CHORIONIC GONADOTROPIN
Clinical safety rating
cautionComprehensive clinical and safety monograph for CHORIONIC GONADOTROPIN (CHORIONIC GONADOTROPIN).
Comprehensive clinical and safety monograph for CHORIONIC GONADOTROPIN (CHORIONIC GONADOTROPIN).
FDA-approved: Induction of ovulation in infertile females (as part of controlled ovarian hyperstimulation)FDA-approved: Treatment of prepubertal cryptorchidismFDA-approved: Treatment of hypogonadotropic hypogonadism in malesOff-label: Weight loss (not recommended)Off-label: In vitro fertilization protocols
Chorionic gonadotropin (hCG) binds to the luteinizing hormone/choriogonadotropin receptor (LHCGR) on the surface of gonadal cells, stimulating steroidogenesis and gametogenesis. In females, it triggers ovulation and luteinization; in males, it stimulates Leydig cells to produce testosterone.
| Metabolism | Primarily metabolized in the liver via proteolytic degradation; undergoes renal excretion with a half-life of 24-36 hours. |
| Excretion | Primarily renal; intact hCG is excreted in urine. Negligible biliary/fecal elimination. |
| Half-life | Biphasic: initial half-life ~11 hours, terminal half-life ~23–30 hours. Single-dose half-life ~32 hours; repeated dosing may extend due to accumulation. |
| Protein binding | Approximately 80% bound; binds to albumin and sex hormone-binding globulin (SHBG) with low affinity. |
| Volume of Distribution | 0.3–0.5 L/kg; distributes into extracellular fluid, gonadal tissues, and poorly into fat. |
| Bioavailability | IM/SC: ~40% to 100% (mean ~78%) due to variable absorption; IV: 100% (not typical). Oral: negligible (<1% due to degradation). |
| Onset of Action | IM/SC: Ovulation occurs ~36–40 hours after injection. Spermatogenesis response appears after 2–3 weeks of therapy. |
| Duration of Action | IM/SC: Ovulatory effect lasts ~4 days; luteal support ~8–10 days. Repeated doses may prolong testosterone rise for >7 days. |
| Molecular Weight | 36720 |
For hypogonadotropic hypogonadism: 1000-2000 IU subcutaneously or intramuscularly 2-3 times per week. For ovulation induction: 5000-10,000 IU intramuscularly as a single dose.
| Dosage form | Injectable |
| Renal impairment | No specific dose adjustment guidelines available; use with caution in severe renal impairment (GFR <30 mL/min/1.73 m²). |
| Liver impairment | No specific dose adjustment guidelines available; use with caution in severe hepatic impairment (Child-Pugh class C). |
| Pediatric use | Cryptorchidism: 500-1000 IU subcutaneously or intramuscularly 2-3 times per week for 6 weeks. Delayed puberty: 500-1500 IU subcutaneously or intramuscularly 2-3 times per week. |
| Geriatric use | No specific dose adjustments; monitor for fluid retention and cardiovascular effects. |
| 1st trimester | Contraindicated: Risk of multiple gestations and ovarian hyperstimulation syndrome (OHSS); may cause early pregnancy loss if used inappropriately. |
| 2nd trimester | Contraindicated: Not indicated for use during pregnancy; may stimulate ovarian enlargement and discomfort. |
| 3rd trimester | Contraindicated: No therapeutic indication; may induce uterine contractions or cause OHSS. |
Clinical note
Comprehensive clinical and safety monograph for CHORIONIC GONADOTROPIN (CHORIONIC GONADOTROPIN).
| Placental transfer | Likely crosses placenta due to its size (similar to endogenous hCG); however, endogenous hCG is present in high levels during pregnancy. |
| Breastfeeding | Excretion into human milk is unknown; however, due to high molecular weight and poor oral bioavailability, absorption by infant is unlikely. Use with caution in nursing mothers only if clearly needed. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | Chorionic gonadotropin is a pregnancy hormone; exogenous use during first trimester may theoretically alter placental hormone balance, but no increased risk of congenital anomalies has been established. However, use during pregnancy is contraindicated except as part of assisted reproductive technology protocols where its role is physiological. No fetal risks documented from therapeutic use in second or third trimester. |
| Fetal Monitoring | Monitor ovarian response via ultrasound and serum estradiol levels during controlled ovarian hyperstimulation. Assess for ovarian hyperstimulation syndrome (OHSS) symptoms: rapid weight gain, abdominal pain, oliguria. In pregnancy, standard obstetrical monitoring including fetal growth, amniotic fluid volume, and uterine artery Doppler as indicated for high-risk pregnancies. |
| Fertility Effects | Chorionic gonadotropin is used to induce final oocyte maturation and trigger ovulation. It can cause multiple follicle development and multiple pregnancies. In males, used to stimulate testosterone production; no negative impact on spermatogenesis when used appropriately. Risk of OHSS with excessive dosing. |
■ FDA Black Box Warning
None. However, use in females requires careful monitoring to avoid ovarian hyperstimulation syndrome (OHSS), which can be severe.
| Serious Effects |
Pregnancy (except as part of specific assisted reproductive technology protocols under specialist care)Hypersensitivity to hCG or any componentOvarian enlargement or cysts unrelated to polycystic ovary syndromeGonadotropin-independent precocious pubertyActive thromboembolic disordersSex hormone-dependent malignancies (e.g., breast, ovarian, uterine, prostate)
| Precautions | Ovarian hyperstimulation syndrome (OHSS): Risk of severe OHSS with ascites, pleural effusion, and thromboembolic events, Multiple pregnancy: Increased risk due to ovulation induction, Thromboembolic events: Increased risk, especially in patients with prior history, Ovarian enlargement: Monitor with ultrasound, Hormonal-dependent malignancies: Caution in patients with prior history |
| Food/Dietary | No known food interactions. |
| Clinical Pearls | Chorionic gonadotropin (hCG) is used to trigger ovulation in assisted reproduction and to treat hypogonadotropic hypogonadism in males. Monitor for ovarian hyperstimulation syndrome (OHSS) in women; discontinue if severe. Do not use in women with primary ovarian failure. In males, may cause gynecomastia or fluid retention. |
| Patient Advice | Report abdominal pain, bloating, nausea, vomiting, or rapid weight gain (signs of OHSS). · In males, report breast tenderness or swelling, or fluid retention (swollen ankles/feet). · Do not use if pregnant or breastfeeding unless directed by a specialist. · For fertility: timing of intercourse or IUI is critical; follow cycle monitoring closely. · In males: take as prescribed for testicular descent or hypogonadism; may require multiple doses. |
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