IUI meds Flashcards
Oral medications to stimulates multiple follicular growth
Clomid (Clomiphene Citrate)
-Or-
Letrozole (Femara)
Clomid (CC)
Dosage (ONLY a 50mg tablets)
Common dose—100mg/day
Min/Max dosage: 25mg/day/ Max is 250mg/day (rare)
Duration—5 days
Start cycle day 2-5, depending on baseline US or when patient calls with period start..
Take recommended number of tablets together, in the evening,~ same time each day.
CLOMIDblocks estrogenreceptors at the hypothalamus
If Estradiol is low, the pituitary willincrease FSH & LHproduction which will stimulate more follicles to develop
Common side effects:
Hot flashes
Mood swings
Breast tenderness
Bloating
Headache
Thin endometrium
This is the biggest concern - need to stop w/ Blurred /Double vision—If occurs, d/c and don’t use in subsequent cycle..
Chance of multiple pregnancy–
Twins—5-10%
Triplets- 1%
Only FDA approved oral fertility medication. Has been used for ~ 40 years..
Do not confuse with Clomipramine (OCD medication)
Letrozole (LTZ)
alternative to clomid - Dosage (2.5mg tablets)
Common dose—5mg/day
Min/Max dosage: 2.5mg/day-7.5mg/day
Duration—5days
Start cycle day 2-5, depending on baseline US or when patient calls with period start..
Take recommended number of tablets together, in the evening,~ same time each day.
Letrozole is an aromatase inhibitor. It blocks the enzyme aromatase, which is used to convert androgens into estrogens..
Pituitary senses low estradiol, which increases secretion of FSH which will stimulate more follicles todevelop.
Does not cause thin endometrium
Common side effects:
Hot flashes
Headache
Breast tenderness
Fatigue
Leg Cramps
Chance of multiple pregnancy–
Twins—5-10%
Triplets-< 1%
Alternative to Clomid. PCOS patients may respond better to Letrozole.. Often better tolerated than Clomid.
Used aslong- termtherapy for breast cancer patients..
HMG (injectable FSH w/IUI)–rarely recommended
(humungous FSH)
Gonal-F pen-or
Follistim pen-or-
Menopur 75iu/vial
MD will indicate daily dosage (ie. 150iu)
Usually take for ~8-10days depending on protocol
Medication cannot be returned..
Cost per day ~150/day, depending on dosage..
this is usually used for retrieval - it can produce a lot of eggs - used if clomid or letrozol aren’t working.
Common medication order for IUI
Clomid Cycle
Clomid50mg tabletsx 10 tablets
Ovidrel250 mcgx 1 syringe
Letrozole Cycle
Letrozole 2.5 mg tabletsx 10 tablets
Ovidrel250 mcgx 1 syringe
Ovidrel - how to store?
SQ injection (250mcg) prefilled syringe
Recombinant (made in a lab) human Chorionic Gonadotropin
Induces ovulation
Usually advise to take between 8-10pm
Common side effects: (Generally well tolerated)
Injection site pain/bruising
Stomach upset
Nausea
DizzinessRe
Store refrigerated until ready to use
Will test positive on pregnancy test for ~ 7 days
Administration
HCG—Novarel/Pregnyl
Alternative to Ovidrel is HCG (Novarel/Pregnyl or generic)
Requires mixing prior to administration
Box indicates for IM use only, can be used SQ
Administration (Novarel)
Ovidrel/HCG–Controlled substance
When electronically submitting this, the system will alert you—SCHEDULE IV
Prescription was not sent,will need provider sign off
If needed same day, ensure you send to a prescriber that is in office and can sign off
Send task to that provider to alert them..
Cigna/Aetna willnot accept e-prescribe—need to phone/fax
Pharmacies..
Send to local pharmacy (ie. Walgreens, Rite Aid, etc..)
Clomid (Clomiphene Citrate),noted CC
50 mg tablets
Sig: Take X tablets daily for five days, dependent ondosage - if not specified assume dose is 100 mg (2tablets)
Quantity: Dose/50 x 5 – if not specified assume 10tablets
OR
Letrozole (Femara), noted LTZ
2.5 mg tablets
Sig: Take X tablets daily for five days, dependent ondosage - if not specified assume dose is 5 mg (2tablets)
Quantity: Dose/2.5 x 5 – if not specified assume 10tablets
Send to specialty pharmacy (ie. Alto, Freedom fertility, etc..)
Ovidrel250 mcg prefilled syringe
Sig: Inject SQ full dose once whenspecified
Quantity: 1 syringe
Cost of medications for IUI are generally minimal:
Clomid 50mg #10—as low as 8.00 (up to ~20.00)
Letrozole 2.5mg #10—as low as 5.00 (up to 50.00)
Ovidrel #1-$53.50/syringe–Alto pharmacy
. Which medication blocks E2 receptors at the hypothalamuscausing the pituitary to stimulate more FSH/LH? What concerning side effects would warrant a medication change to alternative medication for a future cycle?
clomid - blurred vision,
lestrogen - stops androgens from converting t
. Advise how Letrozole might encourage more than one follicle/oocyte to develop?
. What is the name of the medication prescribed, most often,to trigger ovulation in a patient doing IUI/TIC/TDI cycle?
What is the only strength of tablet for Clomid (CC)? How about Letrozole (LTZ)?
What is the most commonly prescribed dose of CC? What about for LTZ?
clomid - 100 mg, letrozol - 5 mg.
