Ovidrel

Choriogonadotropin alfa.

Each pre-filled syringe contains 250 micrograms choriogonadotropin alfa* (equivalent to approximately 6,500 IU) in 0.5 mL solution.
*recombinant human chorionic gonadotropin, r-hCG produced in Chinese hamster ovary (CHO) cells by recombinant DNA technology
The pH of the solution is 7.0 ± 0.3, its osmolality 250-400 mOsm/kg.
Excipients/Inactive Ingredients: Mannitol, Methionine, Poloxamer 188, Phosphoric acid (for pH adjustment), Sodium hydroxide (for pH adjustment), Water for injections.

Pharmacotherapeutic group: Gonadotropins. ATC code: G03G A08.
Pharmacology: Pharmacodynamics: Mechanism of action: Ovidrel is a medicinal product of chorionic gonadotropin produced by recombinant DNA techniques. It shares the amino acid sequence with urinary hCG. Chorionic gonadotropin binds on the ovarian theca (and granulosa) cells to a transmembrane receptor shared with the luteinizing hormone, the LH/CG receptor.
Pharmacodynamics effects: The principal pharmacodynamics activity in women is oocyte meiosis resumption, follicular rupture (ovulation), corpus luteum formation and production of progesterone and estradiol by the corpus luteum.
In women, chorionic gonadotropin acts as a surrogate LH surge that triggers ovulation.
Ovidrel is used to trigger final follicular maturation and early luteinisation after use of medicinal products for stimulation of follicular growth.
Clinical efficacy and safety: In comparative clinical trials, administration of a dose of 250 micrograms of Ovidrel was as effective as 5000 IU and 10000 IU of urinary hCG in inducing final follicular maturation and early luteinisation in assisted reproductive technologies, and as effective as 5000 IU of urinary hCG in ovulation induction.
So far, there are no signs of antibody development in humans to Ovidrel. Repeated exposure to Ovidrel was investigated in male patients only. Clinical investigation in women for the indication of ART and anovulation was limited to one treatment cycle.
Pharmacokinetics: Following intravenous administration, choriogonadotropin alfa is distributed to the extracellular fluid space with a distribution half-life of around 4.5 hours. The steady state volume of distribution and the total clearance are 6 L and 0.2 L/h, respectively. There are no indications that choriogonadotropin alfa is metabolized and excreted differently than endogenous hCG.
Following subcutaneous administration, choriogonadotropin alfa is eliminated from the body with a terminal half-life of about 30 hours, and the absolute bioavailability is about 40%.
A comparative study between the currently registered freeze-dried formulation and the liquid formulation showed bioequivalence between the two formulations.
Toxicology: Preclinical safety data: Nonclinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity and genotoxicity. Studies on carcinogenic potential were not performed. This is justified, given the proteinous nature of the active substance and the negative outcome of the genotoxicity testing. Studies on reproduction were not performed in animals.

Ovidrel is indicated in the treatment of: Adult women undergoing superovulation prior to assisted reproductive technologies (ART) such as in vitro fertilization (IVF): Ovidrel is administered to trigger final follicular maturation and luteinisation after stimulation of follicular growth.
Anovulatory or oligo-ovulatory women: Ovidrel is administered to trigger ovulation and luteinisation in anovulatory or oligo-ovulatory patients after stimulation of follicular growth.

Treatment with Ovidrel should be performed under the supervision of a physician experienced in the treatment of fertility problems.
Posology: The maximum dose is 250 micrograms.
The following dosing regimen should be used: Women undergoing superovulation prior to assist reproductive technologies (ART) such as in vitro fertilization (IVF): One pre-filled syringe or prefilled pen of Ovidrel (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 or prefilled pen of Ovidrel (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, Ovidrel injection.
Special populations: Renal or hepatic impairment: Safety, efficacy and pharmacokinetics of Ovidrel in patients with renal or hepatic impairment have not been established.
Paediatric population: There is no relevant use of Ovidrel in the paediatric population.
Method of administration: For subcutaneous use. Self-administration of Ovidrel should only be performed by patients who are adequately trained and have access to expert advice.
Ovidrel is for single use only.

The effects of an overdose of Ovidrel are unknown. Nevertheless, there is a possibility that OHSS may result from an overdose of Ovidrel.

