Follistim
Generic Name:
Follitropin Beta
Brand Names:
Follistim, Follistim AQ, Gonal-f RFF, Puregon
Follistim Description:
Follistim is a follitropin beta injection containing is FSH, a follicle-stimulating hormone that is crucial in the development of eggs (follicles) by a woman’s ovaries. Follistim is used by women who wishe to become pregnant but are experiencing difficulty with the normal maturing of the eggs. Follistim helps stimulate the growth of eggs and is also used to help the eggs develop in women who wish to undergo in vitro fertilization in an attempt to become pregnant.
In the body, FSH, the hormone found in Follistim, is secreted by basophilic cells of anterior pituitary gland. FSH is essential for folliculogenesis (development of ovarian follicle) in women and spermatogenesis (formation of sperms) in males. Follistim can stimulate follicular growth in women and spermatogenesis in men.
Follistim Uses:
Follistim is used to stimulate ovulation and pregnancy in women experiencing fertility difficulties not primarily attributed to ovarian failure. This medication is also given to female patients undergoing an Assisted Reproductive Technology program (ART) in an attempt to become pregnant.
Follistim can be used along with human chorionic gonadotropin (hCG) for treating primary and secondary hypogonadotropic hypogonadism in males. Hypogonadotropic hypogonadism refers to a condition of absence or decreased function of the male testes.
Follistim Interactions:
Inform your physician about all the medications you are taking including over-the-counter medications, vitamins, and nutritional supplements. Ask whether you can take these medications when you are receiving Follistim injections.
Antagon (ganirelix) has been shown to interact with Follistim, so talk with your doctor before combining medications.
Follistim Dosage Information:
Typical Dosage Recommendations
Dosage for women:
Women can take Follistim either subcutaneously or intramuscularly. They should take a dose of 150 to 225 IU for the initial four days. The dose will then be adjusted according to the patient’s response to treatment. If patients show good response, they will take 75 to 300 IU for six to 12 days. If the response is poor, the patients should take a maintenance dose of 375 to 600 IU. The maximum dose is 600 IU per day.
Follistim cannot induce ovulation as it can help only in growth and maturation of follicles (eggs). To get the complete result, after the treatment with Follistim or when adequate follicle maturation has achieved, hCG must be given to the patients at a dose of 5000 to 10,000 IU. Ultrasonography and measurement of estradiol levels should be taken to detect the maturation of follicles and also determine the timing of administration of hCG. Ovulation can be confirmed if the patients have:
- Increased basal body temperature
- Menstruation after the change in basal body temperature
- Increased serum progesterone levels
The egg can then be retrieved 34 to 36 hours later. If ovaries are abnormally enlarged, hCG therapy must be withheld.
Dosage for men:
Men can receive Follistim only through subcutaneous injections. Before beginning the therapy with Follistim, male patients must receive a pretreatment with hCG alone to normalize serum testosterone levels. They should receive hCG 1500 IU two times a week If the response is not good, the dose should be adjusted to 3000 IU two times a week.
After regularizing testosterone levels, male patients should begin receiving Follistim at a dose of 450 IU a week, which can be taken as either 225 IU two times a week or 150 IU three times a week, for a period of three to four months. If there is no improvement with spermatogenesis after this period, treatment should be continued. Patients should continue taking hCG at the same dose during this period.
Missing a Dose
If you miss a dose of Follistim, contact your physician.
Overdosing
There have been no reports on the effects of overdosing of Follistim. Seek medical attention following to overdose of Follistim.
Follistim FDA Approval:
September 29, 1997
Follistim Recall/Black Box Warning Information:
There are no recalls or black box warnings for Follistim.
Other Warnings:
Follistim should be given by an experienced infertility physician as it can lead to ovarian hyperstimulation syndrome (OHSS) with or without vascular or pulmonary complications. Ovarian hyperstimulation or excessive stimulation of ovaries is characterized by the enlargement of ovaries. OHSS also causes an increase in vascular permeability, which can lead to fluid accumulation in thorax, peritoneal cavity and pericardium. Other signs and symptoms of OHSS are:
- Nausea and vomiting
- Diarrhea
- Pelvic pain
- Weight gain
- Abdominal pain and distention
- Dyspnea
- Oliguria
OHSS itself can lead to many medical conditions including:
- Electrolyte imbalance
- Hypovolemia
- Ascites
- Pleural effusion
- Hemoconcentration
- Hemoperitoneum
- Acute pulmonary distress
- Hydrothorax
- Thromboembolic events
Risk for ovarian enlargement can be minimized by starting the treatment with the lowest dose of Follistim. Patients should also receive ultrasound evaluations and assessment of serum estradiol levels during the course of treatment. Administration of hCG should be suspended if the ovaries are found to be enlarged on the last days of therapy.
In the case of occurrence of severe OHSS, Follistim should be stopped and patients put on a therapy consisting of bed rest, electrolyte management and, if necessary, pain medications.
Follistim has the potential to cause intravascular thrombosis that can result in serious vascular conditions like venous thrombophlebitis, pulmonary infarction, arterial occlusion (causes loss of limb), pulmonary embolism and stroke.
Pulmonary complications like acute respiratory distress syndrome and atelectasis can also occur due to the use of Follistim.
Patients should be warned about the possibilities of multiple gestations as a result of treatment with this medication.
Sources:
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July 30, 2010, 2:23 pm
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