Source: Medicines & Healthcare Products Regulatory Agency (GB) Revision Year: 2020 Publisher: Sun Pharmaceutical Industries Europe B.V., Polarisavenue 87, 2132 JH Hoofddorp, The Netherlands
Special care should be taken in women with signs and symptoms of active allergic conditions. Cases of hypersensitivity reactions (both generalised and local) have been reported with ganirelix, as early as with the first dose, during post-marketing surveillance. These events have included anaphylaxis (including anaphylactic shock), angioedema and urticaria (see section 4.8). If a hypersensitivity reaction is suspected, ganirelix should be discontinued and appropriate treatment administered. In the absence of clinical experience, ganirelix treatment is not advised in women with severe allergic conditions.
The needle cover contains dry natural rubber/latex which comes into contact with the needle and may cause allergic reactions (see section 6.5).
Ovarian hyperstimulation syndrome (OHSS) may occur during or following ovarian stimulation. OHSS must be considered an intrinsic risk of gonadotrophin stimulation. OHSS should be treated symptomatically, e.g. with rest, intravenous infusion of electrolyte solutions or colloids and heparin.
Since infertile women undergoing assisted reproduction, and particularly in vitro fertilisation (IVF), often have tubal abnormalities the incidence of ectopic pregnancies might be increased. Early ultrasound confirmation that a pregnancy is intrauterine is therefore important.
The incidence of congenital malformations after Assisted Reproductive Technologies (ART) may be higher than after spontaneous conceptions. This is thought to be due to differences in parental characteristics (e.g. maternal age, sperm characteristics) and an increased incidence of multiple gestations. In clinical studies investigating more than 1,000 newborns it has been demonstrated that the incidence of congenital malformations in children born after COH treatment using ganirelix is comparable with that reported after COH treatment using a GnRH agonist.
The safety and efficacy of ganirelix have not been established in women weighing less than 50 kg or more than 90 kg (see also section 5.1 and 5.2).
This medicine contains less than 1 mmol sodium (23 mg) per injection, that is to say essentially ‘sodium-free’.
No interaction studies have been performed.
The possibility of interactions with commonly used medicinal products, including histamine liberating medicinal products, cannot be excluded.
There are no adequate data from the use of ganirelix in pregnant women.
In animals, exposure to ganirelix at the time of implantation resulted in litter resorption (see section 5.3). The relevance of these data for humans is unknown.
It is not known whether ganirelix is excreted in breast milk.
The use of ganirelix is contraindicated during pregnancy and breast-feeding (see section 4.3).
Ganirelix is used in the treatment of women undergoing controlled ovarian hyperstimulation in assisted reproduction programmes. Ganirelix is used to prevent premature LH surges that might otherwise occur in these women during the ovarian stimulation.
For posology and method of administration, see section 4.2.
No studies on the effects on the ability to drive and use machines have been performed.
The table below shows all adverse reactions in women treated with ganirelix in clinical studies using recFSH for ovarian stimulation. The adverse reactions with ganirelix using corifollitropin alfa for ovarian stimulation are expected to be similar.
The adverse reactions are classified according to MedDRA system organ class and frequency; very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1000 to <1/100). The frequency of hypersensitivity reactions (very rare, <1/10,000) has been deduced from post-marketing surveillance.
| System organ class | Frequency | Adverse reaction |
|---|---|---|
| Immune system disorders | Very rare | Hypersensitivity reactions (including rash, facial swelling, dyspnoea, anaphylaxis (including anaphylactic shock), angioedema and urticaria)1 Worsening of a pre-existing eczema2 |
| Nervous system disorders | Uncommon | Headache |
| Gastrointestinal disorders | Uncommon | Nausea |
| General disorders and administration site conditions | Very Common | Local skin reaction at the site of injection (predominantly redness, with or without swelling)3 |
| Uncommon | Malaise |
1 Cases have been reported, as early as with the first dose, among patients administered ganirelix.
2 Reported in one subject after the first ganirelix dose.
3 In clinical studies, one hour after injection, the incidence of at least once a moderate or severe local skin reaction per treatment cycle, as reported by patients, was 12% in ganirelix treated patients and 25% in patients treated subcutaneously with a GnRH agonist. The local reactions generally disappear within 4 hours after administration.
Other reported adverse reactions are related to the controlled ovarian hyperstimulation treatment for ART, notably pelvic pain, abdominal distension, OHSS (see also section 4.4), ectopic pregnancy and spontaneous abortion.
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products.
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