Chorionic Gonadotropin

HCG HAS NOT BEEN DEMONSTRATED TO BE EFFECTIVE ADJUNCTIVE THERAPY IN THE TREATMENT OF OBESITY. THERE IS NO SUBSTANTIAL EVIDENCE THAT IT INCREASES WEIGHT LOSS BEYOND THAT RESULTING FROM CALORIC RESTRICTION, THAT IT CAUSES A MORE ATTRACTIVE OR ‘‘NORMAL’’ DISTRIBUTION OF FAT, OR THAT IT DECREASES THE HUNGER AND DISCOMFORT ASSOCIATED WITH CALORIE-RESTRICTED DIETS. 1. Prepubertal cryptorchidism not due to anatomical obstruction. In general, HCG is thought to induce testicular descent in situations when descent would have occurred at puberty. HCG thus may help predict whether or not orchiopexy will be needed in the future. Although, in some cases, descent following HCG administration is permanent, in most cases, the response is temporary. Therapy is usually instituted between the ages four and nine. 2. Selected cases of hypogonadotropic hypogonadism (hypogonadism secondary to a pituitary deficiency) in males. 3. Induction of ovulation and pregnancy in the anovulatory, infertile woman in whom the cause of anovulation is secondary and not due to primary ovarian failure, and who has been appropriately pretreated with human menotropins.

Precocious puberty, prostatic carcinoma or other androgen-dependent neoplasm, prior allergic reaction to HCG.

HCG should be used in conjunction with human menopausal gonadotropins only by physicians experienced with infertility problems who are familiar with the criteria for patient selection, contraindications, warnings, precautions and adverse reactions described in the package insert for menotropins. The principal serious adverse reactions are: (1) Ovarian hyperstimulation, a syndrome of sudden ovarian enlargement, ascites with or without pain and/or pleural effusion, (2) Rupture of ovarian cysts with resultant hemoperitoneum, (3) Multiple births and (4) Arterial thromboembolism. Anaphylaxis and other hypersensitivity reactions have been reported with urinary-derived HCG products.

General Induction of androgen secretion by HCG may induce precocious puberty in patients treated for cryptorchidism. Therapy should be discontinued if signs of precocious puberty occur. Since androgens may cause fluid retention, HCG should be used with caution in patients with cardiac or renal disease, epilepsy, migraine or asthma. Drug/Laboratory Test Interactions Chorionic gonadotropin may interfere with radioimmunoassay for gonadotropins, particularly luteinizing hormone. Carcinogenesis, Mutagenesis, Impairment of Fertility Long-term studies in animals have not been performed to evaluate the carcinogenic or mutagenic potential of chorionic gonadotropin. Pediatric Use Safety and effectiveness of chorionic gonadotropin in children below the age of four have not been established. Pregnancy Teratogenic Effects: Chorionic gonadotropin may cause fetal harm when administered to a pregnant woman. Defects of forelimbs and central nervous system and alterations in sex ratio have been reported in mice receiving combined gonadotropin and chorionic gonadotropin therapy in dosages to induce superovulation. Multiple ovulations with resulting plural gestations (mostly twins) have been reported to occur in approximately 20% of pregnancies when conception has followed chorionic gonadotropin therapy. Nursing Mothers It is not known whether chorionic gonadotropin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when chorionic gonadotropin is administered to a nursing woman.

Headache, irritability, restlessness, depression, fatigue, edema, precocious puberty, gynecomastia and pain at the site of injection.

Teratogenic Effects: Chorionic gonadotropin may cause fetal harm when administered to a pregnant woman. Defects of forelimbs and central nervous system and alterations in sex ratio have been reported in mice receiving combined gonadotropin and chorionic gonadotropin therapy in dosages to induce superovulation. Multiple ovulations with resulting plural gestations (mostly twins) have been reported to occur in approximately 20% of pregnancies when conception has followed chorionic gonadotropin therapy.

It is not known whether chorionic gonadotropin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when chorionic gonadotropin is administered to a nursing woman.

Safety and effectiveness of chorionic gonadotropin in children below the age of four have not been established.