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(go-NAD-oh-RELL-in ASS-uh-TATE)
Lutrepulse
Class: Gonadotropin-releasing hormone

 Action Causes synthesis and release of luteinizing hormone and follicle-stimulating hormone.

 Indications Treatment of infertility by induction of ovulation in women with primary hypothalamic amenorrhea.

 Contraindications Any condition that could be exacerbated by pregnancy; ovarian cysts or causes of anovulation other than of hypothalamic origin; hormonally dependent tumors.

 Route/Dosage

ADULTS: IV 5 mcg over pulse period of 1 min and pulse frequency of 90 min delivered via gonadorelin pump. Pump also can be programmed to deliver 2.5 mcg, 10 mcg, and 20 mcg doses per pulse. Typically patients are treated for 21 days. If ovulation occurs, therapy is continued for 2 wk to maintain corpus luteum.

 Interactions

Ovulation stimulators: Do not use concomitantly.

 Lab Test Interferences None well documented.

 Adverse Reactions

DERM: Local inflammation; hematoma at catheter site. GU: Multiple pregnancy; ovarian hyperstimulation. HEMA: Mild phlebitis. OTHER: Anaphylaxis.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy in children < 18 yr not established. Multiple pregnancy: Multiple pregnancy is possible. Minimize risk by proper dosage and monitoring. Ovarian hyperstimulation: Drug may cause sudden, abnormal ovarian enlargement.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Reconstitute drug immediately prior to use.
  • Dilute contents of vial with 8 mL of supplied diluent. Reconstituted solution should be clear, colorless and free of particulate matter.
  • After dilution, transfer solution to plastic pump reservoir.
  • An 8 mL solution generally supplies 7 consecutive days.
  • To avoid sepsis, carefully monitor infusion area and change IV site and cannula every 48 hr.
  • Store unopened vials at room temperature.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Monitor for anaphylactic reaction.
  • Assess for irritation or signs of infection at infusion site. Check pump to make sure that it is delivering medication correctly.
  • If ovarian enlargement, ascites, pleural effusion, or phlebitis occurs, discontinue therapy and notify health care provider.
  • Institute supportive therapy for local inflammation (ie, apply ice intermittently).
OVERDOSAGE: SIGNS & SYMPTOMS
  Temporary reduction of pituitary responsiveness

 Patient/Family Education

  • Advise patient of importance of repeated ovarian ultrasonographic examinations and continued treatment in event of pregnancy.
  • When indicated, instruct patient regarding reconstitution of solution and use of pump.
  • Instruct patient about potential side effects (eg, local inflammation) and supportive therapy that can be undertaken.
  • Inform patient of signs and symptoms of ovarian enlargement, ascites, and pleural effusion and advise patient to notify health care provider immediately if these symptoms occur.

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