Cetrotide
Cetrotide - General Information
Cetrotide is a man-made hormone that blocks the effects of Gonadotropin Releasing Hormone (GnRH). GnRH controls another hormone that is called luteinizing hormone (LH), which is the hormone that starts ovulation during the menstrual cycle. When undergoing hormone treatment sometimes premature ovulation can occur, leading to eggs that are not ready for fertilization to be released. Cetrotide does not allow the premature release of these eggs to occur.
Pharmacology of Cetrotide
Cetrotide is a synthetic decapeptide with gonadotropin-releasing hormone (GnRH) antagonistic activity. GnRH induces the production and release of luteinizing hormone (LH) and follicle stimulating hormone (FSH) from the gonadotrophic cells of the anterior pituitary. Due to a positive estradiol (E2) feedback at midcycle, GnRH liberation is enhanced resulting in an LH-surge. This LH-surge induces the ovulation of the dominant follicle, resumption of oocyte meiosis and subsequently luteinization as indicated by rising progesterone levels. Cetrotide competes with natural GnRH for binding to membrane receptors on pituitary cells and thus controls the release of LH and FSH in a dose-dependent manner.
Cetrotide for patients
Prior to therapy with CetrotideTM (cetrorelix acetate for injection), patients should be informed of the duration of treatment and monitoring procedures that will be required. The risk of possible adverse reactions should be discussed. CetrotideTM should not be prescribed if a patient is pregnant.
If CetrotideTM is prescribed to patients for self-administration, information for proper use is given in the Patient Leaflet.
Summary
Cetrotide blocks the effects of a natural hormone, called gonadotropin-releasing hormone (GnRH). GnRH controls the secretion of another hormone, called luteinizing hormone (LH), which induces ovulation during the menstrual cycle. During hormone treatment for ovarian stimulation, premature ovulation may lead to eggs that are not suitable for fertilization. Cetrotide blocks such undesirable premature ovulation.
Uses
Cetrotide is used to prevent premature ovulation during controlled ovarian stimulation.
General Cautions
Do not use Cetrotide if you
ï have kidney disease
ï are allergic to cetrorelix acetate, mannitol or exogenous peptide hormones (medicines similar to Cetrotide) or
ï are pregnant, or think that you might be pregnant, or if you are breast-feeding. Consult your doctor before taking Cetrotide if you have had severe allergic reactions.
Proper Use
Ovarian stimulation therapy is started on cycle Day 2 or 3. Cetrotide is injected under the skin either once daily (0.25 mg dose) or once (3 mg dose), as directed by your physician. When an ultrasound examination shows that you are ready, another drug (hCG) is injected to induce ovulation.
How should you use Cetrotide?
You may self-inject Cetrotide after special instruction from your doctor.
To fully benefit from Cetrotide, please read carefully and follow the instructions given below, unless your doctor advises you otherwise.
Cetrotide is for injection under the skin of the lower abdominal area, preferably around, but staying at least one inch away from the belly button. If you are on a multiple dose (0.25 mg) regimen, choose a different injection site each day to minimize local irritation. Dissolve Cetrotide powder only with the water contained in the pre-filled syringe. Do not use a Cetrotide solution if it contains particles or if it is not clear.
Before you inject Cetrotide yourself, please read the following instructions carefully:
Directions for using Cetrotide 0.25 mg or 3 mg with the enclosed needles and pre-filled syringe:
1. Wash your hands thoroughly with soap and water.
2. On a clean flat surface, lay out everything you need (one vial of powder, one pre-filled syringe, one injection needle with a yellow mark, one injection needle with a grey mark, and two alcohol wipes).
3. Flip off the plastic cover of the vial. Wipe the aluminum ring and the rubber stopper with an alcohol wipe.
4. Take the injection needle with the yellow mark and remove the wrapping. Take the pre-filled syringe and remove the cover. Twist the needle on the syringe and remove the cover of the needle.
5. Push the needle through the center of the rubber stopper of the vial. Inject the water into the vial by slowly pushing down on the plunger of the syringe.
6. Leave the syringe in the vial. Gently shake the vial until the solution is clear and without residue. Avoid forming bubbles during dissolution.
7. Draw the total contents of the vial into the syringe. If liquid is left in the vial, invert the vial, pull back the needle until the opening of the needle is just inside the stopper. If you look from the side through the gap in the stopper, you can control the movement of the needle and the liquid. It is important to withdraw the entire contents of the vial.
8. Detach the syringe from the needle and lay down the syringe. Take the injection needle with the grey mark and remove its wrapping. Twist the needle on the syringe and remove the cover of the needle.
9. Invert the syringe and push the plunger until all air bubbles have been pushed out. Do not touch the needle or allow the needle to touch any surface.
10. Choose an injection site in the lower abdominal area, preferably around, but at least one inch away from the belly button. If you are on a multiple dose (0.25 mg) regimen, choose a different injection site each day to minimize local irritation.
Take the second alcohol wipe and clean the skin at the injection site and allow alcohol to dry. Inject the prescribed dose as directed by your doctor, nurse or pharmacist.
11. Use the syringe and needles only once. Dispose of the syringe and needles immediately after use (put the covers on the needles to avoid injury). A medical waste container should be used for disposal.
