Hypothalamic and pituitary hormones and anti-oestrogens

Hypothalamic and anterior pituitary hormones and anti-estrogens

Anti-oestrogens

CLOMIFENE CITRATE (Clomiphene Citrate):

Indications: Female Infertility, Ovulation Stimulation

Contraindications: Disease of Liver, Intracranial Lesion, Ovarian Cyst, Pituitary Neoplasm, Pregnancy, Severe Adrenal Insufficiency, Thyrotoxicosis, Untreated Hypothyroidism, Endometrial Carcinoma, Endometriosis, Metrorrhagia, Ovarian Hyperstimulation Syndrome, Polycystic Ovarian Syndrome, Thromboembolic Disorder, Thrombophlebitis.

Dose and Administration: 50 mg daily for 5 days, starting within about 5 days of onset of menstruation (preferably on 2nd day) or at any time (normally preceded by a progestogen-induced withdrawal bleed) if cycles have ceased; second course of 100 mg daily for 5 days may be given in absence of ovulation; most patients who are going to respond will do so to the first course; 3 courses should constitute adequate therapeutic trial; long-term cyclical therapy not recommended.

. Anterior pituitary hormones

Corticotrophins

TETRACOSACTIDE (Tetracosactrin):

Indications: used as alternatives to corticosteroids in conditions such as Crohn’s disease or rheumatoid arthritis.

Contraindications: Fungal Infections, Cataracts, Chronic Heart Failure, Duodenal Ulcer, Esophagitis, Gastric Ulcer, Inactive Tuberculosis, Infection, Intestinal Abscess, Intestinal Anastomosis, Measles, Measles Contact, Ocular Infection, Osteoporosis, Peptic Ulcer, Psychotic Disorder, Renal Disease, Varicella Contact, Viral Ocular Infection.

Dose and Administration: by intramuscular injection, 1 mg as a single dose.

Gonadotrophins

CHORIONIC GONADOTROPHIN:

(Human Chorionic Gonadotrophin; HCG)

Indications: Cryptorchidism, Female Infertility, and Hypogonadotropic Hypogonadism, In Vitro Fertilization, Ovulation Stimulation.

Contraindications: Malignant Tumour of Testis, Precocious Puberty, Pregnancy, And Prostatic Carcinoma.

Dose and Administration: By subcutaneous or intramuscular injection, according to patient’s response.

CHORIOGONADOTROPIN ALFA:

(Human chorionic gonadotropin)

Indications: Early Induction Luteinization, Infertility, Ovarian Follicle Maturation Induction, and Ovulation Stimulation.

Contraindications: Abnormal Uterine Bleeding, Breast Carcinoma, Disorder of Adrenal Gland, Disorder of Thyroid Gland, Ovarian Carcinoma, Ovarian Cyst, Pituitary Neoplasm, Pregnancy, Primary Ovarian Failure, Uterine Carcinoma.

Dose and Administration: By subcutaneous or intramuscular injection, according to patient’s response.

FOLLITROPIN ALFA:

(Recombinant human follicle stimulating hormone)

Indications: Follicle Stimulation, Follicle Stimulation for Assisted Fertilization Procedures, Infertility associated with Anovulation, Oligospermia, Ovulation Stimulation.

Contraindications: Estrogen-Dependent Neoplasm, Fallopian Tube Disorder, Hypogonadotropic Hypogonadism, Metrorrhagia, Ovarian Cyst, Pituitary Neoplasm, Pregnancy, Primary Ovarian Failure, Severe Adrenal Insufficiency, Tumor of Hypothalamus, Untreated Hypothyroidism.

Dose and Administration: By subcutaneous or intramuscular injection, according to patient’s response.

FOLLITROPIN BETA:

(Recombinant human follicle stimulating hormone)

Indications: Follicle Stimulation, Follicle Stimulation for Assisted Fertilization Procedures, Infertility associated with Anovulation, Oligospermia, Ovulation Stimulation.

Contraindications: Estrogen-Dependent Neoplasm, Fallopian Tube Disorder, Hypogonadotropic Hypogonadism, Metrorrhagia, Ovarian Cyst, Pituitary Neoplasm, Pregnancy, Primary Ovarian Failure, Severe Adrenal Insufficiency, Tumor of Hypothalamus, Untreated Hypothyroidism.

Dose and Administration: By subcutaneous or intramuscular injection, according to patient’s response.

MENOTROPHIN:

(HUMAN POST-MENOPAUSAL FSH)

Indications: Follicle Stimulation, Follicle Stimulation for Assisted Fertilization Procedures, Infertility associated with Anovulation, Oligospermia, Ovulation Stimulation.

