In addition to the adverse event of dizziness reported during and post Lupron use, just reading and trying to understand Lupron’s literature can also be dizzying. So much of the research and information about this drug is utterly baffling; some circumstances have been manipulated by slick design, with information hidden or suppressed, other Lupron information can be readily disproved by known facts, and all this is admixed with conflicts of interest. In the process, decades of victims have accumulated and are without any real medical or legal advocacy. All the while, the powers that be have essentially appeared inert.
The contradictions found within Lupron documentation are indeed baffling and Lupron’s history is littered with instances of nefarious machinations. In prior installments of this series, the conflicting information about Lupron’s metabolism has been explored (part 4), as well as addressing the fact that Lupron is categorized as a hazardous, Pregnancy Category X drug (meaning it should be avoided by any woman who is or who may become pregnant), yet Lupron is prescribed to women in IVF, egg donation and surrogacy (part 3). Since there are numerous other examples of puzzling – just plain wacky (inexplicable and unacceptable) – ‘circumstances’ surrounding Lupron, this final installment will look at a number of these head-scratchers, as well as reviewing some of the more notorious slick maneuvers associated with Lupron. (The other installments in this series were Part 1, Part 2, and Part 5.)
Why has Lupron’s manufacturer made statements that can be proven inaccurate?
Oral Lupron: No — Yes — Maybe so?
Lupron’s labels and the literature ubiquitously proclaim that Lupron “is not active when given orally” – yet early investigation shows information to the contrary. None other than Andrew Schally, who is responsible for the isolation of the GnRH molecule (allowing the subsequent manufacturing of its analogs), and who won the 1977 Nobel Prize in Medicine for doing so, co-authored a 1975 article on the oral administration of Lupron. Thirteen healthy men were given Lupron (known only chemically, at the time, as “D-Leu-6 des-Gly-NH2-10”) by mouth, and within 45 minutes “the analogue had produced a statistically significant increase in mean plasma LH concentration”, and “the times of maximum LH activity noted … by mouth were not much different from those observed after parenteral injection”.
While the majority of men in this study did not have raised FSH concentrations, the remaining subjects had a significantly different mean change in plasma FSH concentrations “24 hours after the oral dose”. The article notes that “[a]lthough [Lupron] seemed to have little effect on FSH release, the interpretation depends upon how the results are expressed.” Discussion of Lupron’s parenteral effects decades later noted “the lack of long-term suppression of FSH observed in some patients” (American Hospital Formulary Service, Drug Information, 1994; p. 644). So it would appear that both oral and parenteral routes of Lupron have induced similar LH and FSH responses.
Andrew Schally stated 42 years ago that “oral administration [of Lupron] can now be added to the previously established effective methods [of intravenous, subcutaneous, and intramuscular administration].” Yet Lupron’s labels continue to state that it is “not active when given orally”.
Lupron Induces Menopause – NOT
In Lupron brochures for its use in endometriosis, the manufacturer states: “GnRH … acts on the pituitary to stimulate two other hormones, LH and FSH. … When LUPRON DEPOT is administered monthly, production of these hormones is reduced to the very low levels found after menopause” (emphasis mine). Yet, any medical textbook describes menopause as “FSH and LH (mainly FSH) are produced thereafter in large and continuous quantities” (emphasis mine) (‘Textbook of Medical Physiology’, A.C. Guyton. 1981. 6th Edition. W.B Saunders Co. Philadelphia; p. 1016).
And most astoundingly, the hormonal profile of a menopausal woman – increased FSH/LH, decreased estrogen (“hypergonadotropic hypogonadism”) does not match the hormonal profile of a woman on Lupron – decreased FSH/LH, decreased {sometimes} estrogen (“hypogonadotropic hypogonadism”). (See ‘Chart 1″ on page 2 here.) Yet women are repeatedly told Lupron will put them into a temporary “menopause”.
Endometriosis Clinical Trials’ Data versus Claim in Lupron’s Label
Lupron’s female labels state the drug’s hypoestrogenic effect “is reversible on discontinuation of therapy”. However, an independent analysis of the endometriosis clinical trials’ raw data conducted during a product liability litigation revealed “62.5% of study subjects had failed to return to baseline ovarian function one year after stopping Lupron.” (Issue discussed in further detail below.)
Lupron-induced Impotence
Initial 1980s clinical trials for FDA approval of Lupron for use in palliative treatment of prostate cancer found that 2 out of 98 subjects experienced the adverse event of impotence. More than a decade later, it was reported that Lupron “strongly suppresses erectile function and sexual activity” and “sexual desire, sexual interest and sexual intercourse were totally annulled.” Large scale studies have revealed “80%” of subjects using GnRHas reported being impotent, and a “267% increase in impotence was observed after one year of treatment”
A decrease in sex drive (reported by both sexes) and impotence are such well-known, expected, adverse effects of Lupron that the drug has for some time been used (court ordered at times) as ‘treatment’ for sex offenders (see here, here, and here).
It should be found curious that what has become accepted as a near-universal adverse event to Lupron (impotence) was claimed, in the initial clinical trials, to affect a mere “2 out of 98” subjects.
Infamous Fraudulent Marketing Schemes and Unlawful Off-label Promotion of Lupron
There is quite a history of Lupron being unlawfully promoted for off-label indications, including the company receiving “Notices of Adverse Findings” from the FDA about the company’s Lupron symposiums (deemed ‘indoctrinations‘ by the FDA).
