Ovidrel Practical Advice

PRACTICAL ADVICE REGARDING OVIDREL DOSING AND PRESCRIBING FOR MEN WITH HYPOGONADOTROPHIC HYPOGONADISM (Prepared jointly by ESA and Healthy Male)

The recent listing of Ovidrel as a Restricted Benefit Item on the Pharmaceutical Benefits Scheme (PBS), allowing use in males, fills the gap left when Pregnyl was withdrawn from the market in early 2021. However, the off-label use of Ovidrel in men raises some practical issues.

The single-use Ovidrel syringe provides a total 250 µg of recombinant hCG, equivalent to a Pregnyl dose of ~6000 I.U. An appropriate dose of Pregnyl for fertility induction in hypogonadotrophic hypogonadism in males (1500 I.U.) is therefore one-quarter of an Ovidrel syringe.

The full 250-µg dose of Ovidrel is delivered with 25 ‘clicks’ filling the pen. For men, this is convenient as it allows divided doses of 6 or 8 clicks (~1500-2000 I.U. Pregnyl equivalent) two or three times weekly as the standard dose. Educating patients on correct use will be necessary.

However, many men using Ovidrel will exhaust their prescriptions (with repeats) within 6-8 weeks, if prescribed a standard PBS script (1 pen and 5 repeats). To avoid this situation, the PBS does allow a prescriber to phone and ask for an increased quantity of any medication (except for antibiotics and opiates) to allow a patient enough medicine for a 4-week period.

To do this, the prescriber will need to phone to request an “Authority script for increased amounts”, using words to the effect of: "I am requesting an Authority prescription for an increased quantity to allow my patient to have enough supply to last four weeks." The prescriber will then be asked the Ovidrel dose that the patient will be taking and how many Ovidrel pens are needed to last 4 weeks. The following will help prescribers answer this.

1.  Pregnyl 1500 I.U. twice a week = 62.5 ug Ovidrel twice a week (i.e. 6 clicks of the Ovidrel pen twice a week), therefore one Ovidrel pen would be used every 2 weeks, so the prescriber would request 2 pens and 5 repeats in order for the patient to have enough supply for 4 weeks.

2.  Pregnyl 1500 I.U. three times a week = 62.5 ug Ovidrel three times a week (i.e. 6 clicks three a week) therefore one Ovidrel pen would be used every 1.33 weeks, so the prescriber would request 3 pens and 5 repeats 

3. Pregnyl 2000 I.U. twice a week = 83.33 ug Ovidrel twice a week (i.e. 8 clicks twice a week) therefore one Ovidrel pen would be used every 1.5 weeks, so the prescriber would request 3 pens and 5 repeats  (round up 2.67 pens to 3 pens)

4. Pregnyl 2000 I.U. three times a week = 83.33 ug Ovidrel three times a week (i.e. 8 clicks three times a week) therefore one Ovidrel pen would be used every week, so the prescriber would request 4 pens and 5 repeats  

5. Pregnyl 3000 I.U. twice a week = 125 ug Ovidrel twice a week (i.e. 12 clicks twice a week) therefore one Ovidrel pen would be used every week, so the prescriber would request 4 pens and 5 repeats  

Disposable needles

The box containing Ovidrel comes with two screw on needles per pen. If a patient is using the pen for more than 2 injections and does not want to re-use the needle, they will need to purchase extra needles from the pharmacy.

SUMMARY

1500 I.U. Pregnyl is approximately equivalent to 6 clicks of the Ovidrel pen (62.5 ug Ovidrel)

2000 I.U. Pregnyl is approximately equivalent to 8 clicks of the Ovidrel pen (83.3 ug Ovidrel)

3000 I.U. Pregnyl is approximately equivalent to 12 clicks of the Ovidrel pen (125 ug Ovidrel)

Phone Authority to request increased amounts will almost always be needed to ensure the patient receives a 4-week supply