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  HMG
 
Author: Donna Karasic, PharmD Last modified: February 24, 2002
 

  INDICATIONS

  • Male Infertility (due to central Hypogonadotropic Hypogonadism)
  • In Vitro Fertilization
  • Ovulation Induction
  • Polycystic Ovarian Syndrome (non-FDA approved use)

  DOSAGE

  • Male Infertility (due to central hypogonadotrophic hypogonadism)- 75 units 3 times/week IM or SC; prior to Menotropins, HCG 5000 units should be given IM 3 times/week
  • Male Infertility, con't: HCG should be given for a period of time adequate to achieve adequate serum testosterone levels; this may take up to 6 months.
  • Male Infertility, con't: then therapy with menotropins is started and the dose of HCG is reduced to 2000 units 2 times weekly while Menotropins is given.
  • Male Infertility, con't: Combined therapy should continue for 4 months. At the end of 4 months, the dose of Menotropins may be continued or be increased to 150 units
  • In Vitro Fertilization: 150 units daily for 7 to 12 days w/HCG 5000 to 10,000 units administered the day after the last dose of MENOTROPINS.

  PHARMACOKINETICS

  • The half-life of follicle stimulating hormone is 2.9 hours, the half-life of luteinizing hormone is 2.2 hours
  • Menotropins are cleared from circulation by glomerular filtration; they are then degraded in the proximal tubule or excreted unchanged in the urine

  ADVERSE EFFECTS

  • Hypersensitivity reactions
  • Thromboembolism, arterial occlusion, vascular occlusion
  • Tachycardia
  • Dizziness
  • Gynecomastia in men
  • Nausea, vomiting, diarrhea
  • Ovarian hyperstimulation, pelvic pain, ovarian cysts
  • Arthralgia
  • Tachypnea, atelectasis, acute respiratory distress syndrome, pulmonary embolism

  CONTRAINDICATIONS

  • Primary testicular failure
  • Intracranial bleeding
  • Adrenal or thyroid disorders
  • Preexisting ovarian cysts or enlargement
  • Primary ovarian failure
  • Pituitary tumor
  • Pregnancy
  • Undiagnosed vaginal bleeding

  DRUG INTERACTIONS

  • Other drugs that stimulate ovulation

  FORMS

  • Pergonal 75 IU FSH and LH activity; powder or pellet for injection; lyophilized
  • Pergonal 150 IU FSH and LH activity; powder or pellet for injection; lyophilized
  • Repronex 75 IU FSH and LH activity; powder or pellet for injection; lyophilized
  • Repronex 150 IU FSH and LH activity; powder or pellet for injection; lyophilized

  MECHANISM OF ACTION

  • MENOTROPINS are a mixture of an equal potency of follicle stimulating hormone (FSH) and luteinizing hormone (LH).
  • They are isolated from the urine of postmenopausal women
  • These hormones have specific actions necessary for the development, maturation and release of ova from ovaries and for spermatogenesis in the testes.
 
IMPORTANT POINTS/RECOMMENDATIONS
  • HMG is recommended for male infertility; if virilization alone is indicated, then testosterone replacement therapy is more efficient and cost effective
  • For men- document lack of pituitary function prior to treatment with menotropins
  • For women- use lowest effective dose to minimize hazard of ovarian enlargement/ overstimulation
  • Pergonal can be given IM; Repronex can be given IM or SC
 
REFERENCES
  1. Hutchinson TA & Shahan DR (Eds) ;  Menotropins ;  MICROMEDEX Healthcare Series; MICROMEDEX, Greenwood Village, Colorado (edition expires 3-2002)

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