In 2001, Lupron’s manufacturer paid $875 million, the then-highest criminal and civil fine in U.S. history, for its fraudulent marketing scheme to promote sales of Lupron, involving violations of the False Claims Act, 31 U.S.C. §§ 3729. The landmark case highlighted the company’s monetary incentive schemes to physicians to boost Lupron sales. Internal confidential company memos detailed how urologists could earn $105,011.40 annually by prescribing Lupron to just 65 patients. The U.S. government’s investigation revealed that the company provided many sales incentives, such as products, cash prizes, and trips, including a vacation referred to as the “Excalibur” – and the “Excalibur party was awarded annually to the top 30% of the [] sales force. … At times in the 1990s, the annual budget for the Excalibur party exceeded $4,000,000” (see page 9 here).
More recent ideation can be gleaned from anonymous postings in a pharmaceutical ‘sales rep chat room’; i.e., a few noteworthy 2010 posts state: “ABBOTT PAYS MILLIONS UNDER THE TABLE SO DOCS USE LUPRON” (emphasis in original) (posted 3/27/10 @ 7:45 PM); and “the docs know who has buttered their bread, and we [Abbott] got very deep pockets” (posted 3/27/10 @ 9:41 AM)
Why was the preservative in daily Lupron given only to humans, and not given to the “study rats”?
The daily formulation of Lupron is prescribed to both the pediatric and adult population, and was the very first FDA approval Lupron received, in 1985. This initial, approved formulation contains the preservative “benzyl alcohol”. But curiously, the animal toxicology studies required for Lupron’s initial FDA approval were not done using Lupron and benzyl alcohol, but were done using Lupron and “normal saline” (NDA 19-010). Shouldn’t these animal toxicology studies reflect the exact injection intended for humans?
The National Institute for Occupational Safety and Health (NIOSH) lists pages of toxicity data for benzyl alcohol, while the Material Safety Data Sheet (MSDS) for benzyl alcohol identifies that there is “no information available” for numerous areas (such as teratogenicity, neurotoxicity, reproductive effects – See ‘Section 11’ here). Why were rats spared the exposure to benzyl alcohol in their Lupron injections, when humans were and are exposed to the benzyl alcohol day after day in their daily Lupron injections?
Funny Business with Bones
In this discussion, it is important to note that human bones contain 2 different types of bone – cortical (or compact) bone and trabecular (or cancellous or spongy) bone (see here and here).
While there are studies which claim no adverse effect of Lupron/GnRHas on the bones of treated children (i.e., here), other published reports on treated children note leuprolide/GnRHas “may have an adverse effect upon bone health“. As early as 1991, “a small but significant decrease in bone mass” was noted in a small Italian study using another GnRH analog (triptorelin) in children with precocious puberty. Another small Italian study in 1995 using leuprolide to treat precocious puberty found a “reduction of trabecular bone mass”. In a small Taiwanese follow-up study of girls treated with either leuprolide or triptorelin, “45% of patients had lumbar bone mineral density less than 1 SD below that of normal young Taipei adults”, evidencing “45% of patients had decreased bone accretion during therapy“. And recently a small study in Turkey using leuprolide in children concluded “GnRHas may have an adverse effect on bone health” perhaps via an impact upon vitamin D levels.
As early as 1991, in gynecological uses of GnRHas, evidence indicated that there was little or no change in cortical bone density, however “[t]he great majority of studies of trabecular bone show a significant reduction in bone mass in both spine and distal radius during 6 months of agonist therapy … between 5-10% of baseline”. Another early study in treatment of endometriosis found “bone loss induced by GnRH analogs may be associated with adverse effects on cancellous [trabecular] microstructure which are unlikely to be reversed following cessation of therapy.” (An increased rate of bone loss in men receiving Lupron and other GnRHas has also been reported, i.e. here.)
It is important to note that most of the bone mineral testing done using Lupron or other GnRHas in adults have been done using DEXA (Dual-energy X-ray absorptiometry) or DPA (Dual-photon absorptiometry) scans; and there have been GnRHa studies using DEXA in precocious puberty bone mineral density assessments. Another study, using triptorelin in precocious puberty subjects, evaluated bone mineral density by assessment with DEXA and concluded that while bone mineral density was significantly lower at discontinuation of GnRHa, later DEXA scans showed values “not significantly different from controls.” (But what would QCT [quantitated computerized tomography] scans have revealed?)
Bone density scans such as DEXA/DXA and DPA assess both cortical and trabecular bone – and studies using DEXA and DPA scans have revealed adverse effects from GnRHas (i.e. bone mineral density “decreased significantly [6 months: -6.0%, 12 months: -8.0%]”). However, QCT scans assess only trabecular bone and are most effective at detecting “the significant trabecular bone loss of the vertebrae and hip [associated] with GnRH agonists”. (See also here.)
GnRHas appear to have “a significant negative impact on trabecular bone mass. … Initial studies [in women] with dual-photon absorptiometry [DPA] were unable to detect any appreciable bone loss with GnRH agonists. … Quantitated computerized tomography [QCT] always shows significant trabecular bone loss of the vertebrae and hip with GnRH agonists. Depot preparations appear to produce more marked loss than daily intranasal sprays.” (emphasis mine).
