Triptorelin

{{Short description|GnRH-agonist}} {{Use dmy dates|date=September 2025}} {{cs1 config|name-list-style=vanc|display-authors=6}} {{Drugbox | Verifiedfields = changed | Watchedfields = changed | verifiedrevid = 477865893 | image = Triptorelin.svg | image_class = skin-invert-image | width = 250 | alt =  | tradename = Decapeptyl, others | Drugs.com = {{drugs.com|CONS|triptorelin}} | MedlinePlus = | DailyMedID = Triptorelin | pregnancy_category = | routes_of_administration = Intramuscular | class = GnRH analogue; GnRH agonist; Antigonadotropin | ATC_prefix = L02 | ATC_suffix = AE04 | ATC_supplemental = {{ATCvet|H01|CA97}}

| legal_AU = S4 | legal_AU_comment = <ref>{{cite web | title=Prescription medicines: registration of new chemical entities in Australia, 2015 | website=Therapeutic Goods Administration (TGA) | date=21 June 2022 | url=https://www.tga.gov.au/prescription-medicines-registration-new-chemical-entities-australia-2015 | access-date=10 April 2023}}</ref> | legal_BR =  | legal_BR_comment = | legal_CA = Rx-only | legal_CA_comment = | legal_DE =  | legal_DE_comment = | legal_NZ =  | legal_NZ_comment = | legal_UK =  | legal_UK_comment = | legal_US = Rx-only | legal_US_comment = <ref>{{cite web | title=Triptodur- triptorelin kit | work = DailyMed | publisher = U.S. National Library of Medicine | date=28 April 2022 | url= https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f41380e7-b830-432d-a5f5-a872932f107e | access-date=15 May 2022}}</ref> | legal_EU = | legal_EU_comment = | legal_UN =  | legal_UN_comment = | legal_status = Rx-only

| bioavailability = | protein_bound = | metabolism = | elimination_half-life = The elimination half-life for patients with hepatic impairment was similar to that of patients with renal impairment (geometric mean t(1/2, z): 6.6 h, 7.7 h and 7.6 h for Groups II, III and IV, respectively), but significantly longer than in healthy volunteers (2.8 h for Group I)

<ref>{{cite journal | vauthors = Müller FO, Terblanchè J, Schall R, van Zyl Smit R, Tucker T, Marais K, Groenewoud G, Porchet HC, Weiner M, Hawarden D | title = Pharmacokinetics of triptorelin after intravenous bolus administration in healthy males and in males with renal or hepatic insufficiency | journal = British Journal of Clinical Pharmacology | volume = 44 | issue = 4 | pages = 335–341 | date = October 1997 | pmid = 9354307 | pmc = 2042859 | doi = 10.1046/j.1365-2125.1997.t01-1-00592.x }}</ref>

Triptorelin is a gonadotropin-releasing hormone (GnRH) analogue with enhanced affinity for GnRH receptors and a prolonged half-life due to its resistance to enzymatic degradation. | excretion = Kidney

| CAS_number_Ref = {{cascite|changed|??}} | CAS_number = 57773-63-4 | PubChem = 25074470 | IUPHAR_ligand = 1177 | DrugBank_Ref = {{drugbankcite|changed|drugbank}} | DrugBank = DB06825 | ChemSpiderID_Ref = {{chemspidercite|changed|chemspider}} | ChemSpiderID = 17290424 | UNII_Ref = {{fdacite|correct|FDA}} | UNII = 9081Y98W2V | KEGG_Ref = {{keggcite|changed|kegg}} | KEGG = D06247 | KEGG2 = D08649 | ChEBI_Ref = {{ebicite|changed|EBI}} | ChEBI = 63633 | ChEMBL_Ref = {{ebicite|changed|EBI}} | ChEMBL = 1201334 | synonyms =  | IUPAC_name = 5-oxo-D-prolyl-L-histidyl-Ltryptophyl-L-seryl-Ltyrosyl-3-(1''H''-indol-2-yl)-L-alanylleucyl-L-arginyl-L-prolylglycinamide | C = 64 | H = 82 | N = 18 | O = 13 | SMILES = CC(C)C[C@@H](C(=O)N[C@@H](CCCNC(=N)N)C(=O)N1CCC[C@H]1C(=O)NCC(=O)N)NC(=O)[C@@H](Cc2c[nH]c3c2cccc3)NC(=O)[C@H](Cc4ccc(cc4)O)NC(=O)[C@H](CO)NC(=O)[C@H](Cc5c[nH]c6c5cccc6)NC(=O)[C@H](Cc7cnc[nH]7)NC(=O)[C@@H]8CCC(=O)N8 | StdInChI_Ref = {{stdinchicite|changed|chemspider}} | StdInChI = 1S/C64H82N18O13/c1-34(2)23-46(56(88)75-45(13-7-21-69-64(66)67)63(95)82-22-8-14-52(82)62(94)72-31-53(65)85)76-58(90)48(25-36-28-70-42-11-5-3-9-40(36)42)78-57(89)47(24-35-15-17-39(84)18-16-35)77-61(93)51(32-83)81-59(91)49(26-37-29-71-43-12-6-4-10-41(37)43)79-60(92)50(27-38-30-68-33-73-38)80-55(87)44-19-20-54(86)74-44/h3-6,9-12,15-18,28-30,33-34,44-52,70-71,83-84H,7-8,13-14,19-27,31-32H2,1-2H3,(H2,65,85)(H,68,73)(H,72,94)(H,74,86)(H,75,88)(H,76,90)(H,77,93)(H,78,89)(H,79,92)(H,80,87)(H,81,91)(H4,66,67,69)/t44-,45-,46-,47-,48+,49-,50-,51-,52-/m0/s1 | StdInChIKey_Ref = {{stdinchicite|changed|chemspider}} | StdInChIKey = VXKHXGOKWPXYNA-PGBVPBMZSA-N }}