Directions for using Cetrotide 0.25 mg with the Serono Fertility Auto-injectorTM:
1. Follow Steps 1-5 above for enclosed needles and syringe.
2. Remove the empty syringe from the vial and discard. Gently swirl the vial until the solution is clear and without residues. Avoid forming bubbles during dissolution.
3. Insert the 1 mL fixed needle syringe (provided for use with the Serono Fertility Auto-injectorTM) through the center of the rubber stopper of the vial. Keeping the needle in the vial, lift the vial and turn it upside down with the needle pointing toward the ceiling. With the needle tip in the liquid, draw the total contents of the vial into the syringe. If liquid is left in the vial, invert the vial and pull back the needle until the opening of the needle is just inside the stopper. If you look through the side through the gap in the stopper, you can control the movement of the needle and the liquid. It is important to withdraw the entire contents of the vial. Remove the needle from the vial.
4. Proceed to Instructions for Use provided with the Serono Fertility Auto-injectorTM for use with a 1 mL fixed needle syringe.
SPECIAL ADVICE
What do you do if you have used too much Cetrotide?
Contact your doctor in case of overdosage immediately to check whether an adjustment of the further ovarian stimulation procedure is required.
Possible Side Effects
Mild and short lasting reactions may occur at the injection site like reddening, itching, and swelling. Nausea and headache have also been reported.
Call your doctor if you have any side effect not mentioned in this leaflet or if you are unsure about the effect of this medicine.
Storage
How is Cetrotide to be stored?
Store Cetrotide in a cool dry place protected from excess moisture and heat. Store Cetrotide 3 mg at 25°C (77°F). Excursions are permitted to 15-30ºC (59-86ºF). Store Cetrotide 0.25 mg in the refrigerator at 2-8°C (36-46°F). Keep the packaged tray in the outer carton in order to protect it from light.
How long may Cetrotide be stored?
Do not use the Cetrotide powder or the pre-filled syringe after the expiration date, which is printed on the labels and on the carton, and dispose of the vial and the syringe properly.
How long can you keep Cetrotide after preparation of the solution?
The solution should be used immediately after preparation.
Store the medicine out of the reach of children.
If you suspect that you may have taken more than the prescribed dose of this medicine, contact your doctor immediately. This medicine was prescribed for your particular condition. Do not use it for another condition or give the drug to others.
This leaflet provides a summary of the information about Cetrotide. Medicines are sometimes prescribed for uses other than those listed in the Leaflet. If you have any questions or concerns, or want more information about Cetrotide, contact your doctor or pharmacist.
March 2004
Cetrotide Interactions
No formal drug interaction studies have been performed with Cetrotide.
Cetrotide Contraindications
Cetrotide (cetrorelix acetate for injection) is contraindicated under the following conditions:
1. Hypersensitivity to cetrorelix acetate, extrinsic peptide hormones or mannitol.
2. Known hypersensitivity to GnRH or any other GnRH analogs.
3. Known or suspected pregnancy, and lactation.
4. Severe renal impairment
Additional information about Cetrotide
Cetrotide Indication: For the inhibition of premature LH surges in women undergoing controlled ovarian stimulation
Mechanism Of Action: Cetrotide binds to the gonadotropin releasing hormone receptor and acts as a potent inhibitor of gonadotropin secretion. It competes with natural GnRH for binding to membrane receptors on pituitary cells and thus controls the release of LH and FSH in a dose-dependent manner.
Drug Interactions: Not Available
Food Interactions: Not Available
Generic Name: Cetrorelix
Synonyms: SB 75; SB-75; Cetrorelix Acetate; Cetrorelixum [INN-Latin]
Drug Category: Infertility Agents; Hormone Antagonists
Drug Type: Biotech; Approved; Investigational
Other Brand Names containing Cetrorelix: Cetrotide;
Absorption: Rapidly absorbed following subcutaneous injection. The mean absolute bioavailability following subcutaneous administration to healthy female subjects is 85%.
Toxicity (Overdose): Not Available
Protein Binding: 86%
Biotransformation: In in vitro studies, cetrorelix was stable against phase I- and phase II-metabolism. Cetrorelix was transformed by peptidases, and the (1-4) peptide was the predominant metabolite.
Half Life: ~62.8 hours
Dosage Forms of Cetrotide: Powder, for solution Subcutaneous
Powder, for solution Subcutaneous
Powder, for solution Subcutaneous
Chemical IUPAC Name: 1-[(2S)-2-[[(2S)-2-[[(2R)-2-[[(2R)-2-[[(2R)-2-[[(2R)-2-[[(2S)-2-[[(2R)-2-acetamido-3-naphthalen-2-ylpropanoyl]amino]-3-(4-chlorophenyl)propanoyl]amino]-3-pyridin-3-ylpropanoyl]amino]-3-hydroxypropanoyl]amino]-3-(4-hydroxyphenyl)propanoyl]amino]-5-(carbamoylamino)pentanoyl]amino]-4-methylpentanoyl]amino]-5-carbamimidamidopentanoyl]-N-[(2R)-1-amino-1-oxopropan-2-yl]pyrrolidine-2-carboxamide
Chemical Formula: C70H92ClN17O14
Cetrorelix on Wikipedia: https://en.wikipedia.org/wiki/Cetrorelix
Organisms Affected: Humans and other mammals