Early investigations of leuprolide and buserelin’s effect upon cortical and trabecular bone mineral content in women with endometriosis identified that “[b]ecause QCT of the spine measures only the trabecular bone … any significant change affecting mainly the trabecular bone is more readily detected earlier by the QCT”, and “[b]ecause DPA measures both trabecular and cortical bone, a significant reduction in true trabecular bone mass actually may be diluted … thus giving a lack of significant change.”
In further illustration of this point, note that Lupron’s label for endometriosis from 1991 through 1996 stated “after 6 months the vertebral trabecular bone density as measured by QCT was decreased by an average of 13.5%”, however in 1996 Lupron’s endometriosis label was changed to read the “vertebral bone density as measured by DEXA was decreased by an average of 3.9%” (1991 – 1995 Physicians Desk Reference, Lupron Depot 3.75 mg). By using data only from DEXA scans, the significant bone density loss previously detected by QCT was eliminated. Current Lupron Depot 3.75 mg label states “vertebral bone density as measured by dual energy x-ray absorptiometry (DEXA) decreased by an average of 3.2%”. By continuing to use data only from DEXA scans, the “significant” bone density loss detectable by QCT is ensured to remain undetected.
In a 2000 study of bone markers and bone mineral density during growth hormone treatment in children with growth hormone deficiency, it was noted that future research should be carried out “by the direct measurement of bone density using quantitative computer tomography [QCT]. Mineralization is only one facet of bone strength, however; other important components (e.g. bone structure and geometry) should be addressed in future paediatric studies.” (See also here.) A PubMed literature search of ‘QCT bone pediatric GnRHa’ produced zero results for humans, but one result was found for a report on rats (in which bone mineral density was “significantly decreased in GnRHa-treated rats” and concluded “a delay in the onset of sexual maturation may cause prolonged, possibly irreversible defect in bone mineralization”).
In a 1995 study, bone biopsies and microscopic analyses (histomorphometric analysis) were done on women treated with GnRHas and the “results suggest that bone loss induced by GnRH analogs may be associated with adverse effects on cancellous [trabecular] microstructure which are unlikely to be reversed following cessation of therapy.” Microscopic scan photographs of a 28 year old woman treated with GnRHa for 6 months show “severe disruption of the cancellous microstructure in the post-treatment biopsy” – see photo on page 6 here.
It would appear that without a body of data specific for QCT results, appropriate conclusions cannot be reached about the effects of GnRHas upon the type of bone (trabecular) that is most impacted by GnRHas. All the above points to the need to assess Lupron/GnRHas effect upon trabecular bone through QCT scans – and it would seem that to do otherwise would hinder data collection.
Yet many Lupron studies and follow-up studies have been designed using non-QCT bone density scans, and often it is wrist (and not hip or vertebral) scans that are performed. A perverse analogy comes to mind, relating to the heinous act of sick individuals who hide dangerous items (i.e., needles, razor blades) into the center of Halloween candy – and the community safeguards that have been enacted to X-Ray the candy in order to assess and ensure safety (i.e., here and here): What if these community resources were not offering to X-Ray the candy but instead were offering to merely photograph the candy in attempts to ‘assess and ensure safety’?
Tricks in the Courtroom Yield Treats for Lupron’s Manufacturer
The only lawsuit to make it to trial (in 2011), the case of Karin Klein v. TAP, Abbott, stemmed from Karin’s prescription of Lupron Depot 3.75 mg in 2005 as a 17 year old for endometriosis – and resulted in the development of (among others) a thyroid disorder. Pre-2005 Lupron Depot 3.75 mg labels, and post-2005 Lupron Depot 3.75 mg labels (domestic and foreign), warned of thyroid adverse events, but the company removed this warning for the 2005 label – the year of Karin’s prescription.
At trial, Karin was prevented from presenting to the jury any pre-2005 or post-2005 Lupron Depot 3.75 mg labels acknowledging thyroid adverse events, and the trial judge only allowed the jury to consider the 2005 label which lacked the warning. Lupron manufacturer’s principal medical expert, Dr. Richard Blackwell, under oath falsely stated “the thyroid gland … There are no receptors for GnRH. So there is no basic key on the thyroid gland for Lupron. Therefore, it is absolutely biologically impossible for Lupron to affect the thyroid gland. No textbook, no article has ever supported that contention. It’s simply biologically impossible” (emphasis mine) – see page 20 here.
Of note, Dr. Richard Blackwell has a history of receiving monies to study Lupron in women – see ‘Birmingham Center’ in this ‘Multicenter Lupron Study Group’. Also note that the latter study’s lead investigator, Dr. Andrew Friedman, was found guilty of fabricating and falsifying approximately 80% of data in 4 Lupron studies.
When the Klein jury heard Lupron’s expert medical witness proclaim it was “biologically impossible” for Lupron to affect the thyroid gland, they could not possibly know this physician was committing perjury. (Perjury is a felony, and if convicted involves fines and/or imprisonment up to 5 years – see here and here). If only the jury had known that evidence of this misinformation was just a keyboard away – a simple PubMed search (up to, and including, 2005) reveals the following published medical journal articles that evidence it is absolutely biologically possible for Lupron to affect the thyroid gland’:
“The first report to demonstrate the association of thyroid disorder with leuprolide [Lupron] injections” (2000), “Possible induction of Grave’s disease & painless thyroiditis by GnRHa’s” (2003), “The role of leuprolide acetate therapy in triggering auto-immune thyroiditis” (2005).
