Professional Information

Chorionic Gonadotropin

Pronunciation: (core-ee-AHN-ik goe-NAD-oh-troe-pin)
Class: Ovulation stimulant

Trade Names:
Chorionic Gonadotropin
- Powder for injection 5,000 units/vial with 10 mL diluent (to make 500 units/mL)
- Powder for injection 10,000 units/vial with 10 mL diluent (to make 1,000 units/mL)

Trade Names:
Novarel
- Powder for injection 10,000 units/vial with 10 mL diluent (to make 1,000 units/mL)

Trade Names:
Pregnyl
- Powder for injection 10,000 units/vial with 10 mL diluent (to make 1,000 units/mL)

Trade Names:
Profasi
- Powder for injection 5,000 units/vial with 10 mL diluent (to make 500 units/mL)
- Powder for injection 10,000 units/vial with 10 mL diluent (to make 1,000 units/mL)

Pharmacology

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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.

Pharmacokinetics

Absorption

A detectable rise in human chorionic gonadotropin (hCG) is seen in 2 h; peak levels are reached in 6 h and remain at this level for 36 h.

Elimination

hCG levels begin to decline at 48 h and approach baseline at 72 h.

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 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 hCG.

Dosage and Administration

Prepubertal Cryptorchidism
Children (4 yr of age and older) Various authorities have advocated the following regimens

IM (1) 4,000 units 3 times/wk for 3 wk, (2) 5,000 units every other day for 4 injections, (3) 15 injections of 500 to 1,000 units over a period of 6 wk, or (4) 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 Men
Adults Various authorities have advocated the following regimens

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

General Advice

Follow manufacturer's instructions for reconstituting the powder for injection.
Do not administer if particulate matter or discoloration noted.
With patient lying down or sitting, administer drug by IM injection. Rotate injection sites.
To minimize bleeding, do not rub site after injection.
Discard any unused reconstituted material.

Storage/Stability

Store vials at controlled room temperature (59° to 86°F). Store reconstituted solution in refrigerator (36° to 46°F) and use within 30 or 60 days per manufacturer's recommendations.

Drug Interactions

None well documented.

Laboratory Test Interactions

Interference with radioimmunoassay for gonadotropins, particularly luteinizing hormone.

Adverse Reactions

CNS

Headache; irritability; restlessness; depression; fatigue.

Genitourinary

Precocious puberty; gynecomastia.

Metabolic

Edema.

Miscellaneous

Pain at injection site.

Precautions

Monitor

Ovary overstimulation

Monitor women for signs of overstimulation of the ovary (eg, difficulty breathing, severe pelvic pain, nausea, vomiting, weight gain, stomach pain or bloating, diarrhea, infrequent urination) and report to health care provider immediately if noted.

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy in children younger than 4 yr of age not established.

Special Risk Patients

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

Exams

Ensure that women have had a thorough gynecological and endocrinological evaluation before starting therapy. Ensure that men have had a thorough medical and endocrinological evaluation before starting therapy.

Health care provider use

Use in conjunction with human menopausal gonadotropins only by health care provider experienced with infertility problems.

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 health care provider: difficulty breathing, severe pelvic pain, nausea, vomiting, weight gain, stomach pain or bloating, diarrhea, or infrequent urination.