Drugs List

Therapeutic Indications

Uses

Controlled ovarian stimulation: Prevention of premature ovulation

Prevention of premature ovulation in patients undergoing controlled ovarian stimulation followed by oocyte pick-up and assisted reproductive techniques.

Administration

For subcutaneous injection into the lower abdominal wall.

Injection site reactions may be minimised by injecting the product in a slow rate to facilitate the progressive absorption of the product.

Contraindications

Breastfeeding
Pregnancy
Severe renal impairment

Precautions and Warnings

Allergic disposition
Hepatic impairment
Renal impairment

Treatment to be initiated and supervised by a specialist
Contains mannitol
Warm to room temperature prior to use
Advise patient to report symptoms of allergic type hypersensitivity
Ovarian hyperstimulation syndrome can occur
Luteal phase support should be provided in accordance to local practice

Pregnancy and Lactation

Pregnancy

Cetrorelix is contraindicated in pregnancy.

Animal studies have shown that cetrorelix acetate has a dose related effect on fertility, reproductive performance and pregnancy. However when administered during the sensitive phase of gestation no teratogenic effects were observed.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Cetrorelix is contraindicated in breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylaxis
Erythema at injection site
Headache
Hypersensitivity reactions
Itching sensation (local)
Nausea
Ovarian hyperstimulation
Pruritus
Pseudoallergic reactions
Swelling (injection site)

Presentation

Injections of cetrorelix (as cetrorelix acetate)

Drugs List

Therapeutic Indications

Uses

Controlled ovarian stimulation: Prevention of premature ovulation

Prevention of premature ovulation in patients undergoing controlled ovarian stimulation followed by oocyte pick-up and assisted reproductive techniques.

Dosage

The initial cetrorelix injection should be administered in the presence of a physician under conditions suitable to deal with any pseudo-allergic reactions which may occur. Following the initial injection the patient should be observed closely for 30 minutes for signs and symptoms of allergic/pseudo-allergic reactions.

Further injections may be self-administered but only once the patient is aware of the signs and symptoms indicating hypersensitivity and the need for immediate medical attention in that event.

Adults

Administration

For subcutaneous injection into the lower abdominal wall.

Injection site reactions may be minimised by injecting the product in a slow rate to facilitate the progressive absorption of the product.

Contraindications

Breastfeeding
Pregnancy
Severe renal impairment

Precautions and Warnings

Allergic disposition
Hepatic impairment
Renal impairment

Treatment to be initiated and supervised by a specialist
Contains mannitol
Warm to room temperature prior to use
Advise patient to report symptoms of allergic type hypersensitivity
Ovarian hyperstimulation syndrome can occur
Luteal phase support should be provided in accordance to local practice

Pregnancy and Lactation

Pregnancy

Cetrorelix is contraindicated in pregnancy.

Animal studies have shown that cetrorelix acetate has a dose related effect on fertility, reproductive performance and pregnancy. However when administered during the sensitive phase of gestation no teratogenic effects were observed.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Cetrorelix is contraindicated in breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylaxis
Erythema at injection site
Headache
Hypersensitivity reactions
Itching sensation (local)
Nausea
Ovarian hyperstimulation
Pruritus
Pseudoallergic reactions
Swelling (injection site)

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: July 2016

Reference Sources

Summary of Product Characteristics: Cetrotide 0.25mg. Merck. Revised July 2019.