Cetrorelix

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Cetrorelix
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Clinical data
Trade namesCetrotide, others
AHFS/Drugs.comMonograph
Routes of
administration		Subcutaneous injection
Drug classGnRH analogue; GnRH antagonist; Antigonadotropin
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Legal status
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Pharmacokinetic data
Bioavailability85%
Protein binding86%
Elimination half-life62.8 hours / 3 mg single dose; 5 hours / 0.25 mg single dose; 20.6 hours / 0.25 mg multiple doses
Excretionfeces (5% to 10% as unchanged drug and metabolites); urine (2% to 4% as unchanged drug)
Identifiers
  • Acetyl-D-3-(2Template:Prime-naphtyl)-alanine-D-4-chlorophenylalanine-D-3-(3Template:Prime-pyridyl)- alanine-L-serine-L-tyrosine-D-citrulline-L-leucine-L-arginine-L-proline-D-alanine-amide
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Chemical and physical data
FormulaC70H92ClN17O14
Molar mass1431.06 g·mol−1
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  • 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
  • InChI=1S/C70H92ClN17O14/c1-39(2)31-52(61(94)82-51(15-9-28-77-69(73)74)68(101)88-30-10-16-58(88)67(100)79-40(3)59(72)92)83-60(93)50(14-8-29-78-70(75)102)81-63(96)54(34-43-20-25-49(91)26-21-43)86-66(99)57(38-89)87-65(98)56(36-45-11-7-27-76-37-45)85-64(97)55(33-42-18-23-48(71)24-19-42)84-62(95)53(80-41(4)90)35-44-17-22-46-12-5-6-13-47(46)32-44/h5-7,11-13,17-27,32,37,39-40,50-58,89,91H,8-10,14-16,28-31,33-36,38H2,1-4H3,(H2,72,92)(H,79,100)(H,80,90)(H,81,96)(H,82,94)(H,83,93)(H,84,95)(H,85,97)(H,86,99)(H,87,98)(H4,73,74,77)(H3,75,78,102)/t40-,50-,51+,52+,53-,54+,55-,56-,57+,58+/m1/s1 checkY
  • Key:SBNPWPIBESPSIF-MHWMIDJBSA-N checkY
Data page
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Cetrorelix (INNTooltip International Nonproprietary Name, BANTooltip British Approved Name), or cetrorelix acetate (USANTooltip United States Adopted Name, JANTooltip Japanese Accepted Name), sold under the brand name Cetrotide, is an injectable gonadotropin-releasing hormone (GnRH) antagonist. A synthetic decapeptide, it is used in assisted reproduction to inhibit premature luteinizing hormone surges[2] The drug works by blocking the action of GnRH upon the pituitary, thus rapidly suppressing the production and action of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In addition, cetrorelix can be used to treat hormone-sensitive cancers of the prostate[citation needed] and breast (in pre-/perimenopausal women)[citation needed] and some benign gynaecological disorders (endometriosis, uterine fibroids and endometrial thinning).[citation needed] It is administered as either multiple 0.25 mg daily subcutaneous injections or as a single-dose 3 mg subcutaneous injection. The duration of the 3 mg single dose is four days; if human chorionic gonadotropin (hCG) is not administered within four days, a daily 0.25 mg dose is started and continued until hCG is administered.

It is available as a generic medication.[3][4]

Medical uses

Cetrorelix is marketed by Merck Serono for use in in-vitro fertilization in all countries except Japan, where it is marketed by Shionogi and Nippon Kayaku.[5] Aeterna Zentaris receives royalties on these sales and retains rights to develop cetrorelix for other indications. In IVF use it is injected daily after follicle stimulation has been initiated and evidence of follicle maturation is approaching; given daily it prevents an endogenous LH surge that would trigger an untimely ovulation prior to the hCG administration by the treating physician. As an alternative to the GnRH antagonist, also a GnRH agonist could be given, but agonist have to be started earlier to overcome the agonistic effect. Cetrorelix can be mixed with follitropin alpha without compromising their reported safety and efficacy.[6]

Contraindications

The use of cetrorelix is contraindicated in severe renal impairment. It is not intended for women aged 65 years or older. Use in women with severe allergic conditions is not recommended. Use with caution in women with active allergies or history of allergies.[citation needed]

Research

Cetrorelix was under development for the treatment of benign prostatic hyperplasia, premenopausal breast cancer, endometriosis, ovarian cancer, prostate cancer, and uterine fibroids, but development for these indications was discontinued.[7]

Cetrorelix was shown to prevent development of reproductive defects induced by injection of anti-Müllerian hormone in a mouse model of polycystic ovary syndrome (PCOS), suggesting its potential as PCOS therapeutic.[8]

In another study, over a period of 3 weeks, daily injections of cetrorelix were administered to 12 men in order to suppress testosterone levels. Testosterone levels were significantly suppressed as compared to a control group. During this time of suppression, increases in high density lipoproteins (HDLs) were seen. HDLs are responsible for removing cholesterol from the blood and higher amounts are correlated with increased cardiovascular health.[9]

References

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  1. ^ Page Module:Citation/CS1/styles.css has no content."Cetrorelix RBX (Sun Pharma ANZ Pty Ltd)". Therapeutic Goods Administration (TGA). 13 March 2025. Retrieved 24 March 2025.
  2. ^ Page Module:Citation/CS1/styles.css has no content."Cetrotide 0.25 mg" (PDF). emdserono.com. Archived from the original (PDF) on 5 April 2016. Retrieved 30 January 2016.
  3. ^ Page Module:Citation/CS1/styles.css has no content."2022 First Generic Drug Approvals". U.S. Food and Drug Administration (FDA). 3 March 2023. Archived from the original on 30 June 2023. Retrieved 30 June 2023.
  4. ^ Page Module:Citation/CS1/styles.css has no content."Competitive Generic Therapy Approvals". U.S. Food and Drug Administration (FDA). 29 June 2023. Archived from the original on 29 June 2023. Retrieved 29 June 2023.
  5. ^ Aeternia Zentaris product page
  6. ^ Page Module:Citation/CS1/styles.css has no content.Lin YH, Wen YR, Chang Y, Seow KM, Hsieh BC, Hwang JL, Tzeng CR (June 2010). "Safety and efficacy of mixing cetrorelix with follitropin alfa: a randomized study". Fertility and Sterility. 94 (1): 179–83. doi:10.1016/j.fertnstert.2009.02.062. PMID 19339001.
  7. ^ Page Module:Citation/CS1/styles.css has no content."Cetrorelix". AdisInsight.
  8. ^ Page Module:Citation/CS1/styles.css has no content.Tata B, Mimouni NE, Barbotin AL, Malone SA, Loyens A, Pigny P, Dewailly D, Catteau-Jonard S, Sundström-Poromaa I, Piltonen TT, Dal Bello F, Medana C, Prevot V, Clasadonte J, Giacobini P (June 2018). "Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood". Nature Medicine. 24 (6): 834–846. doi:10.1038/s41591-018-0035-5. PMC 6098696. PMID 29760445.
  9. ^ Page Module:Citation/CS1/styles.css has no content.von Eckardstein A (1997). "Suppression of Endogenous Testosterone in Young Men Increases Serum Levels of High Density Lipoprotein Subclass Lipoprotein A-I and Lipoprotein(a)". Journal of Clinical Endocrinology. 82 (10): 3367.

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