Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Kit, Subcutaneous:
Cetrotide: 0.25 mg [contains mannitol]
Pharmacology
Mechanism of Action
Competes with naturally-occurring GnRH for binding on receptors of the pituitary. This delays luteinizing hormone surge, preventing ovulation until the follicles are of adequate size.
Pharmacokinetics/Pharmacodynamics
Absorption
Rapid
Distribution
Vd: ~1 L/kg
Metabolism
Transformed by peptidases; cetrorelix and peptides (1-9), (1-7), (1-6), and (1-4) are found in the bile; peptide (1-4) is the predominant metabolite
Excretion
Feces (5% to 10% as unchanged drug and metabolites); urine (2% to 4% as unchanged drug)
Onset of Action
0.25 mg dose: 2 hours
Time to Peak
1 to 2 hours
Duration of Action
0.25 mg dose: 24 hours
Half-Life Elimination
0.25 mg dose: 5 hours; 0.25 mg multiple doses: 20.6 hours
Protein Binding
86%
Use: Labeled Indications
Controlled ovarian stimulation: Inhibition of premature luteinizing hormone (LH) surges in women undergoing controlled ovarian stimulation
Contraindications
Hypersensitivity to cetrorelix, extrinsic peptide hormones, gonadotropin releasing hormone (GnRH) or other GnRH analogs, mannitol, or any component of the formulation; severe renal impairment; pregnancy; breast-feeding.
Canadian labeling: Additional contraindications (not in the US labeling): Moderate to severe hepatic function; moderate renal function.
Dosage and Administration
Dosing: Adult
Controlled ovarian stimulation in conjunction with gonadotropins (FSH, hMG): Female: SubQ: 0.25 mg once daily the morning or evening of stimulation day 5, or morning of stimulation day 6; continue 0.25 mg once daily until the day hCG is administered.
Dosing: Geriatric
Not intended for use in women ≥65 years of age
Reconstitution
Reconstitute vial using supplied 1 mL SWFI prefilled syringe (and supplied 20-gauge needle). Inject SWFI slowly into vial. With syringe still in vial, gently swirl vial until solution is clear; avoid forming bubbles. Withdraw entire contents from vial. Replace 20-gauge needle with supplied 27-gauge needle prior to injection.
Administration
SubQ: Administer by SubQ injection following proper aseptic technique procedures. Injections should be to the lower abdomen, preferably around the navel (but staying at least 1 inch from the navel). The injection site should be rotated daily.
Storage
Store refrigerated at 2°C to 8°C (36°F to 46°F). Store in outer carton to protect from light.
Drug Interactions
Indium 111 Capromab Pendetide: Antigonadotropic Agents may diminish the diagnostic effect of Indium 111 Capromab Pendetide. Avoid combination
Adverse Reactions
1% to 10%:
Central nervous system: Headache (1%)
Endocrine & metabolic: Ovarian hyperstimulation syndrome (WHO grade II or III: 4%), increased gamma-glutamyl transferase (≤1% to 2%)
Gastrointestinal: Nausea (1%)
Hepatic: Increased serum alkaline phosphatase (≤1% to 2%), increased serum ALT (≤1% to 2%), increased serum AST (≤1% to 2%)
<1%, postmarketing and/or case reports: Anaphylaxis (includes cough, hypotension, skin rash), injection site reactions (bruising at injection site, erythema at injection site, injection site pruritus, local swelling)
Warnings/Precautions
Concerns related to adverse effects:
- Hypersensitivity: Hypersensitivity reactions, including severe anaphylactoid reactions, have been reported after initial dose and months after starting therapy; use with caution in patients with signs and symptoms of active allergic conditions or known history of allergic predisposition. Treatment is not recommended in patients with severe allergic conditions.
Other warnings/precautions:
- Experienced specialists: Should only be prescribed by fertility specialists.
Monitoring Parameters
Ultrasound to assess follicle size
Pregnancy
Pregnancy Considerations
Use is contraindicated in females who are pregnant. Resorption resulting in fetal loss would be expected if used in a pregnant woman. Evaluate pregnancy status before beginning treatment.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience injection site edema, itching, or redness. Have patient report immediately to prescriber severe dizziness, passing out, cough, or signs of ovarian hyperstimulation syndrome (severe abdominal pain or bloating; severe nausea, vomiting, or diarrhea; excessive weight gain; shortness of breath; or change in amount of urine passed) (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
