Hormones

Product Details:

Indications:

• Polycystic ovarian syndrome
• Female infertility
• In vitro fertilisation procedures or other assisted conception techniques
• Male infertility

Dosage:

Polycystic ovarian syndrome:

• Adult: Initially, 150 IU daily SC/IM for the first 5 days. Adjust subsequent dosing based on clinical monitoring (e.g. serum oestradiol levels and vaginal ultrasound). Dose adjustments should not be made more frequently than once every 2 days and be ≤75-150 units per adjustment. Max dose: 450 units daily and max course of treatment: 12 days. Stop treatment when adequate response obtained as determined by oestrogen monitoring or ultrasonic visualisation of follicles. A single dose of chorionic gonadotrophin 5000 to 10 000 units is given to induce ovulation after 1-2 days. Urofollitropin treatment may be tried again in future cycles.

Female infertility:

• Adult: Initially, 150 IU daily SC/IM for the first 5 days. Adjust subsequent dosing based on clinical monitoring (e.g. serum oestradiol levels and vaginal ultrasound). Dose adjustments should not be made more frequently than once every 2 days and be ≤75-150 units per adjustment. Max dose: 450 units daily and max course of treatment: 12 days. Stop treatment when adequate response obtained as determined by oestrogen monitoring or ultrasonic visualisation of follicles. A single dose of chorionic gonadotrophin 5000 to 10 000 units is given to induce ovulation after 1-2 days. Urofollitropin treatment may be tried again in future cycles.

In vitro fertilisation procedures or other assisted conception techniques:

• Adult: In conjunction with other agents: 150-225 units of FSH daily SC/IM from day 2 or 3 of menstrual cycle. Alternatively, begin therapy with clomifene citrate and continue with urofollitropin; or urofollitropin may be given after gonadorelin analogue is given to suppress gonadotrophin release. Continue treatment until an adequate response is obtained and admin 5000 to 10 000 units of chorionic gonadotrophin 1-2 days after final injection of urofollitropin. Oocyte retrieval is performed 34-35 hr later.

Male infertility:

• Adult: In conjunction with chorionic gonadotrophin, 150 units of FSH SC/IM 3 times a wk, continue for at least 4 mth. .

Product Details:

Indications:

• As supplement in adrenal insufficiency during minor surgery under general anaesthesia
• As supplement in adrenal insufficiency during moderate or major surgery
• Acute adrenocortical insufficiency
• Soft tissue inflammation
• Joint inflammations

Dosage:

As supplement in adrenal insufficiency during minor surgery under general anaesthesia:

• Adult: In patients taking >10 mg of prednisolone or its equivalent by mouth daily. 25-50 mg at induction. Resume with usual oral corticosteroid after surgery.

As supplement in adrenal insufficiency during moderate or major surgery:

• Adult: In patients taking >10 mg of prednisolone or its equivalent by mouth daily. Usual oral corticosteroid dose on the morning of the surgery followed by 25-50 mg at induction, then similar doses of hydrocortisone tid for 24 hr after moderate surgery or 48-72 hr after major surgery. Resume oral therapy once injections are stopped.

Acute adrenocortical insufficiency:

• Adult: 100-500 mg 3-4 times/24 hr according to the severity of the condition and patient response. Fluids and electrolytes should be administered as needed to correct any metabolic disorder. Doses may also be given via IM inj but the response may be slower.
• Child: <1 yr: 25 mg; 1-5 yr: 50 mg; 6-12 yr: 100 mg. Fluids and electrolytes should be administered as needed to correct any metabolic disorder. Doses may also be given via IM inj but the response may be slower.
• Soft tissue inflammation Adult: As Na phosphate or Na succinate esters: 100-200 mg as local inj.

Joint inflammations:

• Adult: As acetate: 5-50 mg depending on size of affected joint.

