menotropins

Action

Simulates action of follicle-stimulating hormone (FSH) by promoting follicular growth and maturation

Availability

Injection (powder or pellet for reconstitution): 75 international units luteinizing hormone (LH); 150 international units LH and 150 international units FSH activity/vial

Indications and dosages

➣ Controlled ovarian stimulation in patients with oligoanovulation

Women: Dosage individualized. Recommended dosage is 150 international units I.M. or subcutaneously daily during first 5 days of treatment, with subsequent dosages adjusted based on response. Adjust dosage no more often than every 2 days, and don't exceed 75 to 150 international units per adjustment. Maximum daily dosage is 450 international units. Dosing beyond 12 days is not recommended. If response is appropriate, human chorionic gonadotropin (hCG) should be given I.M. 1 day after last menotropins dose.

➣ Assisted reproductive technologies

Women: In patients who've received gonadotropin-releasing hormone agonists or antagonist pituitary suppression, recommended initial dosage is 225 international units I.M. or subcutaneously, with subsequent dosage adjustments based on response. Adjust dosage no more often than every 2 days, and don't exceed 75 to 150 international units per adjustment. Maximum daily dosage is 450 international units. Dosing beyond 12 days isn't recommended. Once adequate follicular development appears, hCG is given to induce follicular maturation in preparation for oocyte retrieval.

Contraindications

• Hypersensitivity to drug

• High FSH levels (indicating primary ovarian failure)

• Abnormal bleeding of undetermined origin

• Uncontrolled thyroid or adrenal dysfunction

• Organic intracranial lesion (such as pituitary tumor)

• Causes of infertility other than anovulation (unless patient is candidate for in vitro fertilization)

• Ovarian cysts or enlargement not caused by polycystic ovarian syndrome

• Pregnancy

Precautions

Use cautiously in:

• renal or hepatic insufficiency (safety and efficacy not established)

• breastfeeding patients.

Administration

• Know that drug may be given either I.M. or subcutaneously.

• To reconstitute powder or pellet for injection, add accompanying 2 ml of 0.9% sodium chloride injection to vial.

• Inject immediately after reconstitution. Discard unused portion.

• Rotate injection sites.

• Use lower abdomen for subcutaneous injection.

• Withhold hCG if serum estradiol level exceeds 2,000 pg/ml or abdominal pain occurs.

Adverse reactions

CNS: headache, malaise, dizziness, cerebrovascular accident

CV: tachycardia, venous thrombophlebitis, arterial occlusion, arterial thromboembolism

GI: nausea, vomiting, diarrhea, abdominal cramps and distention, hemoperitoneum

GU: ovarian enlargement with pain, gynecomastia, ovarian cysts, multiple births, ovarian hyperstimulation syndrome (OHSS), ectopic pregnancy

Metabolic: electrolyte imbalances

Musculoskeletal: muscle aches, joint pain

Respiratory: dyspnea, tachypnea, atelectasis, adult respiratory distress syndrome, pulmonary embolism, pulmonary infarction

Skin: rash

Other: fever, hypersensitivity reaction, anaphylaxis

Interactions

None significant

Patient monitoring

• Know that before starting menotropins/hCG therapy to induce ovulation and pregnancy, patient should undergo gynecologic and endocrine evaluation with hysterosalpingogram to rule out pregnancy and neoplastic lesions.

• Assess patient to confirm anovulation. Obtain urinary gonadotropin levels as ordered to rule out primary ovarian failure. (Male partner's fertility should be evaluated, also).

• In older females (who have greater risk of anovulatory disorders and endometrial cancer), assess cervical dilation and curettage results.

• Evaluate patient for expected ovarian stimulation without hyperstimulation.

See Monitor for early indications of OHSS-severe pelvic pain, nausea, vomiting, and weight gain. OHSS usually occurs 2 weeks after treatment ends, peaks 7 to 10 days after ovulation, and resolves with menses onset.

See If OHSS occurs, drug is withdrawn and patient is hospitalized for bed rest, fluid and electrolyte management, and analgesics. Monitor daily fluid intake and output, weight, abdominal girth, hematocrit, serum and urinary electrolytes, urine specific gravity, blood urea nitrogen, and creatinine. Watch for hemoconcentration caused by fluid loss into peritoneal, pleural, and pericardial cavities.

See Stay alert for pulmonary and thromboembolic complications.

• Assess male patient for pituitary insufficiency as possible cause of infertility.

Patient teaching

• Before therapy, teach patient about duration of treatment and necessary monitoring.

• Inform patient about risk of multiple births with menotropins and hCG use.

• For infertile females, encourage daily intercourse starting on day before hCG administration.

• As appropriate, review all other significant and life-threatening adverse reactions.