'''Triptorelin''', sold under the brand name '''Decapeptyl''' among others, is a medication that acts as an agonist analog of gonadotropin-releasing hormone, repressing expression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).<ref name="encyclopedia.com">{{Cite web|url=https://www.encyclopedia.com/caregiving/dictionaries-thesauruses-pictures-and-press-releases/gonadorelin-analogue|title=gonadorelin analogue |website=Encyclopedia.com|access-date=21 September 2019}}</ref><ref name=":0">{{Cite book|title=British National Formulary (BNF) 70| author = Joint Formulary Committee|publisher=Pharmaceutical Press|year=2018|isbn=978-0-85711-173-9|location=London|page=635}}</ref> It was patented in 1975 and approved for medical use in 1986.<ref name=Fis2006>{{cite book | vauthors = Fischer J, Ganellin CR |title=Analogue-based Drug Discovery |date=2006 |publisher=John Wiley & Sons |isbn=978-3-527-60749-5 |page=514 |url=https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA514 }}</ref> Triptorelin is a therapeutic alternative on the World Health Organization's List of Essential Medicines.<ref name="WHO24th">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines, 2025: WHO Model List of Essential Medicines, 24th list | year = 2025 | hdl = 10665/382243 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | hdl-access=free }}</ref>

It is a decapeptide (pGlu-His-Trp-Ser-Tyr-D-Trp-Leu-Arg-Pro-Gly-NH2) and a gonadotropin-releasing hormone agonist (GnRH agonist) used as the acetate or pamoate salts.

Primary indications include endometriosis,<ref>{{cite journal | vauthors = Leone Roberti Maggiore U, Scala C, Remorgida V, Venturini PL, Del Deo F, Torella M, Colacurci N, Salvatore S, Ferrari S, Papaleo E, Candiani M, Ferrero S | title = Triptorelin for the treatment of endometriosis | journal = Expert Opinion on Pharmacotherapy | volume = 15 | issue = 8 | pages = 1153–1179 | date = June 2014 | pmid = 24832495 | doi = 10.1517/14656566.2014.916279 | publisher = Informa Healthcare | s2cid = 23843087 }}</ref> for the reduction of uterine fibroids, to treat prostate cancer, to treat male hypersexuality with severe sexual deviation<ref name=":0" />, and to delay puberty in cases of precocious puberty or gender dysphoria.<ref>{{cite journal | vauthors = Cohen D, Barnes H | title = Gender dysphoria in children: puberty blockers study draws further criticism | journal = BMJ | volume = 366 | article-number = l5647 | date = September 2019 | pmid = 31540909 | doi = 10.1136/bmj.l5647 | s2cid = 202711942 }}</ref>

==Medical uses== {{See also|Gonadotropin-releasing hormone agonist#Medical uses}}Triptorelin is used to treat prostate cancer as part of androgen deprivation therapy.<ref name="DRUGS.COM">{{cite web|title=triptorelin (Intramuscular route)|url=https://www.drugs.com/cons/triptorelin-intramuscular-injection.html|website=Drugs.com|access-date=11 November 2016}}</ref>

