasal (Synarel)?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

To use the nasal spray:

• Before the first use, prime the spray bottle by pumping it 5 to 10 times until a fine spray appears.
• Gently blow your nose to clear any mucus. Uncap the spray bottle.
• Insert the tip of the spray bottle into your nostril, pointing it straight upward. Block your other nostril with your finger. Quickly and gently pump the spray bottle one time and sniff gently at the same time. Remove the pump from your nose and tilt your head back slightly for a few seconds.
• If using more than one spray per nostril, wait at least 30 seconds between each spray.
• Clean the spray bottle tip with a tissue and recap it.

To be sure this medication is helping your condition and is not causing harmful effects, your doctor will need to check your progress on a regular basis, especially during the first 6 to 8 weeks of treatment. Do not miss any scheduled appointments.

When you first start using nafarelin nasal to treat precocious puberty, you may notice an increase in signs of puberty, such as enlarged breasts or vaginal bleeding. These are normal side effects of this medication during the first month of use. If such pubertal signs continue for longer than 1 month, contact your doctor.

Use nafarelin nasal regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Store at room temperature away from moisture, heat, and light. Keep the bottle upright when not in use.

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