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LHRH Antagonists (ReCetrorelix and Ganirelix)

Cetrorelix and ganirelix are luteinising hormone releasing hormone antagonists.
They inhibit the release of gonadotrophins, luteinising hormone (LH) and follicle-stimulating hormone (FSH).
This effect is dose-dependant. They are used in the treatment of infertility by assisted reproduction. They prevent a premature LH surge in women having a controlled ovarian stimulation. This allows the oocytes adequate time to mature, ready for planned collection.

Indications for Use

As an adjunct to other therapy in the treatment of female infertility, under specialist supervision.

  • Cetorelix is given as a subcutaneous injection into the lower abdominal wall
  • Ganirelix is given into the upper leg, with rotation of injection sites to prevent lipoatrophy, starting on day 5 or 6 of ovarian stimulation with gonadotrophins.
  • It is continued throughout administration of gonadotrophins, including day of ovulation induction

Efficacy

Their efficacy has been shown to be equivalent to gonadotrophin analogues, e.g. buserelin, but with a simpler protocol.1They also have the advantage of no hormonal withdrawal side-effects, e.g.hot flushes.2

Cautions and Contraindications

Their use is contraindicated in:

  • Pregnancy
  • Breast-feeding
  • Moderate renal impairment
  • Moderate hepatic impairment
Adverse Effects
  • Nausea
  • Headache
  • Injection site reactions
  • Rarely hypersensitivity reactions
  • Dizziness, asthenia and malaise also reported with Ganirelix
  • Ovarian hyperstimulation syndrome. Severe reactions occur in 0.6% of all treatment cycles.3

Document References
  1. Albano C, Felberbaum RE, Smitz J, et al; Ovarian stimulation with HMG: results of a prospective randomized phase III European study comparing the luteinizing hormone-releasing hormone (LHRH)-antagonist cetrorelix and the LHRH-agonist buserelin. European Cetrorelix Study Group.; Hum Reprod. 2000 Mar;15(3):526-31. [abstract]
  2. Reissmann T, Felberbaum R, Diedrich K, et al; Development and applications of luteinizing hormone-releasing hormone antagonists in the treatment of infertility: an overview.; Hum Reprod. 1995 Aug;10(8):1974-81. [abstract]
  3. Felberbaum R, Reissmann T, Kupker W, et al; Hormone profiles under ovarian stimulation with human menopausal gonadotropin (hMG) and concomitant administration of the gonadotropin releasing hormone (GnRH)-antagonist Cetrorelix at different dosages.; J Assist Reprod Genet. 1996 Mar;13(3):216-22. [abstract]
Internet and Further Reading AcknowledgementsEMIS is grateful to Dr Hayley Willacy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 348
Document Version: 1
DocRef: bgp25181
Last Updated: 25 Sep 2007
Review Date: 24 Sep 2008






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