HMG Menotrophin

Indications
 Parenteral
Female infertility
Adult: Dosage and schedule depends on patient's needs. Dose is given via IM/SC admin to provide 75-150 units of FSH daily. Adjust dose gradually until adequate response is achieved. Once reached, stop menotrophin admin and induce ovulation by administering chorionic gonadotrophin 1-2 days later at doses of 5,000-10,000 units. In menstruating patients, start treatment within the 1st 7 days of the menstrual cycle; may repeat cycle at least twice more if needed. Alternatively, admin 3 equal doses of menotrophin (each providing 225-375 units of FSH) on alternate days, followed by chorionic gonadotrophin 1 wk after the 1st dose.
Parenteral
In vitro fertilisation procedures or other assisted conception techniques
Adult: As monotherapy or in conjunction with clomiphene citrate or gonadorelin agonist: Dose providing 75-300 units of FSH is admin daily via IM/SC inj to stimulate follicular growth, usually started on the 2nd or 3rd of the menstrual cycle and continued until adequate response is obtained. After the final inj of menotrophin, this is followed by chorionic gonadotrophin 1-2 days later to stimulate egg maturation. Admin human chorionic gonadotrophin only if there are at least 3 follicles >17 mm in diameter with 17-β-oestradiol levels ≥3500 pmol/L (920 picograms/ml). Egg retrieval may be carried out 32-36 hr after the human chorionic gonadotrophin inj.
Parenteral
Male infertility
Adult: In conjunction with chorionic gonadotrophin (1000 - 2000 IU 2-3 times wkly): Menotrophin is admin at a dose providing 75 or 150 units of FSH via IM/SC inj 2-3 times wkly, continue treatment for at least 3-4 mth.

Reconstitution: Reconstitute with the provided diluent before use.
Contraindications
 Pregnancy & lactation. Ovarian cysts or enlarged ovaries (not due to polycystic ovarian syndrome), uncontrolled thyroid and adrenal dysfunction, organic intracranial lesions (e.g. pituitary tumours), abnormal genital bleeding of unknown cause, presence of other causes of infertility other than anovulation (unless they are candidates of in vitro-fertilisation), hormone sensitive tumours e.g. breast, uterus, prostate, ovaries or testes. Primary ovarian failure, malformation of sexual organs or fibroid tumours of the uterus incompatible with pregnancy, structural abnormalities such as tubal occlusion (unless superovulation is to be induced), ovarian dysgenesis, absent uterus or premature menopause.
Warnings / Precautions
 In females: Monitor ovarian activity and measure urinary oestrogen at regular intervals, until stimulation occurs. Discontinue menotrophin treatment and withhold human chorionic gonadotrophin if urinary oestrogen levels >540 nmol/24 hr, or if plasma 17 β-oestradiol levels >3000 pmol/l, or if there is any sharp rise in values. Refrain from sexual intercourse or use barrier contraception methods for at least 4 days and pelvic examinations to be avoided or carried out with care.
Adverse Reactions
 Ovarian enlargement, ovarian cysts, enlarged abdomen, GI disturbances (e.g. nausea, vomiting, diarrhoea, abdominal pain or cramps, bloating), inj site reactions, headache, dizziness, tachycardia, dyspnoea, tachypnoea, hypersensitivity reactions. Multiple births and miscarriages.
Potentially Fatal: Ovarian Hyperstimulation Syndrome, severe pulmonary conditions (e.g atelectasis, acute respiratory distress syndrome) and thromboembolic events.
Overdose Reactions
 Symptoms: Ovarian hyperstimulation, ranging from mild to severe. Management: In mild to moderate hyperstimulation: Bed rest, close observation and symptomatic relief. In severe hyperstimulation: Treatment is conservative and aims at restoring blood volume and preventing shock. If conception does not occur, acute symptoms will go away after several days and ovaries return to normal in 20 - 40 days. If conception occurs, symptoms may be prolonged.
Drug Interactions
 Increased follicular response with clomiphene citrate. Higher dose of menotrophin needed when gonadotropin-releasing hormone agonist is used for pituitary desensitisation.
See Below for More menotrophin Drug Interactions
Mechanism of Actions
 Menotrophins, a purified extract of human post-menopausal urine, contain follicle-stimulating hormone (FSH) and luteinising hormone (LH) in a ratio of 1:1. The biological effectiveness of menotrophins is mainly due to its FSH content. In the ovaries, the FSH-component increases the quantity of growing follicles and stimulates their development. Under the influence of LH, FSH increases oestradiol production in the granulosa cells. In the testes, FSH induces the maturation of Sertoli cells and the seminal canals and the development of the spermatozoa.
Absorption: Max FSH serum levels reached: 18 hr (IM inj) and 12 hr (SC inj).
Excretion: Half-life: 55 hr (IM inj) and 50 hr (SC inj). Mainly excreted by kidneys.
Storage Conditions
 Parenteral: Store ≤25°C. Protect from light.
Storage
 Parenteral: Store ≤25°C. Protect from light.
Available As
  • HMG Menotrophin 75 iu

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