Tumors of the hypothalamus and pituitary gland.
Hypersensitivity to the active substance or to any of the excipients.
Ovarian enlargement or cyst unrelated to polycystic ovarian disease.
Gynaecological haemorrhages of unknown aetiology.
Ovarian, uterine or mammary carcinoma.
Active thrombo-embolic disorders.
Ovidrel must not be used in conditions when an effective response cannot be obtained, such as: primary ovarian failure, malformations of sexual organs incompatible with pregnancy, fibroid tumors of the uterus incompatible with pregnancy, postmenopausal women.

Traceability: In order to improve the traceability of biological medicinal products, the name and batch number of the administered product should be clearly recorded.
General Recommendations: Before starting treatment, the couple's infertility should be assessed as appropriate and putative contraindications for pregnancy evaluated. In particular, patients should be evaluated for hypothyroidism, adrenocortical deficiency, hyperprolactinemia and pituitary or hypothalamic tumors, and appropriate specific treatment given.
There is no clinical experience with Ovidrel in the treatment of other conditions (such as corpus luteum insufficiency or male conditions) therefore Ovidrel is not indicated in these conditions.
Ovarian Hyperstimulation Syndrome (OHSS): A certain degree of ovarian enlargement is an expected effect of controlled ovarian stimulation. It is more commonly seen in women with polycystic ovarian syndrome and usually regresses without treatment.
In distinction to uncomplicated ovarian enlargement, OHSS is a condition that can manifest itself with increasing degrees of severity. It comprises marked ovarian enlargement, high serum sex steroids, and an increase in vascular permeability which can result in an accumulation of fluid in the peritoneal, pleural and, rarely, in the pericardial cavities. Mild manifestations of OHSS may include abdominal pain, abdominal discomfort and distension, and enlarged ovaries. Moderate OHSS may additionally present with nausea, vomiting, ultrasound evidence of ascites and marked ovarian enlargement.
Severe OHSS further includes symptoms such as severe ovarian enlargement, weight gain, dyspnoea or oliguria. Clinical evaluation may reveal signs such as hypovolaemia, haemoconcentration, electrolyte imbalances, ascites, pleural effusions, or acute pulmonary distress. Very rarely, severe OHSS may be complicated by ovarian torsion or thromboembolic events, such as pulmonary embolism, ischaemic stroke or myocardial infarction.
Independent risk factors for developing OHSS include young age, lean body mass, polycystic ovarian syndrome, higher doses of exogenous gonadotropins, high absolute or rapidly rising serum estradiol levels and previous episodes of OHSS, large number of developing ovarian follicles and large number of oocytes retrieved in ART cycles.
Adherence to recommended Ovitrelle dosage and regimen of administration can minimise the risk of ovarian hyperstimulation. Monitoring of stimulation cycles by ultrasound scans as well as estradiol measurements are recommended to early identify risk factors.
There is evidence to suggest that hCG plays a key role in triggering OHSS and that the syndrome may be more severe and more protracted if pregnancy occurs. Therefore, if signs of ovarian hyperstimulation occur, it is recommended that hCG be withheld and the patient be advised to refrain from coitus or use barrier contraceptive methods for at least 4 days.
As OHSS may progress rapidly (within 24 hours) or over several days to become a serious medical event, patients should be followed for at least two weeks after hCG administration.
Mild or moderate OHSS usually resolves spontaneously. If severe OHSS occurs, it is recommended that gonadotropin treatment be stopped and that the patient be hospitalised and appropriate therapy be started.
Multiple pregnancy: In patients undergoing induction of ovulation, the incidence of multiple pregnancy and births is increased compared with natural conception. The majority of multiple conceptions are twins. Multiple pregnancies, especially high order, carry and increased risk of adverse maternal and perinatal outcomes.
To minimise the risk of higher order multiple pregnancy, careful monitoring of ovarian response is recommended. ART procedures the risk of multiple pregnancy is related mainly to the number of embryos replaced, their quality and the patient age.
Pregnancy loss: The incidence of pregnancy loss by miscarriage or abortion is higher in patients undergoing stimulation of follicular growth for ovulation induction or ART than following natural conception.
Ectopic pregnancy: Women with a history of tubal disease are at increased risk for ectopic pregnancy, whether the pregnancy is obtained by spontaneous conception or with fertility treatments. The prevalence of ectopic pregnancy after ART in this population was reported to be higher than in the general population.
Congenital malformations: The prevalence of congenital malformations after ART may be slightly higher than after spontaneous conceptions. This is thought to be due to differences in parental characteristics (e.g. maternal age, sperm characteristics) and the higher incidence of multiple pregnancies.
Thromboembolic events: In women with recent thromboembolic disease or women with generally recognised risk factors for thromboembolic events, such as personal or family history, treatment with gonadotropins may further increase the risk for aggravation or occurrence of such events. In these women, the benefits of gonadotropin administration need to be weighed against the risks. It should be noted, however, that pregnancy itself as well as OHSS also carry an increased risk of thromboembolic events.
Reproductive system neoplasms: There have been reports of ovarian and other reproductive system neoplasms, both benign and malignant, in women who have undergone multiple treatment regimens for infertility. It is not yet established whether or not treatment with gonadotropins increases the risk of these tumours in infertile women.
Interference with serum or urinary testing: Following administration, Ovidrel may interfere for up to ten days with the immunological determination of serum or urinary hCG, potentially leading to a false positive pregnancy test. Patients should be made aware of this.
Sodium content: This medicinal product contains less than 1 mmol sodium (23 mg) per dose, i.e. it is essentially "sodium-free".
Effects on ability to drive and use machines: Ovidrel has no or negligible influence on the ability to drive and use machines.

