menotropins

REMS

Used in conjunction with chorionic gonadotropin to stimulate ovulation in patients with ovarian dysfunction and resultant infertility.
Used in conjunction with chorionic gonadotropin to stimulate spermatogenesis in male patients with hypogonadotropic hypogonadism and resultant infertility.
As part of assisted reproductive technologies (ART) to stimulate the production of multiple oocytes in ovulatory patients.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Vaginal bleeding of unknown cause;
Uterine fibroid tumors;
Ovarian cysts;
Pregnancy.

Use Cautiously in:

Asthma;
CV disease;
Seizure disorders;
Migraine headaches;
Polycystic ovaries;
Pituitary hypertrophy or tumor;
Severe renal impairment.

Adv. Reactions/Side Effects ⬆ ⬇

CV: edema, THROMBOEMBOLISM, thrombophlebitis

Endo: gynecomastia (men)

GI: abdominal pain, bloating, diarrhea, nausea, vomiting

GU: pelvic pain, multiple births, ovarian enlargement

Misc: fever

Interactions ⬆ ⬇

Drug-drug:

None significant.

Availability ⬆ ⬇

Powder for injection: 75 units FSH activity and 75 units LH activity in vial; 150 units FSH activity and 150 units LH activity in vial

Route/Dosage ⬆ ⬇

SC IM (Adults ): Repronex—Infertile patients with oligo-anovulation: 150 units FSH and 150 units LH daily for first 5 days of treatment after GnRH agonist or antagonist pituitary suppression, dosage adjustments may be made every 2 days and should not exceed 75–150 units/adjustment (not to exceed 450 units/day or more than 12 days of therapy). If response is appropriate, hCG should be given after discontinuation of menotropins. Assisted reproduction technologies: 225 units FSH and 225 units LH daily after GnRH agonist or antagonist pituitary suppression, dosage adjustments may be made every 2 days and should not exceed 75–150 units/adjustment (not to exceed 450 units/day or more than 12 days of therapy) followed by chorionic gonadotropin.
IM (Adults —females): Pergonal: 75 units FSH and 75 units LH/day for 7–12 days followed by hCG if ovaries are not enlarged. If pregnancy does not occur, dose may be doubled for 2–3 more courses.
IM (Adults —males): Pergonal: following pretreatment with hCG alone, 75 units FSH activity and 75 units LH 3 times weekly concurrently with hCG, dose may be doubled if ineffective after 4 mo.

US Brand Names ⬆ ⬇

HMG, Menopur, Pergonal, Repronex

Action ⬆ ⬇

A purified form of human pituitary gonadotropins consisting of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In women, FSH causes growth and maturation of the ovarian follicle. LH causes ovulation and development of the corpus luteum. In men, LH causes spermatogenesis.

Therapeutic effects:

Ovulation or spermatogenesis, with resultant fertility.

Classifications ⬆ ⬇

Therapeutic Classification: hormones

Pharmacologic Classification: gonadotropins

Pharmacokinetics ⬆ ⬇

Absorption: Appears to be well absorbed after IM administration.

Distribution: Unknown.

Metabolism/Excretion: 8% excreted unchanged in the urine.

Half-Life: FSH: 70 hr; LH: 4 hr.

Time/Action Profile ⬆ ⬇

(effects on reproductive function‡)

ROUTE	ONSET	PEAK	DURATION
IM, SUBQ (women)	unknown	18 hr	unknown
IM (men)	unknown	4 mo	unknown

‡Women—peak = ovulation after chorionic gonadotropins; men—peak = increased spermatogenesis.

Patient/Family Teaching ⬆ ⬇

Instruct patient in correct technique for medication reconstitution and administration of IM injection. Ensure that patient understands medication administration schedule.
Female Infertility: Instruct patient in the correct method for measuring basal body temperature. A record of the daily basal body temperature should be maintained before and throughout course of therapy.
- Reinforce physician’s instructions regarding timing of sexual intercourse (usually daily beginning 1 day after administration of chorionic gonadotropin).
- Emphasize the importance of close monitoring by the physician throughout course of therapy (daily pelvic examinations are indicated after estrogen levels rise and for 2 wk after chorionic gonadotropin therapy).
- Inform patient before therapy of the potential for multiple births.
- Instruct patient to notify physician immediately if pregnancy is suspected (menses do not occur when expected and basal body temperature is biphasic).
- Advise patient to report to physician signs and symptoms of fluid retention (swelling of ankles and feet, weight gain), thromboembolic disorders (pain, swelling, tenderness in extremities, headache, chest pain, blurred vision), or abdominal or pelvic pain or bloating.
Male Infertility: Inform patient that breast enlargement may occur. Physician should be consulted if this is problematic.

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Indications ⬇