Nafarelin Nasal Spray

Nafarelin nasal spray is used to manage endometriosis (a condition in which the type of tissue that lines the uterus [womb] grows in other areas of the body and causes infertility, pain before and during menstrual periods, pain during and after sexual activity, and heavy or irregular bleeding) and to treat central precocious puberty (CPP; a condition causing children to enter puberty too soon, resulting in faster than normal bone growth and development of sexual characteristics). Nafarelin is in a class of medications called gonadotropin-releasing hormone (GnRH) agonists. It works by decreasing the amount of certain hormones in the body.

Nafarelin comes as a solution (liquid) to spray in the nose..

If you are using nafarelin nasal spray to treat endometriosis, use twice a day (about 12 hours apart) as one spray in one nostril in the morning and one spray in the other nostril in the evening. Start nafarelin between the second and fourth days of your menstrual period. After 2 months, your doctor may increase your dose. The length of treatment is usually 6 months.

If you are using nafarelin nasal spray to treat precocious puberty, spray in each nostril 2 or 3 times a day. Your doctor will tell you how much nafarelin nasal spray to use and when to use it.

Use nafarelin nasal spray exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor. Do not stop using nafarelin nasal spray without talking to your doctor.

Avoid sneezing or blowing your nose during or immediately after using nafarelin nasal spray. This decreases nafarelin's effectiveness.

Before you use nafarelin nasal spray for the first time, read the written directions that come with it. Ask your doctor or pharmacist if you have any questions about how to use the nasal spray.

To use the nasal spray, follow these steps:

1. Gently blow your nose.
2. Remove the plastic cap and safety clip from the pump.
3. Hold the pump with the applicator between your index and middle finger with your thumb under the bottle.
4. If you are using the pump for the first time, point the applicator away from your face. Press your thumb and fingers firmly and quickly against the pump 7 to 10 times until you see a fine spray.
5. Before and after using the spray, hold the pump horizontally, and rinse the tip with warm water for 15 seconds while wiping the tip with a cloth or your finger. Wipe the tip with a clean tissue to dry.
6. Hold one nostril closed with your finger.
7. Tilt your head slightly forward and insert the nasal tip into the other nostril. Keep the bottle upright. Point the tip toward the back and outer side of the nose. Children using the nasal spray should tilt their head slightly back.
8. Begin to breathe in through your nose. 
9. While you are breathing in, use your index and middle finger to press firmly down on the applicator and release a spray. Remove the sprayer from your nose and tilt your head back for a few seconds.
10. If your doctor told you to use two sprays in the same nostril, wait 30 seconds and then repeat steps 6 through 9 in the same nostril.
11. If your doctor told you to use the spray in the other nostril, repeat steps 6 through 9 in the other nostril.
12. Repeat step 5 to clean the spray tip and replace the cap and safety clip.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using nafarelin,

• tell your doctor or pharmacist if you are allergic to this drug, any part of this drug, or any other drugs, foods or substances. Tell your doctor or pharmacist about the allergy and what symptoms you had.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while using nafarelin nasal spray. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• If you are using nasal spray decongestants such as oxymetazoline (Afrin^®, others), use them at least 2 hours after using nafarelin nasal spray.
• tell your doctor if you have unusual vaginal bleeding. Your doctor may tell you not to use nafarelin nasal spray.
• tell your doctor if you have a history of drinking alcohol or using tobacco products for a long period of time, or if you or anyone in your family has or has ever had osteoporosis (condition where bones are thin and more likely to break). Also tell your doctor if you have or have ever had ovarian cysts, seizures, brain tumors, cerebrovascular disease (clogging or weakening of the blood vessels within the brain or leading to the brain), chronic rhinitis (runny nose), or mental problems such as depression.
• tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while you are using nafarelin nasal spray. You may need to take a pregnancy test before starting treatment. If you can become pregnant, use an effective non-hormonal birth control to prevent pregnancy while using nafarelin nasal spray (e.g., condom or diaphragm). If you become pregnant while using nafarelin nasal spray, call your doctor immediately. Nafarelin may harm the fetus.
• tell your doctor if you are breastfeeding. You should not breastfeed while you are using nafarelin nasal spray.

Use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.

If doses are missed, you may experience breakthrough menstrual bleeding or signs of puberty. Do not be alarmed, but inform your doctor.

Nafarelin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• acne
• changes in breast size
• vaginal bleeding (menstruation should stop with this medication)
• mood swings
• increase in pubic hair
• body odor
• oily, flaky, or scaly skin
• nasal irritation
• headache
• hot flashes
• vaginal dryness or vaginal discharge
• change in sex drive
• muscle aches
• rhinitis (stuffy or runny nose)

If you experience any of the following symptoms, call your doctor immediately:

• abdominal or pelvic pain
• rash, hives, itching, shortness of breath or difficulty breathing, or chest pain
• dry, itchy, blistering, or peeling skin; rash; acne; redness or swelling of your face, hands or soles of your feet; mouth sores or blisters; fever; muscle or joint aches; or swollen glands
• crying, irritability, impatience, anger, or aggressive behavior
• depression
• sudden headache, blurred vision, vision changes, eye pain, ringing in the ears, dizziness, or nausea
• seizures

Nafarelin may cause a decrease in the density of your bones, which can increase the chance of broken bones. Talk to your doctor about the risks of using this medication and to find out what you can do to decrease these risks.

In children receiving nafarelin nasal spray for precocious puberty, new or worsening symptoms of sexual development may occur during the first month of treatment. In girls receiving nafarelin nasal spray for precocious puberty, the onset of menstruation or spotting (light vaginal bleeding) and breast enlargement may occur during the first month of treatment. If bleeding continues beyond the second month, call your doctor.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, upright, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom).

Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website https://goo.gl/c4Rm4p for more information.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests before you begin treatment and during your treatment.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

• Synarel^®