Serving as an “expert”, this is information that must certainly have been known, yet as a ‘hired gun’ for the drug company, the existence of this information was emphatically denied – leading the jury to believe it was impossible for Lupron to cause Karin’s thyroid disorder, and resulted in the jury finding in favor of the drug company. And thus the queue of Lupron litigation that was forming in anticipation of a Klein victory suddenly evaporated in the face of unmitigated, unethical, unlawful, unseemly, unchallenged ‘expert’ machinations.
To quote a ‘friend of the court’ brief filed on behalf of Klein by the organization “Consumer Attorneys of California”:
“[Klein was] entirely shackled in the evidence she was allowed to present. It is particularly galling to have qualified (and expensive) expert witnesses on hand to testify [on behalf of Klein], only for them to be shut down before the jury and precluded from offering competing expert opinions. The pattern shown by the record is deeply disturbing. Virtually every discovery and evidentiary ruling, and other orders of significance, went for one party [Lupron’s manufacturer]. Klein was not entitled to a perfect trial, but at least an evenhanded one. Such a one-sided proceeding was not the fair trial our system demands” (emphasis mine) – see page 6 here.
Klein ultimately petitioned the U.S. Supreme Court which refused to hear the case – great news for Lupron’s manufacturer, terrible news for young, disabled Klein, and chilling repercussions for society at large and Lupron victims in particular. Apparently, perjury under oath by paid medical experts, grossly misleading a jury, and the denial of a right to fair trial are issues deemed not significant by the U.S. Supreme Court. For further information on the Klein matter, see here, here and here.
Obscuring the Drug’s Hazardous Status
Lupron is categorized by the FDA as a “Pregnancy Category X drug” (page 20, “leuprolide” – meaning any woman who is or who may become pregnant should avoid exposure), yet it became a staple of ovulation induction medication regimens in infertility, egg donation, and surrogacy. Lupron’s labels do state there is “a potential hazard to a fetus” (and oddly the most wording is found within the male Lupron Depot label). Lupron is classified by the National Institute for Occupational Safety and Health (NIOSH) as a “hazardous drug” (page 20, “leuprolide”), however nowhere in any of Lupron’s labels is there identification that Lupron is classified as a “hazardous drug” (i.e., pediatric, female, male); nor does the label advise that as a result of this classification by NIOSH, special requirements apply for the handling, preparation, and administration of “hazardous drugs” (see here and here).
Around 2008, curious changes took place within Lupron labels (multiple indications) whereby it appears that cleverly, as if hiding evidence in plain sight, the “References” section of the labels now contained 4 citations – yet there are no corresponding footnotes within the label’s text for any one of these 4 citations. These 4 new “References” are as follows: (#1) NIOSH Alert, Preventing occupational exposures to antineoplastic and other hazardous drugs in healthcare settings; 2004. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, NIOSH Publication No. 2004-165; (#2) 1999 OSHA Technical Manual on Hazardous Drugs; (#3) 2006 ASHP guidelines on hazardous drugs; and (#4) 2005 Oncology Nursing guidelines on hazardous drugs (see pages 6, 14, 25, 36, and 47). Again, most curiously, not one of these 4 citations/”References” — or the information the citation source contains — were referred to, mentioned, identified, or discussed, at all, within the Lupron labels.
And presently, revised labels no longer contain the 4 citations mentioned above (see pediatric, female, male); and the labels continue to omit any identification of Lupron as a “hazardous drug”.
Measures Undertaken to Silence Critics
The Cardiac Stent Internal Memo
When Lupron’s manufacturer was under investigation for potential fraud related to its cardiac stents, numerous critical articles were written by a Baltimore Sun news columnist – and the drug company apparently targeted this columnist. As reported in a 2010 Senate Committee on Finance (examining a “clear example of potential fraud, waste and abuse”), “one Abbott official suggested that local connections or the “Philly mob” should intervene to silence Baltimore Sun columnist Jay Hancock for his coverage of the scandal, saying “someone needs to take this writer outside and kick his ass!”
Not a ‘seal of approval’ – the Hidden Lupron Endometriosis Clinical Trials’ Data
To the best of my knowledge, no one other than Dr. Redwine has independently analyzed the thousands of pages of raw data from the 1980s clinical trials for Lupron’s initial use in adult females (Lupron Depot 3.75 mg, for endometriosis). The conclusion from this independent analysis was that fraudulent data and misleading outcomes were found within these trials’ raw data. In one example, the raw data showed that “62.5%” of subjects had failed to return to baseline ovarian function one year after stop of study – yet Lupron’s label states Lupron’s hypoestrogenic effect “is reversible on discontinuation of drug therapy.” (For further information, see Part 3 of this series; the FDA’s response to Dr. Redwine’s request for an investigation into this serious matter; and here.)
It certainty appears that Lupron’s manufacturer intends to keep this raw data hidden from public view. Years ago the company sought and obtained a court-ordered seal on the raw data from these endometriosis clinical trials (see page 6 here), ensuring that this data will remain concealed from the public and any inquiring eyes.
Several years ago, when my assistance was sought by a Lupron victim whose attorney had retired in the middle of her case, the opportunity was used to file a motion to request the Court remove this seal (see “Reply Motion … and a Request that Court Seal on Defendants’ Clinical Trial Data Be Lifted”, Document # 135, Case 1:11-cv-04860, filed 2-20-14, Paulsen v. Abbott, Takeda, TAP, US District Court, Northern District of Illinois, Eastern Division). No response from the Court was ever forthcoming from this request to unseal the raw data. The Paulsen case remains pending (see also here). A request to Lupron’s manufacturer to lift their seal also was unsuccessful (personal correspondence, 2015).
