menotropins
Humegon, Pergonal

Available forms
Available by prescription only
Injection: 75 IU of luteinizing hormone (LH) and 75 IU of follicle-stimulating hormone (FSH) activity per ampule; 150 IU of LH and 150 IU of FSH activity per ampule

Indications and dosages
 Production of follicular maturation. Adults: 75 IU each of FSH and LH I.M. daily for 9 to 12 days, followed by 10,000 USP units chorionic gonadotropin (CG) I.M. 1 day after last dose of menotropins; may repeat for two more menstrual cycles if evidence of ovulation, but pregnancy doesn’t occur. Then, if ovulation or follicular development doesn’t occur, increase to 150 IU each of FSH and LH I.M. daily for 9 to 12 days, followed by 10,000 USP units CG I.M. 1 day after last dose of menotropins; may repeat for two menstrual cycles if evidence of ovulation, but pregnancy doesn’t occur.
 Note: If the ovaries are abnormally enlarged or if total urinary estrogen excretion is more than 100 mcg daily, or if urinary estriol excretion is more than 50 mcg daily, hold CG dose because hyperstimulation syndrome is more likely to occur.
 Stimulation of spermatogenesis. Adults: After 5,000 USP units of CG I.M. three times weekly for 4 to 6 months of treatment; 1 ampule (75 IU FSH/LH) I.M. three times weekly (given with 2,000 USP units CG twice weekly) for at least 4 months. If no improvement occurs after 4 months, treatment may continue with 75 IU FSH/LH three times weekly or 150 IU FSH/LH three times weekly. Dosage of CG doesn’t change.

Pharmacodynamics
Ovulation stimulant action: Drug causes growth and maturation of the ovarian follicle in women who don’t have primary ovarian failure by mimicking the action of endogenous LH and FSH. Additional treatment with CG is usually required to achieve ovulation.
Spermatogenesis stimulant action: Drug causes spermatogenesis when coadministered with CG in men with primary or secondary pituitary hypofunction.

Pharmacokinetics
Absorption: Unknown.
Distribution: Unknown.
Metabolism: Unknown.
Excretion: Excreted in urine.

Contraindications and precautions
Contraindicated in patients hypersensitive to drug; in women with primary ovarian failure, uncontrolled thyroid or adrenal dysfunction, pituitary tumor, abnormal uterine bleeding, uterine fibromas, or ovarian cysts or enlargement; in pregnant women; and in men with normal pituitary function, primary testicular failure, or infertility disorders other than hypogonadotropic hypogonadism.

Interactions
None reported.

Adverse reactions
CNS: CVA, headache, malaise, dizziness, fever.
CV: tachycardia.
GI: nausea, vomiting, diarrhea, abdominal cramps, bloating.
GU: ovarian enlargement with pain and abdominal distention, ovarian hyperstimulation syndrome (sudden severe abdominal pain, distention, nausea, vomiting, weight gain, and dyspnea followed by hypovolemia, hemoconcentration, electrolyte imbalance, pleural effusion, ascites, and hemoperitoneum), ovarian cysts, ectopic pregnancy.
Musculoskeletal: musculoskeletal aches, joint pains.
Respiratory: atelectasis, acute respiratory distress syndrome, pulmonary embolism, pulmonary infarction, arterial occlusion, dyspnea, tachypnea.
Skin: rash.
Other: multiple births, hypersensitivity reactions, anaphylaxis, gynecomastia, chills.

Effects on lab test results
None reported.

Overdose and treatment
The most common dose-related adverse effect appears to be ovarian hyperstimulation syndrome.
 Discontinue drug. Symptomatic and supportive care measures include bed rest, fluid and electrolyte replacement, and analgesics.

Special considerations
• Give drug only by I.M. route.
• Reconstitute drug with 1 to 2 ml of sterile saline injection. Use immediately and discard any unused portion.
• Monitor patient at least every other day for enlarged ovaries or hyperstimulation syndrome during and for 2 weeks after therapy.
• Pregnancies that follow ovulation induced with menotropins show a relatively high frequency of multiple births.
• Store drug at 37° to 86° F (3° to 30° C).
Breast-feeding patients
• Drug isn’t indicated for use in breast-feeding women.

Patient education
• Teach patient signs and tests that indicate time of ovulation, such as increase in basal body temperature and increased cervical mucus.
• Warn patient to immediately report symptoms of ovarian hyperstimulation syndrome, such as abdominal distention and pain, dyspnea, and vaginal bleeding.
• Warn patient that multiple births are possible. Ectopic pregnancy and congenital malformations have been reported in pregnancies following treatment.
• Encourage daily intercourse from day before CG is given until ovulation occurs.
• Advise patient that she should be examined at least every other day for signs of excessive ovarian stimulation during therapy and for 2 weeks after treatment is discontinued.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use