Transcript Chapter 16 Cholinesterase Inhibitors

Chapter 63
Drug Therapy of Infertility
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Drug Therapy of Infertility
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Infertility
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Decrease in the ability to reproduce
Sterility
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Complete absence of reproductive ability
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Causes of Female Infertility
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Female infertility
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Anovulation and failure of follicular maturation
Unfavorable cervical mucus
Hyperprolactinemia
Endometriosis
Polycystic ovary syndrome
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Causes of Male Infertility
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Male infertility
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Hypogonadotropic hypogonadism
Erectile dysfunction
Idiopathic male infertility
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Drugs Used to Treat
Female Infertility
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Drugs for controlled ovarian stimulation
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Facilitation of follicular maturation and ovulation
Fertilization can be natural or assisted
reproduction
Mechanisms of action
• Promote follicular maturation
• Stimulate ovulation
• Prevent premature stimulation of ovulation by
endogenous hormones
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Drugs Used to Treat
Female Infertility
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Clomiphene (Clomid, Milophene, Serophene)
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Used to promote follicular maturation and
ovulation
Blocks receptors for estrogen
Adverse effects
• Hot flashes
• Gastrointestinal: nausea, bloating
• Abdominal discomfort
• Breast engorgement
• Visual disturbances: blurred vision
• Multiple births
• Ovarian hyperstimulation (very rare)
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Drugs Used to Treat
Female Infertility
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Menotropins (Pergonal, Repronex, Menopur)
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Used in conjunction with human chorionic
gonadotropin (hCG) to promote follicular
maturation and ovulation in anovulatory patients
Adverse effects
• Ovarian hyperstimulation syndrome
• Multiple births
Follitropins
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Urofollitropin, follitropin alfa, follitropin beta
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Drugs Used to Treat
Female Infertility
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Human chorionic gonadotropin (hCG)
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A polypeptide hormone produced by the placenta
Therapeutic use
• Promotes follicular maturation and ovulation
Adverse effects
• Ovarian hyperstimulation syndrome
• Edema
• Injection site pain
• Central nervous system disturbances
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Headache, irritability, restlessness, fatigue
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Drugs Used to Treat
Female Infertility
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Lutropin alfa (Luveris)
Choriogonadotropin alfa
Gonadotropin-releasing hormone antagonists
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Dopamine Agonists for
Hyperprolactinemia
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Cabergoline (Dostinex)
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Used to correct amenorrhea and infertility
Activates dopamine receptors
Adverse effects
• Nausea
• Headache
• Dizziness
• Orthostatic hypotension
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Dopamine Agonists for
Hyperprolactinemia
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Bromocriptine (Parlodel)
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Used to correct amenorrhea, galactorrhea, and
infertility
Activates dopamine receptors
Adverse effects
• Nausea
• Headache
• Dizziness
• Fatigue
• Abdominal cramps
• Orthostatic hypotension
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Drugs for Endometriosis
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Leuprolide (Lupron Depot, Eligard)
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Synthetic analog of gonadotropin-releasing
hormone (GnRH)
Suppresses ovarian hormone production
Therapeutic uses
• Endometriosis
• Uterine fibroids
• Central precocious puberty
• Advanced prostate cancer
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Drugs for Endometriosis
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Leuprolide (Lupron Depot, Eligard) (cont’d)
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Adverse effects
• Hot flushes
• Vaginal dryness
• Nasal irritation
• Decreased libido
• Bone loss
• Mood changes
• Headache
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Drugs for Endometriosis
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Danazol (Danocrine)
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Used to improve symptoms of endometriosis, but
does not increase fertility
Induces regression of endometrial implants
Adverse effects
• Acne
• Deepening of the voice
• Growth of facial hair
• Edema
• Thrombotic events
• Hepatotoxicity
• Intensifies effects of warfarin
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