Suppression of Lupron’s Risks in Physician Continuing Medical Education
Renowned endometriosis surgeon Dr. Redwine became an outspoken critic of the use of Lupron in gynecology, and his opinion was reinforced by more than 700 women in his surgical practice who relayed harm from prior Lupron exposure. Dr. Redwine had most honorably refused the Lupron sales representative’s offer of $100,000 if he would prescribe Lupron to his patients. In 1994, Dr. Redwine wrote a ‘letter to editor’ in a fertility journal stating
“Inclusion of patients with a poor response to GnRHa therapy has not always occurred in outcome analysis in the published medical literature” (Letters: Pros and Cons of “Add-Back” Therapy. 1994. Fertility and Sterility, 61:2:404).
According to Dr. Redwine’s expert medical testimony in the Klein case (in which he describes Lupron as being “unsafe and harmful in addition to being ineffective”), the following incident from the 1990s is described: Dr. Redwine was scheduled to be a speaker at a continuing medical education forum but was prevented from doing so by Lupron’s manufacturer because of his opposition to the use of Lupron. The drug manufacturer “interfered in the continuing medical education of physicians in order to enhance the sales of Lupron Depot” (see other excerpts of Dr. Redwine’s testimony here).
Peculiar Omission of Lupron/GnRHa Data in Studies of Health Disorders in Women With Endometriosis
Bone Density Loss
In 1989, a leading Lupron/GnRHa investigator in precocious puberty and gynecology concluded in a study that reduced bone mass (“significantly decreased cortical and trabecular bone mass”) was associated with the disease endometriosis. However, another study which found contrasting findings reported that “women with endometriosis do not have reduced bone density … One explanation for the difference between the results of this study and those of Comite et al. is that they included women who previously had been treated with GnRH agonists and these agonists are associated with bone loss.” (For further elaboration on these studies, see here.)
In my opinion, claims that the disease of endometriosis is associated with bone density loss, while appearing to deliberately omit the endometriosis patients’ common history of prior use of Lupron (which is known to causes bone density loss), is a treacherous concept and a slick maneuver — seeming to shield and manipulate iatrogenic, adverse drug effects into an ‘endometriosis-disease-related’ (and non-tort) phenomenon. This is something that deserves attention.
Autoimmune and Endocrine Disorders, Fibromyalgia, Chronic Fatigue Syndrome and Atopic Diseases
A 2002 publication (“High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis”) also failed to make any mention of Lupron or other GnRHas as treatment for endometriosis. This survey analysis, co-authored by the President of the Endometriosis Association (which has received hundreds of thousands of dollars from Lupron and other GnRHa manufacturers) also failed to identify the reported adverse events to Lupron (the most commonly prescribed medical therapy for endometriosis) – which have included autoimmune and endocrine disorders, fibromyalgia-like syndrome, chronic fatigue syndrome, and atopic diseases.
Yet, the survey upon which this analysis drew its conclusion does contain reference to Lupron/GnRHa use in the survey participants. In fact, of the 4000 surveys tabulated, 59% of survey respondents reported a history of Lupron/GnRHa use (‘Key Results from North American Membership Survey’, Endometriosis Association, 1998. Presented at VI World Congress on Endometriosis). Given that the majority of the endometriosis respondents reported a history of Lupron/GnRHa use, how could this fact and highly significant confounding factor be ignored?
In my opinion, claims that the disease of endometriosis is associated with autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases, while appearing to deliberately omit the endometriosis patients’ common history of prior use of Lupron (which is known to cause autoimmune and endocrine disorders, fibromyalgia-like symptoms, chronic fatigue syndrome and atopic diseases), is a treacherous concept and a slick maneuver — seeming to shield and manipulate iatrogenic, adverse drug effects into an ‘endometriosis-disease-related’ (and non-tort) phenomenon. This is something that deserves attention.
Coronary Heart Disease
Upon initial FDA approval for men in 1985, Lupron was alleged to have ‘insignificant cardiac adverse events’. (For further details on cardiac adverse events provided to and withheld from FDA by the manufacturer prior to approval, see page 4 here.) Subsequently, Lupron became the most prescribed GnRH analog. Decades later, a large study would show that the use of Lupron (and other GnRH analogs) for androgen deprivation therapy in management of prostate cancer was associated with a “10 – 50% increase” in the risks of coronary heart disease, myocardial infarction and sudden cardiac death (as well as fractures, strokes, and diabetes).
As a result of this and similar studies, the FDA issued a warning in 2010 concerning an increased risk of developing cardiovascular problems in men prescribed Lupron/GnRHas. The FDA acknowledged that there are no studies evaluating the cardiovascular risks of Lupron/GnRHas in children or women. (To the best of my knowledge, there remains today no studies looking at Lupron/GnRHas cardiovascular risks in pediatric or female use; however there is presently an FDA “specific review” of nervous system and psychiatric events in children, and the NIH is in the midst of a study of long-term outcomes in transgender youth’s use of Lupron/GnRHas, evaluating “physiological and psychosocial impact, as well as safety”.)