There is no indication for the use of Ovidrel during pregnancy. Data on a limited number of exposed pregnancies indicate no increased risks of malformation or foeto/neonatal toxicity. No reproduction studies with choriogonadotropin alfa in animals were performed. The potential risk for humans is unknown.
Breast-feeding: Ovidrel is not indicated during breast-feeding. There are no data on the excretion of choriogonadotropin alfa in milk.
Fertility: Ovidrel is indicated for use in infertility.

In comparative trials with different doses of Ovidrel, OHSS found to be associated with Ovidrel in a dose-related fashion. Ovarian hyperstimulation syndrome was observed in approximately 4% of patients treated with Ovidrel. Severe ovarian hyperstimulation syndrome was reported in less than 0.5% patients (see Precautions).
List of adverse reactions: The following definitions apply to the frequency terminology used hereafter: very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000), very rare (< 1/10,000), not known (cannot be estimated from the available data).
Immune system disorders: Very rare: Mild to severe hypersensitivity reactions including anaphylactic reactions and shock.
Nervous system disorders: Common: Headache.
Vascular disorders: Very rare: Thromboembolism (both in association with and separate from OHSS).
Gastrointestinal disorders: Common: Abdominal pain, abdominal distension, nausea, vomiting. Uncommon: Abdominal discomfort, diarrhoea.
Reproductive system and breast disorders: Common: Mild or moderate OHSS. Uncommon: Severe OHSS.
General disorders and administration site conditions: Common: Injection site reactions.
Reporting of suspected adverse reactions: Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions.

No specific interaction studies with Ovidrel and other medicines have been performed however no clinically significant drug interactions have been reported during hCG therapy.

Incompatibilities: In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products.
Special precautions for disposal and other handling: Only clear solution without particles should be used.
For single use only.
Self-administration of Ovidrel should only be performed by patients who are adequately trained and have access to expert advice.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
If patient administers Ovidrel to oneself, please carefully read the following instructions: Prefilled syringe: 1. Wash hands. It is important that the hands and the items used are as clean as possible.
2. Assemble everything patient needs. Please note that alcohol swabs are not contained in the package. Find a clean area and lay out everything: two alcohol swabs, one pre-filled syringe containing the medicinal product.
3. Injection: Immediately inject the solution: The doctor or nurse will have already advised patient where to inject (e.g. tummy, front of thigh). Wipe the chosen area with an alcohol swab. Firmly pinch the skin together and insert the needle for injection at a 45° to 90° angle using a dart-like motion. Inject under the skin, as taught. Do not inject directly into a vein. Inject the solution by pushing gently on the plunger.
Take as much time as needed to inject all the solution. Immediately withdraw the needle and clean the skin with an alcohol swab using a circular motion.
4. Dispose of all used items: Once finished with the injection, immediately discard the empty syringe in a sharps container. Any unused solution must be discarded.

Store at 2°C - 8°C (in a refrigerator). Store in the original package. Within its shelf-life, the solution may be stored at or below 25°C for up to 30 days without being refrigerated again during this period. It must be discarded if not used after these 30 days.
Shelf life: 2 years.
After opening, the medicinal product should be used immediately. However, the in-use stability has been demonstrated for 24 hours at +2° to 8°C.

Trophic Hormones & Related Synthetic Drugs

G03GA08 - choriogonadotropin alfa ; Belongs to the class of gonadotropins. Used as ovulation stimulants.

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