Humog

Humog is a follicle-stimulating drug.

Indications Humog

It is used in the following cases:

• infertility (women) caused by a disorder in the processes of follicle formation, accompanied by normo- and hypogonadotropic ovarian insufficiency;
• stimulation of the superovulation process (growth of a large number of follicles, which helps to carry out additional reproductive procedures that facilitate subsequent conception) in combination with the hCG component;
• infertility (men) caused by a disorder of spermatogenesis and accompanied by normo- and hypogonadotropic hypogonadism (together with the element of hCG).

Release form

The drug is released in the form of a powder, from which a liquid is made for intramuscular injections (volumes - 75 ME LH + 75 ME FSH or 150 ME LH + 150 ME FSH). The powder is placed in glass vials with a capacity of 2 ml, and the solvent is in glass ampoules with a capacity of 1 ml. Inside the box there is 1 vial with powder and 1 ampoule with solvent.

Pharmacodynamics

Humog is a component of hMG, which is produced on the basis of the urine of women in the postmenopausal period. The composition of the drug in the proportion of 1:1 contains components of LH and FSH.

Has a gonadotropic and follicle-stimulating effect. Increases plasma levels of sex hormones.

When used by women, it leads to an increase in blood estrogen levels and induces ovarian growth activity, the process of follicle formation within them along with ovulation, and also promotes endometrial proliferation.

When used by men, it stimulates spermatogenesis (by activating the processes of protein binding that synthesize androgens inside the seminiferous tubules and sustentocytes) and activates testosterone production. This effect is mainly provided by the influence of FSH.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ]

Pharmacokinetics

Plasma Cmax values of the FSH component are observed after 6-24 hours from the moment of intramuscular injection; then the blood level of FSH gradually decreases. The half-life is within 4-12 hours. After absorption into the blood, the distribution of the hMG element occurs mainly within the kidneys and ovarian tissues, and excretion occurs mainly through the kidneys.

Decreased excretion may be observed in people with renal insufficiency.

[ 8 ], [ 9 ]

Dosing and administration

Humog must be administered intramuscularly after preliminary dilution of the substance in a solvent, which is sold together with the powder.

Use in women.

To stimulate the growth of 1 dominant follicle, 2 different methods of administration can be used.

The first method: daily administration of the drug in a dose of 75 ME (during the first week of the menstrual cycle). It is necessary to continue the injections until an adequate reaction is obtained - this can be determined by daily blood tests of estrogen levels and detection of follicle sizes through an ultrasound procedure. Follicles often mature during a therapeutic course lasting 7-12 days. If there is no reaction of the ovaries to the use of the drug, the daily dose can be gradually increased to 150 ME.

The second method: use of the medicine every other day for 7 days. The initial dosage is within 225-375 IU per day. In the absence of adequate stimulation, the portion may be gradually increased.

After completion of therapy using any of the above methods, and also provided that there is an adequate (not excessive) ovarian response, monitored through folliculometry and monitoring of plasma estradiol levels, it is necessary to administer 5000-10000 IU of hCG once 24-48 hours after the last use of Humog (it increases LH levels and stimulates the release of a mature egg).

If the patient has at least 3 follicles with a diameter of 16-20 mm (information is obtained through ultrasound), as well as an adequate ovarian response (plasma estradiol values are 300-400 pg / ml (or 1000-1300 pmol / l) for each follicle whose diameter is greater than 18 mm), then hCG should not be administered. In addition, measures should be taken to prevent possible conception in order to avoid multiple pregnancy. Since each of the follicles with a diameter greater than 14 mm is considered preovulatory, the presence of several such follicles creates the possibility of multiple conception.

If ovulation is present but pregnancy has not occurred, the therapy can be repeated using one of the methods indicated for 2 cycles. On the day when hCG is administered, as well as in the following 2-3 days, the woman is recommended to have sexual intercourse. If stimulation of the superovulation process is performed (in the case of additional reproductive procedures), the duration of drug use may increase.

Use in men.

The drug is used in secondary hypogonadism to stimulate spermatogenesis, in cases where previous treatment with the introduction of hCG led only to the appearance of an androgen response without symptoms of spermatogenesis potentiation. In this case, the therapy is continued by introducing 2000 IU of hCG twice a week, together with injections of Humog in the amount of 75 IU, 3 times a week. Therapy according to this scheme should be continued for at least 4 months, and if there is no effect, it is continued by introducing 2000 IU of hCG twice a week and 150 IU of Humog 3 times a week.