Product Details:

Indications:

• Endometriosis
• Contraception
• Breast cancer
• Palliative treatment of endometrial and renal carcinoma
• Palliative treatment of prostatic carcinoma

Dosage:

Intramuscular:
Endometriosis:

• Adult: 50 mg wkly or 100 mg every 2 wk.

Intramuscular:
Contraception:

• Adult: 150 mg every 12 wk.

Intramuscular:
Breast cancer:

• Adult: 0.5-1 g daily for first 4 wk. Maintenance 0.5 g twice wkly.

Intramuscular:

• Palliative treatment of endometrial and renal carcinoma:
• Adult: Initially 0.4-1 g wkly. Reduce as necessary, maintenance may be as low as 0.4 g mthly.

Intramuscular:
Palliative treatment of prostatic carcinoma:

• Adult: 0.5 g twice wkly for first 3 mth. Maintenance 0.5 g wkly.

Subcutaneous:
Contraception:

• Adult: 104 mg every 12-14 wk.

Subcutaneous:
Endometriosis:

• Adult: 104 mg every 12-14 wk.

Product Details:

Indications:

• Somatostatin is an anti growth hormone. Somatostatin is used to prevent and treat excessive bleeding from the gastro intestinal tract. (Gastrointestinal haemorrhage).

Dosage:

• Adult: Initially, 250 mcg as a bolus inj over 3-5 min, followed by a continuous infusion of 3.5 mcg/kg/hr until bleeding has ceased. May continue for a further 48-72 hr to prevent recurrent bleeding. 

Product Details:

Indications:

• Adjunct in abortion
• Postpartum haemorrhage
• Labour induction
• Oxytocin challenge test for evaluating of foetal distress

Dosage:

Adjunct in abortion:

• Adult: 10-20 milliunits/minute. Max total dose: 30 units in a 12-hr period.
• Incompatibility: When admixed: fibrinolysin (human), norepinephrine, prochlorperazine edisylate, variable compatibility with phytonadione.

Postpartum haemorrhage:

• Adult: 10-40 units by infusion in 1000 mL of IV fluid at a rate sufficient to control uterine atony.
• Incompatibility: When admixed: fibrinolysin (human), norepinephrine, prochlorperazine edisylate, variable compatibility with phytonadione.

Labour induction:

• Adult: 1-2 milliunits/minute, may increase at intervals of at least 30 minutes until a max of 3-4 contractions occur every 10 minutes. Not to exceed 32 milliunits/minute and no more than a total of 5 units should be given in 1 day. Not to be given within 6 hr after admin of vaginal prostaglandins. Monitor uterine contractions and foetal heart rate continuously. Withdraw gradually once labour is progressing.

Oxytocin challenge test for evaluating of foetal distress:

• Adult: Dilute 5-10 units in 1 L of 5% dextrose inj. Initially, administer the drug in the mother via IV infusion at a rate of 0.5 milliunits/minute. May gradually increase infusion rate at intervals of 15-30 minutes. Max: 20 milliunits/minute. Monitor foetal heart rate and uterine contractions immediately before and during infusion. Discontinue infusion when 3 moderate uterine contractions occur within one 10-minute interval. Compare baseline and oxytocin-induced foetal heart rates. If no change occurs, repeat the test in 1 wk. Termination of pregnancy may be required if a late deceleration in foetal heart rate occurs.

Product Details:

Indications:              

• Endometriosis
• Recurrent miscarriage
• Menstrual disorders
• Threatened miscarriage
• Infertility
• Endometrial protection during menopausal hormonal replacement therapy

Dosage:

Endometriosis:

• Adult: 10 mg bid-tid cyclically or continuously.

Recurrent miscarriage:

• Adult: 10 mg bid given cyclically until conception, then continuously until wk 20 of pregnancy, after which dose may be gradually reduced.

Menstrual disorders:

• Adult: 10 mg bid in a cyclical regimen.

Threatened miscarriage:

• Adult: Initially, 40 mg followed by 10 mg or more every 8 hr, continued for a wk after symptoms are relieved. Reduce dose gradually after that unless symptoms return.

