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Gonal-F® (follitropin alfa for injection) is indicated for the induction of ovulation and pregnancy anovulatory infertile patients in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-F® (follitropin alfa) is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program.
Selection of Patients
1. Before treatment with Gonal-F® (follitropin alfa) is instituted, a thorough gynecologic and endocrinologic evaluation must be performed. This should include an assessment of pelvic anatomy. Patients with tubal obstruction should receive Gonal-F® (follitropin alfa) only if enrolled in an in vitro fertilization program.
2. Primary ovarian failure should be excluded by the determination of gonadotropin levels.
3. Appropriate evaluation should be performed to exclude pregnancy.
4. Patients in later reproductive life have a greater predisposition to endometrial carcinoma as well as a higher incidence of anovulatory disorders. A thorough diagnostic evaluation should always be performed in patients who demonstrate abnormal uterine bleeding or other signs of endometrial abnormalities before starting Gonal-F® (follitropin alfa) therapy.
5. Evaluation of the partner's fertility potential should be included in the initial evaluation.
DOSAGE AND ADMINISTRATION
Infertile Patients with oligo-anovulation: The dose of Gonal-F® (follitropin alfa for injection) to stimulate development of the follicle must be individualized for each patient. The lowest dose consistent with the expectation of good results should be used. Over the course of treatment doses of Gonal-F® (follitropin alfa) may range up to 300 IU per day depending on the individual patient response. Gonal-F® (follitropin alfa) should be administered until adequate follicular development is indicated by serum estradiol and vaginal ultrasonography. A response is generally evident after 5 to 7 days. Subsequent monitoring intervals should be based on individual patient response.
It is recommended that the initial dose of the first cycle be 75 IU of Gonal-F® (follitropin alfa) per day, ADMINISTERED SUBCUTANEOUSLY. An incremental adjustment in dose of up to 37.5 IU may be considered after 14 days. Further dose increases of the same magnitude could be made, if necessary, every seven days. Treatment duration should not exceed 35 days unless an E2 rise indicates imminent follicular development. To complete follicular development and effect ovulation in the absence of an endogenous LH surge, chorionic gonadotropin, hCG, (5,000 USP units) should be given 1 day after the last dose of Gonal-F® (follitropin alfa) . Chorionic gonadotropin should be withheld if the serum estradiol is greater than 2,000 pg/mL. If the ovaries are abnormally enlarged or abdominal pain occurs, Gonal-F® (follitropin alfa) treatment should be discontinued, hCG should not be administered, and the patient should be advised not to have intercourse; this may reduce the chance of development of the Ovarian Hyperstimulation Syndrome and should spontaneous ovulation occur, reduce the chance of multiple gestation. A follow-up visit should be conducted in the luteal phase.
The initial dose administered in the subsequent cycles should be individualized for each patient based on her response in the preceding cycle. Doses larger than 300 IU of FSH per day are not routinely recommended. As in the initial cycle, 5,000 USP units of hCG must be given 1 day after the last dose of Gonal-F® (follitropin alfa) to complete follicular development and induce ovulation. The precautions described above should be followed to minimize the chance of development of the Ovarian Hyperstimulation Syndrome.
The couple should be encouraged to have intercourse daily, beginning on the day prior to the administration of hCG until ovulation becomes apparent from the indices employed for the determination of progestational activity. Care should be taken to ensure insemination. In light of the indices and parameters mentioned it should become obvious that unless a physician is willing to devote considerable time to these patients and be familiar with and conduct the necessary laboratory studies, he/she should not use Gonal-F® (follitropin alfa) .
Assisted Reproductive Technologies: In the treatment of patients with oligo-anovulatory infertility the dose of Gonal-F® (follitropin alfa) to stimulate development of the follicle must be individualized for each patient. For Assisted Reproductive Technologies, therapy with Gonal-F® (follitropin alfa) should be initiated in the early follicular phase (cycle day 2 or 3) at a dose of 150 IU per day, until sufficient follicular development is attained. In most cases, therapy should not exceed ten days.
In patients undergoing ART, whose endogenous gonadotropin levels are suppressed, Gonal-F® (follitropin alfa) should be initiated at a dose of 225 IU per day. Treatment should be continued until adequate follicular development is indicated as determined by ultrasound in combination with measurement of serum estradiol levels. Adjustments to dose may be considered after five days based on the patient's response; subsequently dosage should be adjusted no more frequently than every 3-5 days and by no more than 75-150 IU additionally at each adjustment. Doses greater than 450 IU per day are not recommended. Once adequate follicular development is evident, hCG (5,000 to 10,000 USP units) should be administered to induce final follicular maturation in preparation for oocyte retrieval. The administration of hCG must be withheld in cases where the ovaries are abnormally enlarged on the last day of therapy. This should reduce the chance of developing OHSS.
Dissolve the contents of one or more ampules of Gonal-F® (follitropin alfa) in one-half to one mL of Sterile Water for Injection, USP (concentration should not exceed 225 IU/0.5 mL) and ADMINISTER SUBCUTANEOUSLY immediately. Any unused reconstituted material should be discarded.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Gonal-F® (follitropin alfa for injection) is supplied in a sterile lyophilized form in single dose ampules containing 75 or 150 IU FSH activity. The following package combinations are available:
- 1 ampule 75 IU Gonal-F® (follitropin alfa) and 1 ampule 1 mL Sterile Water for Injection, USP, NDC 44087-9075-1
- 10 ampules 75 IU Gonal-F® (follitropin alfa) and 10 ampules 1 mL Sterile Water for Injection, USP, NDC 44087-9075-3
- 100 ampules 75 IU Gonal-F® (follitropin alfa) and 100 ampules 1 mL Sterile Water for Injection, USP, NDC 44087-9075-4
- 1 ampule 150 IU Gonal-F® (follitropin alfa) and 1 ampule 1 mL Sterile Water for Injection, USP, NDC 44087-9150-1
Lyophilized ampules may be stored refrigerated or at room temperature 2°-25° C (36°-77° F). Protect from light. Use immediately after reconstitution. Discard unused material.
Caution: Federal law prohibits dispensing without prescription.This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 12/8/2004
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