In 2016, a cardiology journal published a study based on survey responses from the large-scale ‘Nurses’ Health Study II’ database, and this study associated endometriosis with an increased risk of coronary heart disease. Can you guess which drug was not queried in this ‘Nurses’ Health Study II’ survey? This survey sought information on the woman’s use of alcohol, cigarettes, post-menopausal hormones, oral contraceptives, multivitamins, analgesics (including acetaminophen, aspirin, ibuprofen, indometacin, naproxen, nabumetone, ketoprofen, celecoxib, rofecoxib, and valdecoxib), but omitted any questions about the woman’s exposure to the most frequently prescribed treatment for endometriosis – Lupron/GnRHas.
My response to this inexcusable omission of Lupron/GnRHa exposure data was published in the journal – see “Article’s conclusions seriously flawed without data on Lupron/GnRHa use”. The authors of the study responded with inaccurate information on Lupron (see May 11, 2016 response), prompting me to submit a reply addressing this incorrect information. The journal failed to publish this corrective information, therefore I’ve published my reply on my own website.
In my opinion, claims that the disease of endometriosis is associated with coronary heart disease, while appearing to deliberately omit the endometriosis patients’ common history of prior use of Lupron (which is known to cause numerous cardiovascular adverse effects in women – see ‘Cardiovascular Effects’, Left column here; and here), is a treacherous concept and a slick maneuver — seeming to shield and manipulate iatrogenic, adverse drug effects into an ‘endometriosis-disease-related’ (and non-tort) phenomenon. This trend is very troubling, and is something that deserves significant attention and investigation.
Conclusions
The above information, as well as information found within this series, the Kaiser Report, and other media sources (see here) should be more than sufficient indication that numerous investigations into the effects of Lupron (and all GnRHas) are warranted.
That there are large numbers of Lupron victims cannot be disputed – one need only have computer access to verify this sad fact. (For links to a large sampling of Lupron reviews, stories, posts and comments in various medication and legal websites, see here.) The petitions to Congress requesting an investigation into Lupron appear to have fallen on deaf ears; one petition started in 2009 states more than 21,000 messages have been sent to date. (Links to multiple petitions, in the U.S. and France, containing more Lupron horror stories, can be found here.) There are more than ample numbers of Lupron victims complaining, the problem has been identified – what is needed is action.
Investigative reporters, the FDA, Congress, public health authorities, and the medical and legal community need to do their job and focus multiple spotlights on all the aspects of this drug, its effects, its associated harms, and the lack of medicolegal advocacy for its victims.
In my opinion, this drug should have been withdrawn from the market a long time ago – just how many more victims will it take?
Someone needs to be held responsible for all the suffering, and the ruined health, and careers, and lives of so many Lupron victims and their families. The devastation that Lupron has wrought ought to be criminal. People need to go to jail.
Or perhaps, they should just get a Lupron injection themselves.
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This article was published originally on May 31, 2017.
Image by Peter Timmerhues from Pixabay.
First, thank you for the brevity and detail in your research. This was a little too similar to Diethylstilbestrol (DES) the synthetic estrogen that marketed to help pregnancies but caused birth defects and miscarriages.
A few questions popped into my head as I was reading and perhaps you have wondered this too; where do all the minerals lost from bone density go??? My first thought is soft tissue calcification. It fits with both the heart disease and endometriosis. soft tissue calcification must first involve a lack of ATP production leading to the subsequent failure of active membrane transport system under that stress. So, low energy environment experiences a huge influx of calcium and can not transport it all out of the cell.
If this is the case then my first thought is that if there is any chance of reversing the damage the first thing I would consider is vitamin K2 MK4 to start to move calcium out of soft tissue and begin the process of redepositing into the bone.
Hi! I’m a man taking monthly Lupron injections for metastatic prostate cancer. 12 injections thus far. Is Firmagon a better choice? Would someone please comment. Gerald
I was put on Lupron for endometriosis for 34 months straight without ever being told you weren’t supposed to do that. That was in 2001-2003. I started having side effects the second month and the doctor kept assuring me that it wasn’t so bad and that they would go away when I stopped the Lupron. I was then diagnosed with Hypothyroidism, Hypo-pituitarism, severe Adult Growth Hormone Deficiency, Cushing’s Disease, Osteoporosis, Interstitial Cystitis, Vulvadynia and have had organ prolapse, and small heart attacks from the GHD, plus having to use a walker to get around, along with all the other side effects that come with these diseases. I gained 70 lbs in 7 months and could never get the weight off although I have a heavy labor job and have been on a Keto diet for over 10 years. I am now 48, and I feel like my life has been over for a decade, I just hover in this fatigue and pain with no ability to recognize myself or control my life anymore. I’ve spend tens of thousands of dollars out of pocket to treat what I can, but I am a shadow of myself. Where do we all go from here?
It has been 1 year and 7 months since my 1 and only 3 month lupron shot. I am now 35 years old, gained FIFTY pounds, infertile, depressed and full of regret. It has literally ruined my life. I am a completely different person than I once was.
When I refused Lupron, then later hysterectomy, I was dropped for non-compliance. I found another doctor who recommended Provera as well as hysterectomy. When I refused both I was again dropped for non-compliance. I have been dropped for non-compliance at least 6 times since I sought treatment for my fibroid tumor that avoided surgery and drugs. This philosophy is not in the wheelhouse of the revenue driven ob/GYN. I found relief outside the speciality in the field of Interventional Radiology. This branch of medicine specializes in fibroid resolution and is is uterine sparring. My tumor has shrunk 90% and my bleeding immediately stopped. This was 7 years ago. Turns out this incredible option is greatly underused because it is performed outside the speciality. Drug companies spiff doctors for the hormones they sell to their trusting patients which reeks of a conflict of interest. To stay mum about a viable fibroid treatment and recommend major surgery is crooked. I long lost faith in this branch of medicine.