Contraindications: ovarian cysts (not caused by polycystic ovarian syndrome); tumours of pituitary, hypothalamus, breast, uterus, ovaries, testes or prostate; vaginal bleeding of unknown cause; pregnancy and breast-feeding

Dose and Administration: By subcutaneous or intramuscular injection, according to patient’s response.

UROFILLITROPIN:

(HUMAN POST-MENOPAUSAL FSH)

Indications: Follicle Stimulation, Follicle Stimulation for Assisted Fertilization Procedures, Infertility associated with Anovulation, Oligospermia, Ovulation Stimulation.

Contraindications: ovarian cysts (not caused by polycystic ovarian syndrome); tumours of pituitary, hypothalamus, breast, uterus, ovaries, testes or prostate; vaginal bleeding of unknown cause; pregnancy and breast-feeding

Dose and Administration: By subcutaneous or intramuscular injection, according to patient’s response.

Growth hormone

SOMATROPIN:

(Synthetic Human Growth Hormone)

Indications: Gonadal dysgenesis (Turner’s syndrome), Deficiency of growth hormone in children, Growth disturbance, Prader-Willi syndrome, Chronic renal insufficiency in children, Adult growth hormone deficiency.

Contraindications: evidence of tumour activity (complete antitumour therapy and ensure intracranial lesions inactive before starting); not to be used after renal transplantation or for growth promotion in children with closed epiphyses (or near closure in Prader-Willi syndrome); severe obesity or severe respiratory impairment in Prader-Willi syndrome; pregnancy (interrupt treatment if pregnancy occurs.

Dose and Administration: Gonadal dysgenesis (Turner’s syndrome), by subcutaneous injection, 45–50 micrograms/kg daily or 1.4 mg/m² daily. Deficiency of growth hormone in children, by subcutaneous or intramuscular injection, 23– 39 micrograms/kg daily or 0.7–1 mg/m² daily. Prader-Willi syndrome, by subcutaneous injection in children with growth velocity greater than 1 cm/year, in combination with energy-restricted diet, 35 micrograms/kg daily or 1 mg/m² daily; max. 2.7 mg daily. chronic renal insufficiency in children (renal function decreased to less than 50%), by subcutaneous injection, 45–50 micrograms/kg daily or 1.4 mg/m² daily (higher doses may be needed) adjusted if necessary after 6 months. Adult growth hormone deficiency, by subcutaneous injection, initially 150–300 micrograms daily, gradually increased if required to the max. 1 mg daily; use the minimum effective dose.

Posterior pituitary hormones

VASOPRESSIN:

Indications: pituitary diabetes insipidus; bleeding from oesophageal varices. Contraindications: vascular disease (especially disease of coronary arteries) unless extreme caution, chronic nephritis (until reasonable blood nitrogen concentrations attained).

Dose and Administration: By subcutaneous or intramuscular injection, diabetes insipidus, 5–20 units every four hours. By intravenous infusion, initial control of variceal bleeding, 20 units over 15 minutes.

DESMOPRESSIN:

Indications: diabetes insipidus; Primary nocturnal enuresis; Postoperative polyuria or polydipsia, Diabetes insipidus, Mild to moderate hemophilia and von Willebrand’s disease, Fibrinolytic response testing.

Contraindications: cardiac insufficiency and other conditions treated with diuretics; psychogenic polydipsia and polydipsia in alcohol dependence.

Dose and Administration: By mouth (as desmopressin acetate), Diabetes insipidus, treatment, adult, and child initially 300 micrograms daily (in 3 divided doses); maintenance, 300–600 micrograms daily in 3 divided doses; range 0.2– 1.2 mg daily. Primary nocturnal enuresis (if urine concentrating ability normal), adult (under 65 years) and child over 5 years (preferably over 7 years) 200 micrograms at bedtime, only increased to 400 micrograms if a lower dose is not effective. Sublingually (as desmopressin base), Diabetes insipidus, treatment, adult and child initially 180 micrograms daily in 3 divided doses; range 120– 720 micrograms daily. Intranasally (as desmopressin acetate), Diabetes insipidus, diagnosis, adult and child 20 micrograms (limit fluid intake to 500 mL from 1 hour before to 8 hours after administration). Diabetes insipidus, treatment, adult 10– 40 micrograms daily (in 1–2 divided doses); child 5–20 micrograms daily; infants may require lower doses. Mild to moderate hemophilia and von Willebrand’s disease, adult 300 micrograms (one 150-microgram spray into each nostril) 30 minutes before surgery or when bleeding; may be repeated at intervals of 12 hours.