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Gonadotropins

Gonadotropins
Gonadotropins are hormones produced by the pituitary
gland that act on the gonads (the sexual organs) i.e. Ovaries
& Testes to effect various endocrine functions.

Preparations Main
Gonadotropins
available Complications:
Human Conventional
Menopausal OHSS
Gonadotropin GTs
Follicle Highly Multiple
Stimulating Purified GTs
Hormone
Recombinant pregnancies
Human Chorionic
Gonadotropin GTs
Human Menopausal Gonadotropin
Menotropins are extracted from the urine of postmenopausal
women

Human menopausal gonadotropin contains an equivalent


amount of 75IU FSH and 75IU LH

Menotropin preparations are designed for use in selected


women where they stimulate the ovaries to mature follicles

They are administered by typically daily injection,


intramuscularly or subcutaneously, for about ten days under
close supervision to adjust dose and duration of therapy
Follicle stimulating hormone
Follicle-stimulating hormone is a hormone found in
humans and other animals. It is synthesized and secreted
by gonadotrophs of the anterior pituitary gland

FSH regulates the development, growth, pubertal


maturation and reproductive processes of the body

FSH stimulates the growth and recruitment of immature


ovarian follicles in the ovary
Human Chorionic Gonadotropin
HCG is produced by the placenta during pregnancy.

Because it is very similar biologically to LH, it is used to


trigger ovulation by mimicking the natural LH surge at mid
cycle.

It can be used in combination with Clomiphene and also


HMG/FSH to induce ovulation.

It is isolated and purified from the urine of pregnant


women.

It is available in ampoules as a sterile white powder


containing 2000IU, 5000 IU or 10000 IU.
GnRH Analogues
GnRH Analogues
The aim is to :
Block estrogen-initiated positive feedback mechanism to prevent
premature LH surge

Options Available:
GnRH Agonists
GnRH Antagonists
GnRH Agonists
Prevents premature LH surge
Used:
as adjunctive therapy in order to enhance induction
of ovulation with HMG, especially for IVF
For the treatment of endometriosis and fibroids.

Available Molecules:
Leuprolide Acetate
Burseriln Acetate
Goserilin Acetate
GnRH Antagonists
For the inhibition of premature LH surge in women undergoing
controlled ovarian stimulation
Causes pituitary down regulation by receptor competition

Causes immediate decrease in gonadotrophin concentration

Available Molecules:
Cetrorelix
Ganirelix
Infertile Patient Treatment Flow

IVF- IN Vitro
IUI- Intra Uterine
Gynaec Insemination
Fertilization
-IVF is simply uniting the egg &
- Treated with 4-5 cycles -If there is tubal blockage then sperm in vitro ( Lab )
with clomiphene citrate , if directly sent for IVF or ICSI
-Subsequently the embryos are
failed then send to IUI - Or else 5-6 max cycles of IUI transferred to uterus through
cyles are tried before sending to cervix
IVF
IVF MARKET MAPPING
TOTAL NO OF IVF :- 540

133 IVF centers does : 5815 CYCLES P.M

Assuming remaining 407 centers doing 5 cycles


per month: 2035 cycles P.M

Total no of IVF cycles P.M : 7850

Total No of IVF cycles per annum : 94200 cycles


Ready Reckoner For Gonadotropin Protocol
FSH/HMG
Ovulation Induction
ART (Assisted Reproductive Technologies)
PCOD (Polycystic Ovarian disease)
5000 1000 I.U.
HCG

0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8

225 I.U. 75/150 I.U


FSH FSH/HMG USG

USG USG
Choice of Gonadotropins

39%
38% Recombinant
IVF
Highly Purified
Conventional

23%

10%

Recombinant
IUI 30%
Highly Purified
60% Conventional
Sales scenario
Ach -206.24
% Ach - 174

Ach 648.63
% Ach 328

Ach -109.01
% Ach -64

Ach 38.28
% Ach - 84

Zyfsh 65 % business comes from 8 HQs


Zyhmg Brand is growing by 46% , 75 % of sales is from 22 HQS
Ovucet- 32% growth ,however 85% sales is from only 9HQs
Academic Approach
Book on infertility - 15 books /ABM

IUI Protocol booklet


IUI updates

IUI /IVF protocol in diff patients

20 booklets /ME

Regular reminders LBLs , Visiting Cards


PPH Management
Postpartum Hemorrhage (PPH):
Definition
Defined as the loss of more than 500 ml of blood after delivery,

