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Chorionic Gonadotropin

(Human)

Pronunciation: kore-ee-ON-ik goe-NAD-oh-troe-pin
Class: Gonadotropin, Ovulation stimulant

Trade Names

Novarel
- Injection, powder for solution 10,000 units

Pregnyl
- Injection, powder for solution 10,000 units

Pharmacology

Stimulates production of gonadal steroid hormones by stimulating interstitial cells (Leydig cells) of the testis to produce androgens and corpus luteum of the ovary to produce progesterone.

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Pharmacokinetics

Absorption

Bioavailability is 40% after subcutaneous administration; C max is reached in 6 h.

Distribution

Distributed mainly to the gonads.

Metabolism

Metabolized mainly in the kidneys.

Elimination

Blood concentrations decline in a biphasic manner with half-lives of approximately 6 to 11 h and 23 to 38 h, respectively. Within 24 h, 10% to 12% is excreted in the urine.

Special Populations

Renal Function Impairment

No data available.

Hepatic Function Impairment

No data available.

Indications and Usage

Prepubertal cryptorchidism not caused by anatomical obstruction; selected cases of hypogonadotropic hypogonadism (eg, hypogonadism secondary to pituitary deficiency) in men; induction of ovulation and pregnancy in anovulatory, infertile women in whom the cause of anovulation is secondary and not caused by primary ovarian failure and who have been appropriately pretreated with human menotropins.

Contraindications

Precocious puberty; prostatic carcinoma or other androgen-dependent neoplasm; prior allergic reaction to human chorionic gonadotropin (hCG); pregnancy.

Dosage and Administration

Prepubertal Cryptorchidism
Children (4 y and older) Various authorities have advocated the following regimens Regimen 1

IM 4,000 units 3 times/wk for 3 wk.

Regimen 2

IM 5,000 units every other day for 4 injections.

Regimen 3

IM 15 injections of 500 to 1,000 units over a period of 6 wk.

Regimen 4

IM 500 units 3 times/wk for 4 to 6 wk (if not successful, another course is begun 1 mo later using 1,000 units/injection).

Hypogonadotropic Hypogonadism in Males
Adults and Children (4 y and older) Various authorities have advocated the following regimens Regimen 1

IM 500 to 1,000 units 3 times/wk for 3 wk, followed by same dose twice a week for 3 wk.

Regimen 2

IM 4,000 units 3 times/wk for 6 to 9 mo, following which the dosage may be reduced to 2,000 units 3 times/wk for an additional 3 mo.

Ovulation Induction in Females
Adults

IM 5,000 to 10,000 units 1 day after the last dose of menotropins. A dosage of 10,000 units is recommended in the labeling for menotropins.

General Advice

  • Follow manufacturer's instructions for reconstituting the powder for injection.
  • Do not administer if particulate matter or discoloration is noted.
  • Administer by IM injection.

Storage/Stability

Store vials between 59° and 86°F. Store reconstituted solution in the refrigerator (36° to 46°F) and use within 30 days ( Novarel and generic formulation) or 60 days ( Pregnyl ).

Drug Interactions

None well documented.

Laboratory Test Interactions

Interference with radioimmunoassay for gonadotropins, particularly luteinizing hormone.

Adverse Reactions

CNS

Depression; fatigue; headache; irritability; restlessness.

Genitourinary

Gynecomastia; ovarian hyperstimulation; precocious puberty; rupture of ovarian cysts resulting in hemoperitoneum.

Hypersensitivity

Hypersensitivity reactions including angioedema, dyspnea, erythema, rash, shortness of breath, urticaria.

Miscellaneous

Arterial thromboembolism; ascites with or without pain; edema; multiple births; pain at injection site; pleural effusion.

Precautions

Monitor

Monitor women for signs of ovary overstimulation (eg, severe pelvic pain, abdominal pain or bloating). In adult men and women, the following hormone levels may be monitored depending on the nature of the diagnostic and therapeutic purpose: testosterone, dihydrotestosterone, 17-beta-estradiol, 17-beta-hydroxyprogesterone, progesterone, and androstenedione. In prepubertal males, testosterone and dihydrotestosterone may be followed.


Pregnancy

Category X . May cause fetal harm.

Lactation

Undetermined.

Children

Safety and efficacy in children younger than 4 y not established. The diluent for reconstitution may contain benzyl alcohol, which has been associated with a fatal gasping syndrome in premature infants.

Renal Function

Use with caution.

Special Risk Patients

Because chorionic gonadotropin may cause fluid retention, use with caution in patients with cardiac disease, epilepsy, migraine, or asthma.

Administration

Only health care providers experienced with fertility problems should use hCG in conjunction with human menopausal gonadotropins.

Precocious puberty

May induce precocious puberty in patients treated for cryptorchidism.

Patient Information

  • Review the treatment regimen, including duration and monitoring, that will be required.
  • If patient will be administering at home, teach patient how to store, prepare, and administer the dose, and dispose of used equipment and supplies.
  • Warn women that close monitoring for overstimulation of the ovary is required and to report any of the following immediately to their health care provider: difficulty breathing, severe pelvic pain, nausea, vomiting, weight gain, stomach pain or bloating, diarrhea, or infrequent urination.

Copyright © 2009 Wolters Kluwer Health.

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