LEUPROLIDE (LUPRON DEPOT) IM INJECTION - Male		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room				
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Prostate specific antigen	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect
	Release to patient (Note: If manual release option is selected, result will auto release 5 days from finalization.): Immediate		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	leuprolide (LUPRON) depot injection 7.5 mg (RESTRICTED)	Every 4 weeks	S	Until discont'd	
		7.5 mg, intramuscular, once, Starting when released
	Administer as a single injection into the gluteal area, anterior thigh, or deltoid.		
	☐	leuprolide (LUPRON) depot injection 22.5 mg (RESTRICTED)	Every 12 weeks	S	Until discont'd	
		22.5 mg, intramuscular, once, Starting when released
	Administer as a single injection into the gluteal area, anterior thigh, or deltoid.		
	☐	leuprolide (LUPRON) depot injection 30 mg (RESTRICTED)	Every 16 weeks	S	Until discont'd	
		30 mg, intramuscular, once, Starting when released
	Administer as a single injection into the gluteal area, anterior thigh, or deltoid.		
	☐	leuprolide (LUPRON) 45 mg intraMUSCULAR injection (RESTRICTED)	Every 24 weeks	S	Until discont'd	
		45 mg, intramuscular, once, Starting when released
	Administer as a single injection into the gluteal area, anterior thigh, or deltoid.