Gonal-F Caution For Usage

Incompatibilities: Not applicable.
Special precautions for disposal and other handling: See the HOW TO USE GONAL-f as follows.
The solution should not be administered if it contains particles or is not clear.
Any unused solution must be discarded not later than 28 days after first opening.
GONAL-f 300 IU/0.5 ml (22 micrograms/0.5 ml) is not designed to allow the cartridge to be removed.
Discard used needles immediately after injection.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
Pre-filled pen: HOW TO USE GONAL-f: Always use GONAL-f exactly as the doctor told. Check with the doctor or pharmacist if  not sure.
Using this medicine: GONAL-f is intended to be given by injection just under the skin (subcutaneously). The pre-filled pen can be used for several injections.
The first injection of GONAL-f should be given under supervision of the doctor.
The doctor or nurse will show how to use the GONAL-f pre-filled pen to inject the medicine.
If administering GONAL-f to oneself, please carefully read and follow the this section.
How much to use: The doctor will decide how much medicine to take and how often.
The doses described as follows are stated in International Units (IU) and millilitres (ml).
Women: If not ovulating and have irregular or no periods: GONAL-f is usually given every day.
If having irregular periods, start using GONAL-f within the first 7 days of the menstrual cycle. If not having periods start using the medicine on any convenient day.
The usual starting dose of GONAL-f is 75 to 150 IU (0.12 to 0.24 ml) each day.
The dose of GONAL-f may be increased every 7 or every 14 days by 37.5 to 75 IU, until getting the desired response.
The maximum daily dose of GONAL-f is usually not higher than 225 IU (0.36 ml).
When getting the desired response, patient will be given a single injection of 250 micrograms of "recombinant hCG" (r-hCG, an hCG made in a laboratory by a special DNA technique), or 5,000 to 10,000 IU of hCG, 24 to 48 hours after the last GONAL-f injection. The best time to have sex is on the day of the hCG injection and the day after.
If the doctor cannot see a desired response after 4 weeks, that treatment cycle with GONAL-f should be stopped. For the following treatment cycle, the doctor will give a higher starting dose of GONAL-f than before.
If the body responds too strongly, the treatment will be stopped and patient will not be given any hCG (see section 2, OHSS). For the following cycle, the doctor will give a lower dose of GONAL-f than before.
If there is a need to develop several eggs for collection prior to any assisted reproductive technology: The usual starting dose of GONAL-f is 150 to 225 IU (0.24 to 0.36 ml) each day, from day 2 or 3 of the treatment cycle.
GONAL-f dose may be increased, depending on the response. The maximum daily dose is 450 IU (0.72 ml).
Treatment is continued until the eggs have developed to a desired point. This usually takes about 10 days but can take any time between 5 and 20 days. The doctor will use blood tests and/or an ultrasound machine to check when this is.
When the eggs are ready, patient will be given a single injection of 250 micrograms "recombinant hCG" (r-hCG, an hCG made in a laboratory by a special recombinant DNA technique), or 5,000 IU to 10,000 IU of hCG, 24 to 48 hours after the last GONAL-f injection. This gets the eggs ready for collection.
In other cases, the doctor may first stop the patient from ovulating by using a gonadotropin-releasing hormone (GnRH) agonist or antagonist. Then GONAL-f is started approximately two weeks after start of agonist treatment. The GONAL-f and GnRH agonist are then both given until the follicles develop as desired. For example, after two weeks of GnRH agonist treatment, 150 to 225 IU GONAL-f is administered for 7 days. The dose is then adjusted according to the ovarian response. When GnRH antagonist is used, it is administered from the 5th or 6th day of GONAL-f treatment and continued until ovulation induction.