Drug information of HCG

Mechanism of effect

The action of HCG is virtually identical to that of pituitary LH, although HCG appears to have a small degree of FSH activity as well.  It stimulates production of gonadal steroid hormones by stimulating the interstitial cells (Leydig cells) of the testis to produce androgens and the corpus luteum of the ovary to produce progesterone. 

Androgen stimulation in the male leads to the development of secondary sex characteristics and may stimulate testicular descent when no anatomical impediment to descent is present. This descent is usually reversible when HCG is discontinued.

Pharmacodynamic

Human chorionic gonadotropin (hCG) is produced by the human placenta; available preparations provide purified luteinizing hormone obtained from the urine of pregnant women. hCG stimulates production of gonadal steroid hormones by causing production of androgen by the testes and the development of secondary sex characteristics in males. In females, hCG acts as a substitute for luteinizing hormone (LH) to stimulate ovulation.

Pharmacokinetics

 HCG Distributes mainly into the testes in males and into the ovaries in females and Excretion is in Urine (~10% to 12%) within 24 hours.

Time to Peak In Plasma after IM injection is Within 6 hours. Duration of action Is about 36 hours.

Half-Life Elimination Is Biphasic: Initial: 6 to 11 hours; Terminal: 23 to 37 hours.

Dosage

Adults

Ovulation induction: Females: IM: 5,000 to 10,000 units 1 day following last dose of menotropins

Hypogonadotropic hypogonadism: Males: IM: Various regimens:

500 to 1,000 units 3 times/week for 3 weeks, followed by the same dose twice weekly for 3 weeks or

4,000 units 3 times/week for 6 to 9 months, then reduce dosage to 2,000 units 3 times/week for additional 3 months

Spermatogenesis induction associated with hypogonadotropic hypogonadism (off-label use): Males: IM: 1,000 to 2,000 units 2 to 3 times/week. Administer hCG until serum testosterone levels are normal (may require 2 to 3 months of therapy), then may add menopausal gonadotropin of FSH if needed to induce spermatogenesis; continue hCG at the dose required to maintain testosterone levels.

Pediatrics

Prepubertal cryptorchidism: Children ≥4 years and Adolescents (males): IM: 4,000 units 3 times/week for 3 weeks or

5,000 units every second day for 4 injections or

500 units 3 times/week for 4 to 6 weeks or

15 injections of 500 to 1,000 units administered over 6 weeks

• recombinant human chorionic gonadotropin OVITRELLE

Each pre-filled syringe contains 250 micrograms choriogonadotropin alfa* (equivalent to approximately 6,500 IU) in 0.5 mL solution.

Women undergoing superovulation prior to assisted reproductive techniques such as in vitro fertilization (IVF):

One pre-filled syringe of Ovitrelle (250 micrograms) is administered 24 to 48 hours after the last administration of a follicle stimulating hormone (FSH) or human menopausal gonadotropin (hMG) preparation, i.e. when optimal stimulation of follicular growth is achieved.

• Anovulatory or oligo-ovulatory women:

One pre-filled syringe of Ovitrelle (250 micrograms) is administered 24 to 48 hours after optimal stimulation of follicular growth is achieved. The patient is recommended to have coitus on the day of, and the day after, Ovitrelle injection.

Drug contraindications

Side effects

Alerts

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.  

Anaphylaxis and other hypersensitivity reactions have been reported with urinary-derived HCG products.

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.

Safety and effectiveness of Chorionic Gonadotropin in children below the age of four have not been established. 

Thromboembolism: Arterial or venous thromboembolism may occur; patients with a history of family history of thrombosis, severe obesity, or thrombophilia are at an increased risk.

Points of recommendation

have ever had an allergic reaction to HCG, or if you have:

• early puberty (also called precocious puberty); or
• a hormone-related cancer (such as prostate cancer).

Before receiving HCG tell your doctor if you are allergic to any drugs or if you have:

• a thyroid or adrenal gland disorder;
• an ovarian cyst;
• premature puberty;
• cancer or a tumor of the breast, ovary, uterus, prostate, hypothalamus, or pituitary gland;
• undiagnosed uterine bleeding;
• heart disease;

• kidney disease;
• epilepsy;

• migraines; or

If you have any of these conditions, you may need a dose adjustment or special tests to safely use HCG.

Although HCG can help you become pregnant, this medication is in the FDA pregnancy category X. This means that using the medication once you are pregnant can cause birth defects in the baby.

Do not use HCG if you are pregnant. Tell your doctor right away if you become pregnant during treatment. It is not known whether HCG passes into breast milk. Do not use HCG without telling your doctor if you are breast-feeding a baby.

Pregnancy level