The state of spermatogenesis processes should be assessed every month. If there is no positive effect within 3 months, the therapy should be discontinued.

In the normogonadotropic form of oligospermia, which is idiopathic in nature, the drug is administered every week at a dosage of 5000 IU hCG (intramuscularly or subcutaneously), and Humog is used in parallel with this - 3-times administration per week of 75-150 IU of the drug for 3 months.

[ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ]

Use Humog during pregnancy

The medication should not be prescribed to a woman during lactation or pregnancy.

Contraindications

General contraindications:

• the presence of intolerance to the medication;
• neoplasms in the hypothalamic-pituitary region;
• hyperprolactinemia;
• diseases affecting the thyroid or adrenal glands.

Contraindications for women:

• an increase in the size of the ovaries that is persistent;
• cyst in the ovarian area (provided there is no Stein-Leventhal syndrome);
• Stein-Leventhal syndrome;
• abnormal development of the genitals (due to which normal bearing of the fetus is impossible);
• leiomyoma;
• metrorrhagia of unknown origin;
• estrogen-dependent neoplasms (uterine, ovarian or breast carcinoma);
• primary ovarian insufficiency.

It is prohibited to prescribe to men in the following cases:

• prostate carcinoma;
• neoplasms in the testicular area;
• tumors that are androgen-dependent.

Caution is required if there are factors that could lead to the development of thromboembolism (for example, family or individual predisposition, thrombophilia or severe obesity (body weight index >30 kg/m2 ⁾ ), because in this case the likelihood of arterial or venous thromboembolism increases (during or after the end of therapy with gonadotropins).

In such conditions, gonadotropins should be used only in situations where the benefit from them is more likely than the risk of complications.

[ 10 ], [ 11 ], [ 12 ], [ 13 ]

Side effects Humog

The use of the medication may cause the following side effects:

• disorders affecting digestive function: vomiting, gastralgia, bloating and nausea;
• endocrine dysfunction: OHSS, mastalgia, enlargement of the ovaries, the appearance of large ovarian cysts, as well as a significant increase in the level of estrogen excretion in the urine; in men, gynecomastia may develop;
• problems with metabolic processes: violation of EBV indicators;
• signs of allergy: fever, rash, arthralgia, urticaria (formation of antibodies after prolonged use); in addition, generalized allergy symptoms develop - urticaria or erythema;
• local manifestations: pain, swelling or itching at the injection site;
• others: hypovolemia, hydrothorax, oliguria, weight gain, blood thickening, as well as ascites, decreased blood pressure, pain in the lower abdomen, hemoperitoneum, multiple pregnancy and TEB.

[ 14 ], [ 15 ], [ 16 ]

Overdose

Intoxication causes ovarian hyperstimulation.

At the 1st degree of pathology (mild form) therapy is not needed. In this case, a slight increase in the size of the ovaries (no more than 5-7 cm), abdominal pain and an increase in sex steroids are noted. The woman should be informed about this, and then her condition should be closely monitored.

At the 2nd stage of the disease, hospitalization is required with symptomatic measures, including intravenous infusions of fluids that support general blood circulation (if the hemoglobin level increases). With ovarian cysts with a size of about 8-10 cm, vomiting, abdominal symptoms and nausea are noted.

At the 3rd stage of the disease, cysts appear that are larger than 10 cm, and in addition, hydrothorax, dyspnea, abdominal pain with ascites, salt retention, increased blood viscosity (against this background, platelet adhesion increases, which threatens the development of thromboembolism) and blood hemoglobin values increase. In this case, hospitalization is absolutely necessary.

[ 22 ]

Interactions with other drugs

It is prohibited to mix the drug in one syringe with other drugs.

Combination with clomiphene enhances the ovarian response to the use of Humog.

[ 23 ], [ 24 ], [ 25 ]

Storage conditions

Humog must be kept in a place closed to children and away from sunlight. The powder must not be frozen; it must be stored at temperatures between 2-8°C. The solvent can be stored at temperatures no higher than 25°C.

[ 26 ], [ 27 ], [ 28 ]

Shelf life

Humog in powder form can be used within 36 months from the date of production of the pharmaceutical product. The shelf life of the solvent is 5 years.

Application for children

The drug is not used in pediatrics.

Analogues

Analogues of the drug are the drugs Menogon, Pergonal with menopausal gonadotropin, and in addition Pergogrin and HMG Massone with Menopur and Humegon.

[ 29 ], [ 30 ], [ 31 ]