Mean blood loss with vaginal delivery: 500cc

Mean blood loss with C/S: 1000cc


Medical
Carboprost and Misoprostol are Prostaglandin which causes uterine
contractions

Technical name carboprost tromethamine


Femiprost 125/250 mcg
IM admnistration
Technical Name Misoprostol
Cervisure 600 mcg
Vaginal /Sub Lingual
PPH Range
SKU Indication Dosage
Femiprost 125 for active
management of 3rd
stage labor
Femiprost 250 3rd stage :high risk Maximum dose 2mg (8
patients doses) every 15-90 mins
C section Delivery, (not more than 1 day
Uterine
Atony/excess
Bleeding

Cervisure - 600 1. Incomplete 1. 600 mcg taken once


Abortion in 1st (single dose) orally
trimester 2. Orally , Immediately after
2. Prevention of delivery of new born .
PPH
External Market Scenario-Carboprost
MAT VAL MAT VAL
BRAND BRAND LD COMPANY MAT VAL IN CRS
MS % GR %

MAY'13 MAY'14 MAY'14 MAY'14

TOTAL 25.7 26.4 100.0% 3

BHARAT
ENDOPROST Feb-05 SERUMS & 14.7 14.6 55.3% (0)
VACCINES LTD

ASTRAZENECA
PROSTODIN Mar-90 PHARMA INDIA 5.8 9.3 35.1% 61
LTD

NEON
CABOPROST Dec-07 LABORATORIES 2.3 1.4 5.3% (40)
LTD

FEMIPROST Feb-12 ZYDUS CADILA 2.6 1.1 4.3% (57)

DR. REDDYS
DEVIPROST Jul-00 LABORATORIES 0.3 0.0 0.0% (98)
LTD
All India Scenario: Femiprost

Ytd Ach %Ach Growth PCPM


45.95
Lacs 40 1.5% 0.04
Above PCPM HQs
HQ ME PCPM
AGRA 1 12
BAREILLY 1 26251
JAIPUR 2 25510
KANNUR 1 22397
BIKANER 1 19531
VADODARA 1 18971
PERINTHALMANNA 1 18798
GWALIOR 1 17850
MUZAFFARPUR 1 16114
CALICUT 1 15575
JODHPUR 1 15453
UDAIPUR 1 14005
HISSAR 1 12924
LUCKNOW 2 10926
AMRITSAR 1 9676
JALGAON 1 9288
GUNTUR 1 7998
CHANDIGARH 1 7238
SURAT 1 6834
ALLAHABAD 1 6244
PATNA 1 6119
GOA 1 6118
JALLANDHAR 1 5968
RAJKOT 1 5653
GHAZIABAD 1 5630
AHMEDABAD 3 5451
NASIK 1 5358
PUNE 4 4907
KOLHAPUR 1 4857
Below PCPM HQs
HQ ME PCPM HQ ME 703
MUMBAI 10 4630 NELLORE 1 695
MEERUT 1 4560 BHOPAL 1 604
AURANGABAD 1 4529 TRIVANDRUM 1 574
WARANGAL 1 4512 SAMBALPUR 1 574
HYDERABAD 4 4480 MANGALORE 1 390
JABALPUR 1 4272 DIBRUGARH 1 368
PONDICHERRY 1 3875 TRICHY 1 361
TRICHUR 1 3505 LUDHIANA 1 300
AMBALA 1 3348 BANGALORE 5 105
DEHRADUN 1 3053 UJJAIN 1 52
VIJAYWADA 1 2945 MYSORE 1 43
PATIALA 1 2799 GUWAHATI 1 -160
DELHI 7 2622 RANCHI 1 -222
KOLKATTA 4 2297 AKOLA 1 -376
CUTTACK 2 2214 KANPUR 1 -395
NIZAMABAD 1 1614 VARANASI 1 -447
NAGPUR 1 1500 ERNAKULAM 1 -480
HUBLI 1 1394 VISHAKHAPATNAM 1 -655
SALEM 1 931 COIMBATORE 1 -938
JAMSHEDPUR 1 825 CHENNAI 4 -1085
RAJAHMUNDRY 1 811 RAIPUR 1 -2075
SOLAPUR 1 796 AGARTALA 1 -3308
KOTTAYAM 1 781 INDORE 1 -3404
NANDED 1 765 MADURAI 1 -3818
GORAKHPUR 1 742 KOTA 1 703
External Market Scenario-Misoprostol 600 mg
MAT VAL MAT VAL
BRAND BRAND LD COMPANY MAT VAL IN CRS
MS % GR %