Infertility:

• Adult: 10 mg bid.

Endometrial protection during menopausal hormonal replacement therapy:

• Adult: 10 mg 1-2 times daily in a cyclical regimen or 5 mg daily.

Product Details:

Indications:   

• Female infertility
• Male infertility
• In vitro fertilisation procedures or other assisted conception techniques

Dosage:

Female infertility:

• Adult: 75-150 units of FSH daily via IM or SC inj; adjust gradually until adequate response is achieved. Treatment is stopped and followed after 1 or 2 days by single dose of chorionic gonadotrophin 5000-10,000 units. In menstruating patients, start within the 1st 7 days of menstrual cycle. Alternatively, 3 equal doses IM or SC, each providing 225-375 units of FSH on alternate days followed by chorionic gonadotrophin 1 wk after the 1st dose. Stop treatment if no response is seen in 3 wk. Course may be repeated twice more, if necessary.

Male infertility:

• Adult: Stimulate spermatogenesis with chorionic gonadotrophin, then with human menopausal gonadotrophin in a dose of 75 or 150 units of FSH 2 or 3 times wkly by IM or SC. Treatment should be continued for at least 3 or 4 mth.

In vitro fertilisation procedures or other assisted conception techniques:

• Adult: (In conjunction with chorionic gonadotrophin and sometimes clomiphene citrate or a gonadorelin analogue.) 75-300 units of FSH daily via IM or SC inj usually beginning on the 2nd or 3rd day of menstrual cycle. Combined regimen: 100 mg clomiphene citrate on days 2-6, with human menopausal gonadotrophins beginning on day 5 in a dose providing 150-225 units of FSH daily. Continue until an adequate response is obtained; final inj of human menopausal gonadotrophins is followed 1-2 days later with up to 10,000 units of chorionic gonadotrophin. 

Product Details:

Indications:

• Recurrent miscarriage
• Amenorrhoea
• Abnormal uterine bleeding
• Palliative treatment of advanced, inoperable endometrial carcinoma

Dosage:

Recurrent miscarriage:

• Adult: 250-500 mg wkly during the 1st half of pregnancy.

Amenorrhoea:

• Adult: Single dose of 375 mg; may repeat at 4-wkly intervals if needed. After 4 days of desquamation, or if there is no bleeding within 21 days after admin of the drug, may initiate cyclic therapy that includes an oestrogen. For cyclic treatment (28-day cycle): Administer 20 mg of estradiol valerate on day 1, and on day 15, administer 250 mg of hydroxyprogesterone caproate and 5 mg of estradiol valerate. May repeat cyclic therapy at 4-wkly intervals as needed.

Abnormal uterine bleeding:

• Adult: Single dose of 375 mg; may repeat at 4-wkly intervals if needed. After 4 days of desquamation, or if there is no bleeding within 21 days after admin of the drug, may initiate cyclic therapy that includes an oestrogen. For cyclic treatment (28-day cycle): Administer 20 mg of estradiol valerate on day 1, and on day 15, administer 250 mg of hydroxyprogesterone caproate and 5 mg of estradiol valerate. May repeat cyclic therapy at 4-wkly intervals as needed.

Palliative treatment of advanced, inoperable endometrial carcinoma:

• Adult: Usual dose: ≥1 g, may repeat once or more times wkly. Usual range: 1-7 g/wk. Discontinue treatment if relapse occurs or if the objective response is not achieved after 12 wk of treatment.

Product Details:

Indications:

• Dysfunctional uterine bleeding
• Amenorrhoea
• Recurrent miscarriage with progesterone deficiency
• Contraception
• Premenstrual syndrome

Dosage:

Dysfunctional uterine bleeding; Amenorrhoea:

• Adult: 5-10 mg daily for 5-10 days until 2 days prior to expected onset of menstruation.

Recurrent miscarriage with progesterone deficiency:

• Adult: 25-100 mg twice wkly from the 15th day of pregnancy until 8-16 wk. May increase to daily inj, if necessary.