Wow, good for you for sticking to your guns, Marjorie! I’m so happy to hear you refused Lupron. It absolutely destroyed my life. Conventional medicine isn’t good for too much anymore. I’m glad your fibroid is under control.
Hi, is the supprelin implant a better option for precocious puberty or does it carry the same risks as lupron?
Has anyone experienced side effects months after taking Lupron???
I’m experiencing chest pains and shortness of breath and my doctors say there is NO WAY this can be Lupron related.
But I also have been experiencing a list of side effects that have been experienced by others (blood in urine, back pain, fatigue, depression, extreme anxiety 24/7 and panic, night sweats, insomnia, the list goes on and on).
Kirsten, yes that is very common. Would you like to write up your symptoms in a health story and share it on the blog as a post? That way, others can see it and offer insight.
Hi Kirstin-
Absolutely! I took only one shot of Lupron when I was 24 yo. I experienced the worst anxiey, panic and depression I’ve ever had in my life. It’s not an exaggeration to say this drug ruined my life. I was put on anti-depressants that I now can’t get off of (I’m 47). Also took benzos off and on for 20+ years and am finally tapering off. I feel I’ve lost so much from this one decision I made when I was young. If only we could go back in time and have a re-do.
I’m so sorry you’re experiencing these symptoms. Please reach out if you’d like to chat.
Hi Karen and Kirsten,
I hope you do not mind a man gate crashing your site,but i agree with all that you both have written.Apart from the differences between sexes,we suffer many of the same side effects.Many of my side effects have appeared long after my last injection.Yes i did have anxiety before lupron but since lupron it has gotten worse each passing month,likewise depression.Lots of women write about their husbands not being the same man that they married,yes they are alive but not living the same as they once were.My own lovely wife of nearly 50 years,is happy that i am alive after cancer and i am happy to be alive,but we had hoped that the side effects would leave me, but after 2 full years since my last shot this now seems a pipe dream.
I now have all the usual side effects that have appeared over time,bone and muscle aches,huge around my middle,etc and an odd tingling sensation that has now just started?
My best wishes to you all and a merry Christmas ladies.
When will we seek justice for this absolute pain and suffering do to nothing more than greed??? We are permanently disabled BOTH PYSICALLY AND MENTALLY DEVASTING FOR US AND OUR FAMILIES… For Gods Sake Somebody Do something to STOP THIS brutal Madness Lupron!!!
Give us acknowledgement and Resources for PAIN AND SANITY TREATMENT NOW!!! We have suffered in Silence FAR TO LONG WE ARE DOOMED AND LOOSING OUR LIVES EVERY DAY!!! FDA Do your JOB. MEDICAL COMMUNITY WAKE UP. THE EXPENSE OF DENIAL OF THIS DRUG IS CATASTROPHIC!!!
I wrote some of my long nightmare of a story. I hope I was able to post it. It is a very long read, yet something that was necessary for me to do. So again I do hope I was able to post it.
Jeanette,
Thank you for taking the time to write about your experiences – that can be a very difficult and taxing thing to do. Your story is heart-wrenching, like far too many others – and you’ve well identified what it is like to read these horror stories … “unbearable”. I would give anything to never hear or read about another Lupron nightmare story. Yet speaking out about your awful Lupron adverse events, and what your life is like now, has the power to warn and help others. And so I would encourage you to consider the below suggestion to make your comment into its own blog post.
Lupron’s effects upon spouses, children, and all family members is also an area that needs attention and discussion. I’m certain your husband will not soon forget racing you repeatedly to the hospital, and it is likely that his life (as well as yours) has undergone major changes.
My name is Jeanette Wideman-Lindsay. Yes I stated my full name because I’m outraged and other words aren’t appropriate to use. I was given six month of o stay hooked up to a heart monitor, given pain meds, high blood pressure Med and other medications throughout my stay. My heart beat was irregular, my blood pressure was extremely high and my pain level was way beyond a ten. On the fifth day I was discharged and I have was told my test came back fine for my heart. I didn’t know at the time that chest pains are a side effect from Lupron in fact I didn’t know any side effects because I wasn’t given any labels to read nor did I own a computer at that time. In November I had my Dr. look up my hospital stay information and told him about the throwing up for an entire night. He couldn’t explain the chest pains however he explain to me in his words that my body was going through a mini menopause and that my body needed sometime to adjust regarding the throwing up was concern. That’s how all my systoms were described to me. I was also told that the benefits were greater and that I my body would adjust soon. This time on my November appointment I was given the last three dosages in one shot. Thru November into December I experienced the worst bone pain and fatigue I’ve never had in my life. I also could barely get out of bed by this point and my pain was so great my Dr. had me on pain meds and several other medications. During the month of December my pain became so bad I didn’t sleep for several nights. I was already having problems sleeping after being given this drug. Again my husband had to rush me to the same hospital because of my pain I couldn’t bare it any longer. I didn’t have to wait, I was seen right away. My blood pressure was 210/105 and still claiming, I was crying out in pain something I’ve never did before in my life, except during childbirth and I gladly wouldn’t indured that pain over what I was going through. I was hooked up to a heart monitor again an IV put into my arm and the doctors and nurses worked on me, trying to lower my blood pressure, get my heart rate and pain level under control. They were able to bring my pressure down some yet no matter what strong dosage of pain meds they gave me they couldn’t get my pain under control which made my heart rate stay out of control and my blood pressure to keep going out of control. It took all night until early the next morning to get my condition under control. One of the ER doctors said he never saw anything like it before, for a patient not to get any relief from their pain after being given the type of meds they gave me through an IV. The Director of my Family Medical practice was called down to the ER so they could consult with him because I told them I know it was the Lupron shots I was given that did this to me. Every time I told any Dr. prior to this, they all tried to make me believe it was all in my head. Now I almost had a stroke or could’ve died if I stayed home, now you believe me. I was sent home a day later with two different pain meds, a medication for nerve pain because my body was burnin all over as well forgot to mention that and instructions to see a Rheumatologist, neurologist and physical therapist.
