CORIOSURGE XP 5000

Indications

• Infertility treatment in women
• Triggering ovulation
• Hypogonadism in men
• Support of early pregnancy

Dosage

Children: Refer to the BNF for Children for specific dosing.

Adults: Refer to relevant clinical guidelines for specific dosing.

Mechanism of action

Chorionic gonadotropin exerts its effects by binding to the luteinizing hormone (LH) receptor, which is expressed in the ovaries and testes. This binding activates the receptor, leading to a cascade of intracellular signaling that promotes steroidogenesis-enhancing the synthesis of progesterone in females and testosterone in males. It mimics the action of LH, thus playing a crucial role in ovulation and maintaining the corpus luteum.

Pharmacodynamics

The pharmacodynamic effects of chorionic gonadotropin include stimulation of ovarian follicle maturation and ovulation in women, and stimulation of testosterone production and spermatogenesis in men. The effects are dose-dependent and can vary based on the route of administration and the specific clinical scenario. In fertility treatments, hCG is used to trigger ovulation, while in men, it can be used to treat hypogonadism.

Pharmacokinetics

Chorionic gonadotropin is administered via subcutaneous or intramuscular injection. After administration, it is absorbed into the bloodstream, with peak plasma concentrations occurring about 24 to 48 hours post-injection. The half-life of hCG is approximately 24 to 36 hours, and it is primarily eliminated through renal excretion. The pharmacokinetics may be influenced by the patient's weight, age, and other individual factors.

Adverse effects

• Nausea
• Vomiting
• Headache
• Abdominal pain
• Ovarian hyperstimulation syndrome (OHSS)
• Injection site reactions

Precautions

• Use with caution in patients with a history of thrombosis or thromboembolic disorders.
• Monitor for signs of OHSS, especially in women undergoing assisted reproductive techniques.
• Evaluate liver and kidney function prior to administration.

Pregnancy

Chorionic is used in pregnancy to support luteal phase and early pregnancy; however, its use should be carefully monitored.

Breast-feeding

Limited data available; use with caution and consult with a healthcare provider.

Storage

Store in a refrigerator (2-8 degrees Celsius). Protect from light. Do not freeze.

Formulations

• Chorionic gonadotropin injection
• Chorionic gonadotropin nasal spray

Indications

• Anovulation
• Infertility
• Hypogonadism
• Assisted reproductive technology (ART)
• Ovarian stimulation

Dosage

Children: Refer to the BNF for Children for dosing information as it varies according to the specific clinical scenario and individual patient

Adults: Dosing regimens vary based on the specific gonadotrophin and clinical indication. Refer to specific guidelines or the relevant BNF for detailed dosing information.

Mechanism of action

Gonadotrophins act by binding to specific receptors on the surface of gonadal cells. FSH primarily promotes the growth and maturation of ovarian follicles in females and spermatogenesis in males. LH triggers ovulation and promotes the secretion of sex steroids, such as estrogen and testosterone, from the gonads. This action is mediated through the activation of adenylate cyclase, leading to increased cyclic AMP levels and subsequent activation of protein kinase A.

Pharmacodynamics

The pharmacodynamics of gonadotrophins involves the regulation of reproductive hormones and the reproductive cycle. FSH stimulates the development of ovarian follicles and the production of estrogen, while LH is responsible for triggering ovulation and supporting luteal function through progesterone secretion. Their synergistic action is crucial for normal reproductive function and fertility.

Pharmacokinetics

Gonadotrophins are administered via injection, as they are not effective orally due to degradation in the gastrointestinal tract. They have a variable half-life depending on the specific type of gonadotrophin used, with FSH typically having a half-life of 3-4 hours and LH having a shorter half-life. The pharmacokinetics may also be influenced by the formulation (e.g., recombinant versus urinary-derived). The gonadotrophins are metabolized in the liver and excreted via the kidneys.

Contra-indications

• Hypersensitivity to gonadotrophins or any of their excipients
• Tumors of the pituitary gland or hypothalamus
• Ovarian cysts or enlarged ovaries not caused by polycystic ovary syndrome
• Primary ovarian insufficiency

Adverse effects

• Ovarian hyperstimulation syndrome (OHSS)
• Multiple pregnancies
• Headache
• Nausea
• Abdominal pain
• Injection site reactions
• Mood swings
• Breast tenderness

Interactions

• Corticosteroids may reduce the effectiveness of gonadotrophins
• Other hormone treatments may interact with gonadotrophins

Precautions

• Monitor for signs of OHSS
• Use with caution in patients with a history of thromboembolic disorders
• Careful consideration in patients with liver or kidney disease

Pregnancy

Gonadotrophins are contraindicated in pregnancy due to the potential for inducing ovarian hyperstimulation syndrome and promoting multiple gestations.

Breast-feeding

There is limited data on the excretion of gonadotrophins in breast milk; caution is advised when administering to breastfeeding mothers.

Storage

Store in a refrigerator (2-8°C). Protect from light. Do not freeze.

Formulations

• Human chorionic gonadotropin (hCG)
• Follicle-stimulating hormone (FSH)
• Luteinizing hormone (LH)
• Recombinant gonadotrophins