Contraception:

• Adult: Insert the device (containing 38 mg of progesterone) into the uterine cavity; efficacy can last up till 1 yr.

Dysfunctional uterine bleeding:

• Adult: 45 mg every other day from the 15th-25th day of the cycle. May increase dose to 90 mg in non-responders.

Amenorrhoea:

• Adult: 45 mg every other day from the 15th-25th day of the cycle. May increase dose to 90 mg in non-responders.

Premenstrual syndrome:

• Adult: 200 mg daily, may increase to 400 mg bid. Treatment is usually started on days 12-14 of the cycle and continues until onset of menstruation. Same doses may also be given rectally. 

Product Details:

Indications:

• Progestogen component of menopausal hormonal replacement therapy
• Dysfunctional uterine bleeding
• Amenorrhoea

Dosage:
 
Progestogen component of menopausal hormonal replacement therapy:

• Adult: 200 mg daily as a single daily dose at night for 12-14 days of each mth.

Amenorrhoea:

• Adult: 400 mg daily for 10 days.

Dysfunctional uterine bleeding:

• Adult: 400 mg daily for 10 days.

Product Details:

Indications:

• Treatment of bleeding oesophageal varices

Dosage:

Adults:

• Initially 1-2 mg terlipressin acetate (equivalent to 1-2 vials of Terlipressin) are administered.
• Depending on the patient's body weight the dose can be adjusted as follows:
• Weight less than 50 kg: 1 mg.
• Weight 50 kg to 70 kg: 1.5 mg.
• Weight exceeding 70 kg: 2 mg.
• After the initial injection, the dose can be reduced to 1 mg every 4 to 6 hours.
• The approximate value for the maximum daily dose of Terlipressin is 120 μg/kg body weight.

Elderly:

• Terlipressin should only be used with caution in patients over 70 years

Children and adolescents:

• Terlipressin is not recommended in children and adolescents due to insufficient experience on safety and efficacy

Renal insufficiency:

• Terlipressin should only be used with caution in patients with chronic renal failure

Hepatic insufficiency:

• A dose adjustment is not required in patients with liver failure.

 
Method of administration:

• The therapy is to be limited to 2 – 3 days in adaptation to the course of the disease.
• Terlipressin is dissolved with the accompanying solvent and is applied intravenously. The intravenous injection should be given during the period of one minute. For further dilution.

Product Details:

Indications:

• Replacement therapy in hypothyroidism
• Severe and chronic hypothyroidism
• TSH suppression

Dosage:

Replacement therapy in hypothyroidism:

• Adult: Initially, 50-100 mcg/day may increase by 25-50 mcg at approx 3- to 4-wk intervals until the thyroid deficiency is corrected. Maintenance: 100-200 mcg/day.
• Child: Neonates: Initially, 10-15 mcg/kg/day. Adjust dose every 4-6 wk. Neonates w/ thyroxine levels <5 mcg/dL: Initially, 50 mcg/day.
• Infants and children: Dose based on body wt and age: 0-3 mth 10-15 mcg/kg/day; 3-6 mth 8-10 mcg/kg/day; 6-12 mth 6-8 mcg/kg/day; 1-5 yr 5-6 mcg/kg/day; 6-12 yr 4-5 mcg/kg/day; >12 yr 2-3 mcg/kg/day. Older children: To minimise hyperactivity, initially ¼ of the recommended dose and increase by ¼ dose each wk until full replacement dose is reached. children who have completed growth and puberty: Initially, 1.7 mcg/kg/day or as per adult dose.
• Elderly: >50 yr Initially, 25-50 mcg/day, at 6- to 8-wk intervals.

Severe and chronic hypothyroidism:

• Adult: Initially, 12.5-25 mcg/day, may increase by increments of 25 mcg at 2- to 4- wk intervals.
• Child: Initially, 25 mcg/day, may increase by increments of 25 mcg at 2- to 4-wk intervals.

