Nafarelin is used in women to treat a condition in which the tissue that normally lines the inside of the uterus grows in the wrong place (endometriosis). This medication helps to decrease the abnormal tissue and also the symptoms of endometriosis (such as pelvic pain, painful menstrual cramps, and pain during/after sex).

This medication is also used by children to treat a certain type of early puberty (central precocious puberty, gonadotropin-dependent). It helps to slow the bone aging and height growth rate so that both are near normal, and it helps to stop or reverse signs of early puberty (such as breast growth in girls, growth of sexual organs in boys).

Nafarelin is similar to a natural hormone made by the body (gonadotropin-releasing hormone-GnRH). It works by decreasing the testosterone hormones in boys and estrogen hormones in women and girls.

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start using nafarelin and each time you get a refill. Follow the illustrated directions for the proper use of this medication. If you have any questions, ask your doctor or pharmacist.

Follow the instructions for test sprays in the air if you are using a bottle for the first time. A fine mist is a sign that the spray is working properly.

Gently blow your nose before using this drug. For very young children, it may be necessary to clear the nose with a bulb syringe.

Use this medication as directed by your doctor, usually twice daily (about every 12 hours). If you are using more than 1 spray at a time, wait 30 seconds between each spray. Avoid spraying this medication in your eyes. Also, avoid sneezing during or right after using this medication because this may decrease the amount of medication absorbed. Follow the detailed instructions for cleaning the spray tip. It is important to clean the spray tip after each use.

The dosage and length of treatment are based on your medical condition and response to treatment.

It is very important to keep using this medication exactly as prescribed by your doctor. Do not skip any doses. To help you remember, use it at the same times each day.

Ask your doctor or pharmacist to find out how long each bottle of the nasal spray should last. Do not use the nasal spray bottle longer, even if there is medication left over, because you will not get a full dose. Make sure to get your medication refills a few days early so that you will not run out of your medication.

Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.

If you need to use a nasal decongestant spray while using this medication, wait at least 2 hours after using this medication before using the decongestant.

When you first start this medication, worsening of symptoms may occur (such as increased vaginal bleeding for women treating endometriosis, or vaginal bleeding/period, increase in breast size/pubic hair, oily skin, or body odor for children treating early puberty). These symptoms should get better after the first month of treatment. Tell your doctor if your symptoms do not get better or if they get worse after 2 months of treatment.

Nasal irritation, hot flashes, or vaginal discharge may occur in children. Nasal irritation, hot flashes, headaches, decreased sexual interest, muscle pain, vaginal dryness, acne, or decrease in breast size may occur in women. If any of these effects last or get worse, tell the doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell the doctor right away if any of these serious side effects occur:

• mental/mood changes (such as depression, thoughts of suicide, mood swings, aggression)

For women using this medication, tell your doctor right away if you have any serious side effects, including:

• abdominal/lower back pain
• bone pain
• fast/pounding heartbeat
• numbness/tingling of arms/legs
• eye pain

Get medical help right away if any of these very serious side effects occur:

• seizures

Children using nafarelin may be at risk for increased pressure around the brain (intracranial hypertension). Get medical help right away if your child has any of these very serious side effects:

• nausea/vomiting that doesn't stop
• headache that is severe or doesn't go away
• eye pain
• vision changes (such as blurred/double vision, decreased vision)
• ringing in the ears

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Before using nafarelin, tell your doctor or pharmacist if you are allergic to it; or to GnRH or other GnRH-like hormones (such as leuprolide); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• unexplained abnormal vaginal bleeding
• smoking
• daily alcohol use
• bone loss (osteoporosis) or family history of osteoporosis
• polycystic ovarian disease
• high cholesterol/triglyceride levels
• seizures
• mental/mood problems (such as depression)

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

This medication must not be used during pregnancy. It may harm an unborn baby. Women should start this medication between days 2 and 4 of their period. Although periods and the release of eggs (ovulation) may stop while you are using this drug, this is not a reliable form of birth control. Discuss the use of non-hormonal forms of birth control (such as condoms, diaphragm with spermicide) with your doctor. If you become pregnant or think you may be pregnant, tell your doctor right away.

It is unknown if this medication passes into breast milk. Because of the possible risk to the infant, breastfeeding is not recommended while using this medication. Consult your doctor before breastfeeding.

See also How to Use section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

This medication may interfere with certain lab tests (such as tests for pituitary gonadotropic and gonadal functions), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call 1-800-222-1222. Canada residents can call 1-844-764-7669.

Do not share this medication with others.

Lab and/or medical tests (such as growth/bone age velocity in children) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

Vaginal bleeding may occur in girls/women who miss doses of this medication.

Store the bottle upright at room temperature away from light. Do not freeze. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.