CHORIONIC GONADOTROPIN

CHORIONIC GONADOTROPIN
(go-nad'oh-troe-pin)
Pregnyl
Classifications: hormone; human chorionic gonadotropin (hcg);
Therapeutic:hcg hormone

Pregnancy Category: X

Availability

10,000 unit vial

Action

Human chorionic gonadotropin (HCG) is a polypeptide hormone produced by the placenta and extracted from urine during first trimester of pregnancy. Actions nearly identical to those of pituitary luteinizing hormone (LH). Promotes production of gonadal steroid hormones by stimulating interstitial cells of the testes to produce androgen, and the corpus luteum of the ovary to produce progesterone.

Therapeutic Effect

Administration of HCG to women of childbearing age with normal functioning ovaries causes maturation of the ovarian follicle and triggers ovulation. When given during normal pregnancy, it maintains corpus luteum after LH decreases, supports continuing secretion of estrogen and progesterone, and prevents ovulation.

Uses

Prepubertal cryptorchidism not due to anatomic obstruction and male hypogonadism secondary to pituitary deficiency. Also used in conjunction with menotropins to induce ovulation and pregnancy in infertile women in whom the cause of anovulation is secondary; ovulation usually occurs within 18 h. To stimulate spermatogenesis in males with hypogonadism.

Unlabeled Uses

Corpus luteum dysfunction.

Contraindications

Known hypersensitivity to HCG, hypogonadism of testicular origin, hamster protein hypersensitivity; hypertrophy or tumor of pituitary, prostatic carcinoma or other androgen-dependent neoplasms, precocious puberty; ovarian failure; dysfunctional uterine bleeding; adrenal insufficiency; uncontrolled thyroid disease; children <4 y; neonates; pregnancy (category X).

Cautious Use

Epilepsy, migraine, asthma, cardiac or renal disease; endometriosis; thrombophlebitis; lactation.

Route & Dosage

Prepubertal Cryptorchidism
Child: IM 4000 units 3 times/wk for 3 wk, or 5000 units q.o.d. for 4 doses, or 500–1000 units 3 times/wk for 4–6 wk

Hypogonadotropic Hypogonadism
Adult: IM 500–1000 units 3 times/wk for 3 wk, then 2 times/wk for 3 wk or 4000 units 3 times/wk for 6–9 mo followed by 2000 units 3 times/wk for 3 mo

Stimulation of Spermatogenesis
Adult: IM 5000 units 3 times/wk until normal testosterone levels are achieved (4–6 mo), then 2000 units 2 times/wk with menotropins for 4 mo

Induction of Ovulation
Adult: IM 500–1000 units 1 d following last dose of menotropins

Administration

  • Reconstitute only with diluent supplied by manufacturer.
  • Following reconstitution solution is stable for 30–90 d, depending on manufacturer, when refrigerated; thereafter potency decreases.
  • Store powder for injection at 15°–30° C (59°–86° F) unless otherwise directed.

Adverse Effects (≥1%)

Body as a Whole: Edema, pain at injection site, arterial thromboembolism. Endocrine: Gynecomastia, precocious puberty, increased urinary steroid excretion, ectopic pregnancy (incidence low). When used with menotropins (human menopausal gonadotropin): Ovarian hyperstimulation (ascites with or without pain, pleural effusion, ruptured ovarian cysts with resultant hemoperitoneum, multiple births). CNS: Headache, irritability, restlessness, depression, fatigue.

Diagnostic Test Interference

Pregnancy tests: Possibility of false results.

Interactions

Drug: No clinically significant drug interactions established. Herbal: Black cohosh may antagonize fertility effects.

Pharmacokinetics

Onset: 2 h. Peak: 6 h. Distribution: Testes in males, ovaries in females. Elimination: 10–12% in urine within 24 h. Half-Life: 23 h.

Nursing Implications

Assessment & Drug Effects

  • Assess prepubescent males for development of secondary sex characteristics.
  • Assess females for and report excessive menstrual bleeding, irregular menstrual cycles, and abdominal/pelvic distention or pain.

Patient & Family Education

  • Treatment for prepubertal cryptorchidism is usually started between 4 and 9 y. HCG can help predict whether orchidopexy will be needed in the future.
  • When used for treatment of infertility, timing of coitus is important. Daily intercourse is encouraged from day before HCG is given until ovulation occurs.
  • Report promptly onset of abdominal pain and distension (ovarian hyperstimulation syndrome).
  • Report to physician if the following appear: axillary, facial, pubic hair; penile growth; acne; deepening of voice. Induction of androgen secretion by HCG may induce precocious puberty in patient treated for cryptorchidism.
  • Observe for signs of fluid retention. A weight chart should be maintained for a biweekly record. Report to physician if weight gain is associated with edema.
  • Report vaginal bleeding during treatment of corpus luteum deficiency; drug will be discontinued.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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