TSH suppression:

• Adult: For thyrotropin-dependent well-differentiated thyroid cancer: Doses >2 mcg/kg/day may be given as a single dose to suppress TSH to <0.1 MIU/L. For benign nodules and nontoxic multinodular goitre: Target TSH is generally higher at 0.1-0.5 MIU/L for nodules and 0.5-1 MIU/L for multinodular goitre.

Product Details:

Indications:

• Anaphylaxis, asthma, severe hypersensitivity reactions
• Rheumatoid arthritis, juvenile chronic arthritis, polymyalgia rheumatica
• Systemic lupus erythematosus, dermatomyositis, mixed connective tissue disease (other than systemic sclerosis), polyarteritis nodosa, sarcoidosis
• Pemphigus, bullous pemphigoid, pyoderma gangrenosum
• Minimal change nephrotic syndrome, acute interstitial nephritis
• Rheumatic carditis
• Ulcerative colitis, Crohn's disease
• Uveitis, optic neuritis
• Autoimmune haemolytic anaemia, idiopathic thrombocytopenic purpura
• Acute and lymphatic leukaemia, malignant lymphoma, multiple myeloma
• Immune suppression in transplantation

Dosage:

• Adults: For acute disorders, up to 120 mg/day Deflazacort may need to be given initially. Maintenance doses in most conditions are within the range 3 - 18 mg/day. The following regimens are for guidance only.
• Rheumatoid arthritis: The maintenance dose is usually within the range 3 - 18 mg/day. The smallest effective dose should be used and increased if necessary.
• Bronchial asthma: In the treatment of an acute attack, high doses of 48-72 mg/day may be needed depending on severity and gradually reduced once the attack has been controlled. For maintenance in chronic asthma, doses should be titrated to the lowest dose that controls symptoms.
• Other conditions: The dose of Deflazacort depends on clinical need titrated to the lowest effective dose for maintenance. Starting doses may be estimated on the basis of ratio of 5mg Prednisone or Prednisolone to 6mg Deflazacort.
• Hepatic Impairment: In patients with hepatic impairment, blood levels of Deflazacort may be increased. Therefore the dose of Deflazacort should be carefully monitored and adjusted to the minimum effective dose.
• Renal Impairment: In renally impaired patients, no special precautions other than those usually adopted in patients receiving glucocorticoid therapy are necessary.
• Elderly: In elderly patients, no special precautions other than those usually adopted in patients receiving glucocorticoid therapy are necessary. The common adverse effects of systemic corticosteroids may be associated with more serious consequences in old age.
• Children: There has been limited exposure of children to Deflazacort in clinical trials.In children, the indications for glucocorticoids are the same as for adults, but it is important that the lowest effective dosage is used. Alternate day administration may be appropriate.
• Doses of deflazacort usually lie in the range 0.25 - 1.5 mg/kg/day.
• Juvenile chronic arthritis: The usual maintenance dose is between 0.25 - 1.0 mg/kg/day.
• Nephrotic syndrome: Initial dose of usually 1.5 mg/kg/day followed by down titration according to clinical need.
• Bronchial asthma: On the basis of the potency ratio, the initial dose should be between 0.25 - 1.0 mg/kg deflazacort on alternate days.

Product Details:

Indications:              

• Anabolic after debilitating illness
• Postmenopausal osteoporosis
• Metastatic breast cancer
• Anaemia of chronic renal failure
• Anaemia in chemotherapy patients

Dosage:

INTRAMUSCULAR
Anabolic after debilitating illness; Postmenopausal osteoporosis; Metastatic
breast cancer:
Adult: As decanoate: 25-100 mg once every 3-4 wk.

INTRAMUSCULAR
Anaemia of chronic renal failure:
Adult: As decanoate: 50-200 mg wkly.

INTRAMUSCULAR
Anaemia in chemotherapy patients:
Adult: 50-150 mg wkly.