Another common use in the United Kingdom is for hormone replacement therapy to suppress testosterone or estrogen levels in transgender people (in conjunction with estradiol valerate for trans women or testosterone for trans men). Spironolactone and cyproterone acetate are other drugs used by trans people to suppress sex hormones, but these drugs have a completely different mechanism of action.<ref>{{cite journal | vauthors = Wylie KR, Fung Jr R, Boshier C, Rotchell M |title=Recommendations of endocrine treatment for patients with gender dysphoria|journal=Sexual and Relationship Therapy|volume=24|issue=2|pages=175–187|doi=10.1080/14681990903023306|year=2009 |s2cid=20471537}}</ref> It can also be used as a puberty blocker<ref>{{cite journal | vauthors = Shumer DE, Nokoff NJ, Spack NP | title = Advances in the Care of Transgender Children and Adolescents | journal = Advances in Pediatrics | volume = 63 | issue = 1 | pages = 79–102 | date = August 2016 | pmid = 27426896 | pmc = 4955762 | doi = 10.1016/j.yapd.2016.04.018 }}</ref> in the case of precocious puberty.<ref name="DRUGS.COM"/>

Triptorelin has been used as a chemical castration agent for reducing sexual urges in sex offenders.<ref>{{cite web | url = http://edition.cnn.com/HEALTH/9802/11/sex.offender.drug/ | title = Study: Drug effectively treats pedophilia | work = CNN | date = 11 February 1998 | access-date = 8 July 2018 | archive-date = 11 July 2021 | archive-url = https://web.archive.org/web/20210711073414/http://edition.cnn.com/HEALTH/9802/11/sex.offender.drug/ }}</ref>

== Drug action == Triptorelin is a gonadorelin analogue, also known as luteinizing hormone releasing analogue (GnRH analogue, LHRH analogue).<ref name="encyclopedia.com"/> The drug binds to receptors in the pituitary gland and stimulates secretion of gonadotropins (namely luteinizing hormone LH and follicle-stimulating hormone FSH). This causes an initial phase of LH and FSH stimulation, prior to down-regulation of the gonadotrophin-releasing hormone receptors, thereby reducing the release of gonadotropins in the long term, which in turn leads to the inhibition of androgen and estrogen production.<ref name=":0" />

== Side-effects == General side effects can include:<ref name=":0" /> * Anaphylaxis * Arthralgia * Asthenia * Asthma * Breast tenderness (males and females) * Changes in blood pressure * Changes in breast size * Depression * Ovarian cysts * Mood changes * Skin rashes * Hot flashes * Weight changes

==Society and culture==

===Brand names=== Triptorelin is marketed under the brand names Decapeptyl (Ipsen) for treating prostate cancer, endometriosis, uterine myomas, and precocious puberty,<ref>{{Cite web |title=Decapeptyl SR 11.25mg (triptorelin pamoate) - Patient Information Leaflet (PIL) - (emc) |url=https://www.medicines.org.uk/emc/product/780/pil#gref |access-date=14 November 2022 |website=www.medicines.org.uk}}</ref> and Diphereline and Gonapeptyl (Ferring Pharmaceuticals).<ref>{{Cite web |title=Gonapeptyl Depot 3.75 mg - Summary of Product Characteristics (SmPC) - (emc) |url=https://www.medicines.org.uk/emc/product/2229/smpc#gref |access-date=14 November 2022 |website=www.medicines.org.uk}}</ref> In the United States, it is sold by Watson Pharmaceuticals as Trelstar <ref>{{Cite web |title=Trelstar intramuscular: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing | work = WebMD |url=https://www.webmd.com/drugs/2/drug-153984-8162/trelstar-intramuscular/triptorelin-3-month-11-25-mg-injection/details |access-date=14 November 2022 |language=en}}</ref> and by Arbor Pharmaceuticals as Triptodur (an extended-release 6-month depot injection).<ref>{{Cite web |title=Triptodur Intramuscular: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing | work = WebMD |url=https://www.webmd.com/drugs/2/drug-174078/triptodur-intramuscular/details |access-date=14 November 2022 |language=en}}</ref> In Iran, triptorelin is marketed under the brand name Variopeptyl. In the UK and Germany, it is sold as Salvacyl for the treatment of sexual deviations.<ref>{{Cite web |title=Salvacyl, developed by Debiopharm, is launched in two European countries - a new therapeutic avenue for the treatment of sexual deviations |url=https://www.debiopharm.com/drug-development/press-releases/salvacyl-developed-by-debiopharm-is-launched-in-two-european-countries-a-new-therapeutic-avenue-for-the-treatment-of-sexual-deviations/ |access-date=14 November 2022 |website=Debiopharm |date=23 June 2009 |language=en-US}}</ref>