The Rheumatologist took blood work and did several tests. My vitamin D was almost in the single digits and my Rheumatologist told me, any lower I would’ve had to be hospitalized as if I haven’t had enough of that. The vitamin-D deficiency was contributing to my bone pain and fatigue. My Neurologist did a EMG I believe its called and found nerve damage thru out my entire body where the wires were placed. That test along took a lot out of me. You’re actually shocked, not a good thing at all. I couldn’t do the physical therapy because I left feeling worst then when I went, so I stopped going. I also had to go to a pain & back Dr. because I still couldn’t control my pain and my back hurt so bad. Between the servere pain in my hip bone I also had bone pain thru out my body, joint pain and my entire body was burning me, headaches and I could go on. I’ve been diagnosed with Sjogren’s, I have narapathy thru out my entire body due to the nerve damage including and my face. Yes my face at times burn as if hot ashes from coals are being rubbed everywhere. I’ve also been been diagnosed with fibromyalgia also, because of the pain through out my body the Dr.s diagnosed me with chronic pain. I’m in pain 24 hours a day 7 days a week. My pain never leave my body, it fluctuates between differs levels that it. I don’t like the winter anymore because it causes me great pain. The cold air makes body burn more, my joints hurt more as do my bones. My hands and fingers actually turn blue if not covered well. Two years ago I started losing my balance and even falling at times I also caught a cold from being around an infected person and the cold was as if I had the flu. I had it for over a month and I just didn’t feel right. I knew I couldn’t get colds because of my autoimmune system isn’t normal any longer. This was something different though. My Rheumatologist’s ran some test and it came back showing I now have Lupus. I always sign the release form to have all copies of my blood work sent to me and I looked everything over and my Dr. was correct, she had the test ran a second time to confirm. Oh I forgot no pun intended, I suffer from memory loss which started after the injections. My life has been completely altered since 2008, a complete nightmare you don’t wake up from. I loss my job I can’t sleep, I’m in constant pain and I’m suppose to take eight pills a day just to get by and live not truly live but to exist. NOW IS THAT CRAZY OR WHAT? This only part of my story. It’s a SIN for this medication to still be on the market. And they have the audicity to give this poison to children also. I’m truly heart broken for all the people who’ve been sicken by this poison. I don’t go on face book often and when I do I don’t go to the Lupron’s Victims group because it’s always the same thing someone asking questions about their systoms after taking this poison and if it’s normal have these problems after being give it, or someone’s horror story. It truly breaks my heart because I know how I suffer and to read of someone else pain and suffering, it’s unbearable. I need strong women who are willing to form a group and work with me, we work together and we get this POISON off the market. I know it’s been tried many times before, but there’s always a way. I’ve had enough. Each year I get worse and worse as do a lot of you do. When do we say enough is enough. My body is literally attacking itself from within. Before I leave this world I need to know the world are aware to what happened to all of us and that this POISON has been removed from the market. Yes I said it. To all the Lupron Victims that read my story this isn’t the entire story yet what everything you read here is 100% the truth. I forgot to add I was given Lupron because I kept growing ovarian cysts. My right ovary was removed in an emergency surgery in March 2006. Afterward I started having problems on my left side. At my six week post operative appointment I told the doctor I believe the same thing was happening to my left side. I was firmly told that wasn’t so. I was having a lot of pain on that side, the Dr. thought I was trying to get more pain meds yet I had never taken any type of pain meds before this. The only thing I ever took was Tylenol and barely that. Four days later I was admitted to the hospital because a cyst had grown on my left ovary and was in the process of rupturing. That’s how everything began. When first suggested I be given Lupron I knew nothing about the Poison yet something said don’t do it. Yet after more hospital stays, missing so much time at work, abdominal pain and heavy menstral cycles out of a horror movie and the Dr. prodding me I finally broke and let them them give me the injections. Now I would trade that abdominal pain for the pain I now deal with all the time. My biggest mistake every in my life. To anyone who’s reading this and is thinking about taking Lupron, please reread my story a second time then and as many other Lupron Victims stories, then make your decision. May God bless you all and help you through your suffering and for those that don’t believe in God I say the samething again. May God bless you and help you through your suffering. LOVE You All AND GOD BLESS
Jeanette, what a horrible experience. Thank you for sharing. Can we copy and paste it into its own blog post so that we can share your experience more broadly. Women need to read your story before they consider Lupron.