CHORIONIC GONADOTROPIN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CHORIONIC GONADOTROPIN (CHORIONIC GONADOTROPIN).
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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CHORIONIC GONADOTROPIN (CHORIONIC GONADOTROPIN).
| Breastfeeding | Chorionic gonadotropin is not orally bioavailable and is likely degraded in infant gastrointestinal tract. Excretion into breast milk is unknown; M/P ratio not established. However, due to its protein nature, transfer is expected to be minimal. Use during breastfeeding is not recommended unless clearly necessary; theoretical risk of hormonal effects on infant. |
| 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. |
■ 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","Primary ovarian failure","Uncontrolled thyroid or adrenal dysfunction","Active thromboembolic disorder","Hormone-sensitive tumors (e.g., prostate, breast, ovarian)","Hypersensitivity to hCG or any component"]
| 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"] |
Loading safety data…
| 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. |