Usage
Menotrophin is prescribed for the treatment of infertility in both men and women. In women, it is used to stimulate follicle development in those who are not ovulating, including those with polycystic ovarian syndrome (PCOS). It is also used in women undergoing assisted reproductive technologies (ART), such as in-vitro fertilization (IVF), to induce the development of multiple follicles. In men, it is used to stimulate spermatogenesis in those with hypogonadotrophic hypogonadism.
Pharmacological Classification: Menotrophin is classified as a gonadotropin.
Mechanism of Action: Menotrophin is a mixture of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), extracted and purified from the urine of postmenopausal women. These hormones play crucial roles in the development and maturation of follicles in the ovaries and the production of sperm in the testes. In women, FSH stimulates the growth and development of ovarian follicles, while LH triggers ovulation (release of the mature egg). In men, FSH is essential for spermatogenesis (sperm production), and LH stimulates the production of testosterone, which supports various reproductive functions.
Alternate Names
Menotropins, human menopausal gonadotropin (hMG).
Brand Names: Menopur, Repronex, Humegon, Pergonal, Meriofert.
How It Works
Pharmacodynamics: Menotrophin mimics the action of endogenous FSH and LH. In females, it stimulates follicular growth and maturation, leading to ovulation. In males, it stimulates spermatogenesis and testosterone production.
Pharmacokinetics: Menotrophin is administered via subcutaneous (SC) or intramuscular (IM) injection. Absorption is relatively slow. Metabolism and elimination pathways are not fully characterized, but both hepatic and renal routes likely play a role.
Mode of Action: FSH and LH bind to their respective receptors on the surface of target cells in the ovaries and testes. This receptor activation triggers intracellular signaling pathways, ultimately leading to the desired reproductive effects.
Dosage
Standard Dosage
Adults:
The initial dose varies according to the specific clinical scenario but typically ranges from 75 IU to 225 IU daily via SC or IM injection. Dosages are adjusted according to the patient’s response, assessed by monitoring follicle development (ultrasound) and estradiol levels in women, and sperm counts in men. The maximum daily dose generally should not exceed 450 IU. The duration of therapy usually does not exceed 20 days for ovarian stimulation protocols.
Children:
Menotrophin is not typically used in children.
Special Cases:
- Elderly Patients: There is limited data to support specific dosing recommendations in the elderly.
- Patients with Renal Impairment: Dosage adjustments may be necessary; consult specialized resources.
- Patients with Hepatic Dysfunction: Dosage adjustments may be necessary; consult specialized resources.
- Patients with Comorbid Conditions: Careful consideration is needed in patients with thromboembolic disorders, gonadal endocrinopathies, pituitary tumors, abnormal bleeding, and other relevant medical conditions.
Clinical Use Cases
Menotrophin is not typically indicated for use in clinical scenarios such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dosage adjustments are based on the patient’s individual response and clinical monitoring.
Side Effects
Common Side Effects:
Headache, abdominal pain/discomfort, bloating, injection site reactions (pain, redness, swelling), breast tenderness, dizziness, nausea, vomiting, diarrhea.
Rare but Serious Side Effects:
Ovarian hyperstimulation syndrome (OHSS), thromboembolic events (blood clots), allergic reactions (rash, hives, difficulty breathing, swelling).
Long-Term Effects:
Increased risk of ovarian and other reproductive organ neoplasms (both benign and malignant) has been associated with prolonged use of gonadotropins.
Adverse Drug Reactions (ADR):
OHSS, thromboembolism, anaphylaxis, pulmonary complications.
Contraindications
- Primary ovarian failure
- Uncontrolled thyroid or adrenal dysfunction
- Pituitary tumor
- Abnormal vaginal bleeding of unknown origin
- Ovarian cysts or enlarged ovaries (not due to PCOS)
- Pregnancy and lactation
- Hypersensitivity to menotropins
Drug Interactions
Concomitant use of clomiphene citrate may potentiate the effects of menotrophin on the ovaries. When used with GnRH agonists for pituitary desensitization, higher doses of menotrophin may be required. Alcohol should be avoided or limited due to the potential for increased side effects.
Pregnancy and Breastfeeding
Menotrophin is contraindicated in pregnancy and breastfeeding.
Drug Profile Summary
- Mechanism of Action: Stimulates follicular growth and maturation in women and spermatogenesis in men.
- Side Effects: Headache, abdominal pain, OHSS, injection site reactions.
- Contraindications: Pregnancy, primary ovarian failure, pituitary tumors.
- Drug Interactions: Clomiphene citrate, GnRH agonists.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: 75-225 IU daily initially, adjustable according to response, not to exceed 450 IU/day.
- Monitoring Parameters: Follicle development (ultrasound), estradiol levels (women), sperm count (men).
Popular Combinations
Menotrophin is often used in combination with human chorionic gonadotropin (hCG) to trigger ovulation after follicular maturation. It can also be used in combination with GnRH agonists or antagonists in ART protocols.
Precautions
Thorough gynecological and endocrinological evaluation is essential before treatment. Monitor closely for OHSS. Patients with a history of thromboembolic events should be monitored carefully.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Menotrophin?
A: The initial dosage is typically 75-225 IU daily, adjusted based on individual response. The maximum daily dose should not exceed 450 IU.
Q2: How is Menotrophin administered?
A: It is administered via subcutaneous (SC) or intramuscular (IM) injection.
Q3: What are the common side effects?
A: Common side effects include headache, abdominal pain, injection site reactions, and bloating.
Q4: What is OHSS?
A: Ovarian Hyperstimulation Syndrome (OHSS) is a potentially serious complication characterized by ovarian enlargement and fluid accumulation in the abdomen.
Q5: What are the contraindications to using Menotrophin?
A: Contraindications include pregnancy, primary ovarian failure, uncontrolled thyroid/adrenal dysfunction, and pituitary tumors.
Q6: Can Menotrophin be used in men?
A: Yes, it can be used in men with hypogonadotrophic hypogonadism to stimulate spermatogenesis.
Q7: How is patient response monitored during treatment?
A: Response is monitored by ultrasound assessment of follicular development and serum estradiol levels in women, and sperm counts in men.
Q8: What are the drug interactions to consider?
A: Concomitant use with clomiphene citrate can enhance ovarian stimulation. Interactions may also occur with GnRH agonists and antagonists.
Q9: Can Menotrophin be used during pregnancy?
A: No, menotrophin is contraindicated during pregnancy. It should be discontinued if pregnancy is confirmed.