== History == Triptorelin was developed in Andrew V. Schally's lab at Tulane University.<ref>{{cite web|url=https://research.tulane.edu/oipm/about-us |access-date=4 January 2024 |publisher=Tulane University |title=About Us – Technology Transfer at Tulane University}}</ref> Debiopharm licensed the drug from Tulane in 1982.<ref>{{cite web|url=https://www.fiercepharma.com/pharma/dr-reddy-s-launches-debiopharm-s-pamorelin%C2%AE-la-india-for-treatment-of-locally-advanced-or |access-date=4 January 2024 |publisher=Fierce Pharma |date=7 December 2012 |title=Dr. Reddy's Launches Debiopharm's Pamorelin LA in India for the Treatment of Locally Advanced or Metastatic, Hormone-Dependent Prostate Cancer}}</ref>

==Research== Triptorelin and other antiandrogens may be effective in the treatment of obsessive–compulsive disorder.<ref name="pmid31814547">{{cite journal | vauthors = Nomani H, Mohammadpour AH, Moallem SM, YazdanAbad MJ, Barreto GE, Sahebkar A | title = Anti-Androgen Drugs in the Treatment of Obsessive-Compulsive Disorder: A Systematic Review | journal = Current Medicinal Chemistry | volume = 27 | issue = 40 | pages = 6825–6836 | date = December 2019 | pmid = 31814547 | doi = 10.2174/0929867326666191209142209 | s2cid = 208956450 }}</ref>

=== Dosage in IVF treatment === Minimal daily dose of triptorelin acetate needed to suppress a premature LH surge during IVF treatment has been determined to be 15 microgram daily, and that 50 microg is equivalent to 100 microg in terms of IVF results.<ref>{{cite journal | vauthors = Janssens RM, Lambalk CB, Vermeiden JP, Schats R, Bernards JM, Rekers-Mombarg LT, Schoemaker J | title = Dose-finding study of triptorelin acetate for prevention of a premature LH surge in IVF: a prospective, randomized, double-blind, placebo-controlled study | journal = Human Reproduction | volume = 15 | issue = 11 | pages = 2333–2340 | date = November 2000 | pmid = 11056128 | doi = 10.1093/humrep/15.11.2333 }}</ref><blockquote>GnRHa doses used in IVF are derived from treatment

schedules used in disseminated prostate cancer, which aim at

complete gonadal suppression under all circumstances. Some

comparative studies indicate that the daily dose of agonist

used in IVF may be decreased without compromising the

results</blockquote>The interval between initiation of study medication and start of FSH stimulation was defined as the desensitization phase.

For both parameters, adjacent comparisons showed a statistically significant difference between the effect of placebo and 15 μgtriptorelin, but not between 15 and 50 μg, or between 50 and 100 μg (Table II).

moreover, it appeared that a daily dose of 50 μg triptorelincreates a state of pituitary desensitization comparable with the "standard" dose of 100 μg, and this endocrine finding was confirmed in the current study.

=== In prostate cancer === <blockquote>Modern assay technologies reveal that bilateral orchiectomy results in a serum T level of approximately 15 ng/dL as compared to the historical definition of castration of T < 50 ng/dL</blockquote>

== Pharmacokinetics ==

=== Gonapeptyl Depot 3.75 mg === The systemic bioavailability of the active component triptorelin from the intramuscular depot is 38.3% in the first 13 days (2.9% per day). Further release is linear at 0.92% of the dose per day on average (34μg). Bioavailability after S.C. application is 69% of I.M. availability.

Plasma triptorelin values decreased to approx. 100 pg/ml before the next application after I.M. or S.C. application (median values).

== References == {{Reflist}}

== Further reading == {{refbegin}} * {{cite journal | vauthors = Lahlou N, Carel JC, Chaussain JL, Roger M | title = Pharmacokinetics and pharmacodynamics of GnRH agonists: clinical implications in pediatrics | journal = Journal of Pediatric Endocrinology & Metabolism | volume = 13 | issue = Suppl 1 | pages = 723–737 | date = July 2000 | pmid = 10969915 | doi = 10.1515/jpem.2000.13.s1.723 | s2cid = 3639804 }} * {{cite journal | vauthors = Padula AM | title = GnRH analogues--agonists and antagonists | journal = Animal Reproduction Science | volume = 88 | issue = 1–2 | pages = 115–126 | date = August 2005 | pmid = 15955640 | doi = 10.1016/j.anireprosci.2005.05.005 }} {{refend}}

Category:Anaphrodisiacs Category:Gonadotropin-releasing hormone agonists Category:Decapeptides Category:Puberty blockers Category:Drugs developed by AbbVie Category:World Health Organization essential medicines