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  HCG
 
Author: Donna Karasic, PharmD Last modified: March 31, 2002
 

  INDICATIONS

  • Hypogonadism in men of hypothalamic or pituitary etiology desiring fertility; for induction or maintenance of virilization, testerone replacement should be used
  • Cryptorchidism
  • Ovulatory failure
  • Diagnostic test to evaluate testicular reserve
  • Hypospadias (non-FDA approved use)
  • Kaposi's Sarcoma (non-FDA approved use)

  DOSAGE

  • Male hypogonadism of hypothalamic or pituitary etiology when fertility is desired: 500-1000 units 3 times weekly for up to 2 yrs
  • Cryptorchidism: dosing regimen varies widely; 4 regimens have been used: 4000 units 3 times weekly for 3 weeks; 5000 units every 2nd day for 4 doses;
  • Cryptorchidism, con't: 15 injections of 500 to 1000 units over a period of 6 weeks; or 500 units 3 times weekly for 4 to 6 weeks;
  • Cryptorchidism, con't: if ineffective another course of therapy is begun 1 month later using 1000 units per dose
  • HCG Stimulation Test- 2000 units IM with testosterone levels drawn at 0 and 72 hours
  • Ovulatory failure: 5000 to 10,000 units on the first day following menotropin treatment
  • Kallman's Syndrome- HCG 2000 units IM 3 times a week for a few months, then add Gonal 75 units three times a week

  PHARMACOKINETICS

  • Onset- initial response 2 hours (IM)
  • Onset- peak response 6 hours (IM)
  • Duration- single dose is 36 hours (IM)
  • SC administration results in a delayed peak serum level, a lower peak concentration, and a lower AUC, relative to IM administration.
  • Cleared from the circulation by glomerular filtration
  • Elimination half-life is 5.6 hours

  ADVERSE EFFECTS

  • Thromboembolism
  • Edema
  • Headache
  • Irritability, Restlessness
  • Depression
  • Tiredness
  • Gynecomastia
  • Precocious puberty, reversible phallic enlargement, testicular enlargement, testicular cancer and growth of pubic hair

  CONTRAINDICATIONS

  • Precocious puberty
  • Prostatic carcinoma or other androgen dependent neoplasia
  • Prior allergic reaction to HCG

  FORMS

  • A.P.L. 5000 USP units, 10,000 USP units and 20,0000 USP units for injection (with diluent with benzyl alcohol and phenol)
  • Profasi HP 5000 USP units, 10,000 USP units for injection (with bacteriostatic water for injection with benzyl alcohol)
  • Chorex, Novrael, Pregnyl 10,000 USP units for injection

  MECHANISM OF ACTION

  • The action of HCG is almost identical to luteinizing hormone which is produced in the pituitary gland
  • However, HCG has a small amount of follicle stimulating hormone activity as well
  • HCG exerts its actions primarily on the ovaries and testes. In ovaries, it works with follicle stimulating hormone to produce a mature ovum and it stimulates the corpus luteum to produce Progesterone.
  • It stimulates the production of androgen, leading to the development of male secondary sex characteristics, and may stimulate testicular descent if there are no anatomical abnormalities
 
IMPORTANT POINTS/RECOMMENDATIONS
  • Use with caution in patients with epilepsy, migraine, asthma, or cardiac or renal disease
 
REFERENCES
  1. Hutchison TA & Shahan DR (Eds) ;  Chorionic Gonadotropin ;  MICROMEDEX┬« Healthcare Series: MICROMEDEX, Greenwood Village, Colorado (Edition expires 3-2002)

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