Cetrorelix

H01C - Hypothalamic hormones ATC H01CC02 Protein approved 1999 Parenteral Natural product

JFDA label: Cetrotide 0.25mg inj

Mechanism of Action

Competes with naturally-occurring GnRH for binding on receptors of the pituitary. This delays luteinizing hormone surge, preventing ovulation until the follicles are of adequate size.

Indications

Approved

Controlled ovarian stimulation

Contraindications

Source: Lexicomp

Additional contraindications (not in the US labeling): Moderate to severe hepatic function Absolute
Hypersensitivity to cetrorelix, extrinsic peptide hormones, gonadotropin releasing hormone (GnRH) or other GnRH analogs, mannitol, or any component of the formulation Absolute
breast-feeding Absolute
moderate renal function Absolute
severe renal impairment Absolute

Adverse Reactions

Very Common >10%Common 1–10%Uncommon 0.1–1% Rare 0.01–0.1%Very Rare <0.01%Not Known

Nervous system disorders (1)

Common Headache

Hepatobiliary disorders (3)

Common Increased serum alkaline phosphatase · increased serum ALT · increased serum AST

Metabolism and nutrition disorders (2)

Common increased gamma-glutamyl transferase · Ovarian hyperstimulation syndrome

Gastrointestinal disorders (1)

Common Nausea

Dosing

Source: Lexicomp

Controlled ovarian stimulation in conjunction with gonadotropins (FSH, hMG): Female: SubQ: Single-dose regimen: 3 mg given when serum estradiol levels show appropriate stimulation response, usually stimulation day 7 (range: days 5 to 9). If hCG is not administered within 4 days, continue cetrorelix at 0.25 mg/day until hCG is administered. Multiple-dose regimen: 0.25 mg once daily the morning or evening of stimulation day 5, or morning of stimulation day 6; continue until hCG is administered.

Not intended for use in women ≥65 years of age

Mild to moderate impairment: There are no dosage adjustments provided in the manufacturer's labeling (has not been studied). Severe impairment: Use is contraindicated.

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Warnings & Precautions

Source: Lexicomp

Hypersensitivity

Hypersensitivity reactions, including severe anaphylactoid reactions, have been reported after initial dose and months after starting therapy; use with caution in patients with signs and symptoms of active allergic conditions or known history of allergic predisposition. Treatment is not recommended in patients with severe allergic conditions. Other warnings/precautions:

Experienced specialists

Should only be prescribed by fertility specialists.

Pregnancy & Lactation

Pregnancy

FDA category X Contraindicated

Studies in animals or pregnant women have shown evidence of fetal abnormalities and use is contraindicated in women who are or may become pregnant. Resorption resulting in fetal loss would be expected if used in a pregnant woman. Exclude pregnancy before beginning treatment.

Lactation

Contraindicated

It is not known if cetrorelix is excreted in breast milk. Use while breast-feeding is contraindicated.

Monitoring

Clinical pearl	Ultrasound to assess follicle size

Chemistry & Properties

Formula	C70H92ClN17O14
Molecular weight	1431.06 g/mol
IUPAC name	(2S)-1-[(2S)-2-[[(2S)-2-[[(2R)-2-[[(2S)-2-[[(2S)-2-[[(2R)-2-[[(2R)-2-[[(2R)-2-acetamido-3-naphthalen-2-ylpropanoyl]amino]-3-(4-chlorophenyl)propanoyl]amino]-3-pyridin-3-ylpropanoyl]amino]-3-hydroxypropanoyl]amino]-3-(4-hydroxyphenyl)propanoyl]amino]-5-(carbamoylamino)pentanoyl]amino]-4-methylpentanoyl]amino]-5-(diaminomethylideneamino)pentanoyl]-N-[(2R)-1-amino-1-oxopropan-2-yl]pyrrolidine-2-carboxamide
CAS	120287-85-6
PubChem CID	25074887
InChIKey	`SBNPWPIBESPSIF-MHWMIDJBSA-N`

SMILES

CC(=O)N[C@H](Cc1ccc2ccccc2c1)C(=O)N[C@H](Cc1ccc(Cl)cc1)C(=O)N[C@H](Cc1cccnc1)C(=O)N[C@@H](CO)C(=O)N[C@@H](Cc1ccc(O)cc1)C(=O)N[C@H](CCCNC(N)=O)C(=O)N[C@@H](CC(C)C)C(=O)N[C@@H](CCCNC(=N)N)C(=O)N1CCC[C@H]1C(=O)N[C@H](C)C(N)=O

Biology & Pharmacokinetics

Pharmacokinetics predicted

Bioavailability	70.0%
Half-life	1.778 h
Volume of distribution	0.329 L/kg
Protein binding	85.0%
BBB penetrant	No

Receptor binding (top 1)

Target	Action	Affinity
GnRH1 receptor (GNRHR)	Antagonist	pIC50 8.7

Transporters

BCRP (Inhibitor)BSEP (Inhibitor)BSEP (Inhibitor)MRP1 (Inhibitor)MRP4 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)P-gp (Inhibitor)P-gp (Substrate)

Registered Products (3)

Brand	Form / strength	Pack	Agent	Citizen (JOD)
CETROLIX	Vial 0.25 mg	1 vial	Safadi Drugstore	—
Cetrotide	Powder for Injection 0.25 mg	7 PFS pack varies	THE ARAB DRUG STORE P.S.C	—
Cetrotide	Powder for Injection 0.25 mg	1 PFS pack varies	THE ARAB DRUG STORE P.S.C	—