MAY'13 MAY'14 MAY'14 MAY'14

TOTAL 3.2 4.4 100.0% 38

MEYER
PPH Jul-10 ORGANICS 1.8 2.4 55.9% 33
PVT. LTD

MISOPROST Sep-01 CIPLA LTD. 1.3 1.8 40.9% 38

ZYDUS
CERVISURE Jan-13 0.0 0.1 3.2% 291
CADILA
All India Scenario- Cervisure

Ytd Ach %Ach Growth PMPM


18.85
Lacs 60 -20% 60
Above PMPM HQs Cervisure
HQ ME PMPM
JALGAON 1 268
GWALIOR 1 257
KOLHAPUR 1 244
HUBLI 1 228
AHMEDABAD 3 224
TRICHUR 1 144
MUMBAI 10 144
NIZAMABAD 1 143
AMRITSAR 1 128
AGRA 1 127
HISSAR 1 123
JAIPUR 2 117
CALICUT 1 102
AURANGABAD 1 100
HYDERABAD 4 94
LUCKNOW 2 92
KANNUR 1 82
BIKANER 1 79
RAJKOT 1 78
GORAKHPUR 1 76
PONDICHERRY 1 76
ERNAKULAM 1 74
ALLAHABAD 1 72
GUNTUR 1 70
UDAIPUR 1 67
MADURAI 1 64
HQ Wise Performance Cervisure
HQ ME PMPM HQ ME PMPM
SOLAPUR 1 57 PATIALA 1 17
KOTTAYAM 1 56 PERINTHALMANNA 1 17
NANDED 1 56 SALEM 1 17
DIBRUGARH 1 55 BHOPAL 1 11
NAGPUR 1 54 WARANGAL 1 11
AKOLA 1 54 DEHRADUN 1 10
BAREILLY 1 53 KANPUR 1 10
GOA 1 52 AGARTALA 1 10
PUNE 4 50 NELLORE 1 9
DELHI 7 45 MANGALORE 1 8
VADODARA 1 44
JALLANDHAR 1 7
CUTTACK 2 39
VISHAKHAPATNAM 1 6
SURAT 1 37
COIMBATORE 1 4
VIJAYWADA 1 31
PATNA 1 4
LUDHIANA 1 28
GHAZIABAD 1 3
MUZAFFARPUR 1 28
VARANASI 1 2
UJJAIN 1 26
BANGALORE 5 1
CHANDIGARH 1 24
CHENNAI 4 1
JABALPUR 1 23
RAJAHMUNDRY 1 1
SAMBALPUR 1 23
INDORE 1 0
TRICHY 1 23
RANCHI 1 0
MEERUT 1 22
GUWAHATI 1 21 TRIVANDRUM 1 0
KOLKATTA 4 20 RAIPUR 1 -1
MYSORE 1 18 JAMSHEDPUR 1 -3
Wall of Fame
Target 5 hospitals /ME/Month -Non Supporters
Modalities
Posters with message from patients to the Nursing staff along with their
photographs
That poster to be displayed on the hospital board
Quarterly one poster will be sent and monthly column will be there
Small Prize for all to build rapport
Order Demand 50 ampoules
SHIKSHA PATH AHEAD
To initiate CDs for teaching procedures on various topics
Cleanliness
Bedding
Suturing
A well developed movie will cover all the precautions and important patient
handling tips for nursing staff of maternity home which can help them for better
practising and managing pregnant women.
ME/RMO will utilize this movie for training of nursing staff which indirectly helps
doctor in better patient
Refreshment to be provided for the team- 1000 rs/activity
5 CDs /ABM
Content Outline:
Common sources of infections in nursing home
Basic /critical Hygiene practices to be maintained by nurses in nursing homes.
General Guidelines on Hygiene
Personal Protective equipment
Video of hand hygiene
Video on How to wear sterile gloves as per guideline
Waste Dispoal and colour coding
Incentive Scheme
- Target all hospitals having a labour room
- upto 100 2rs /ampoule
- 100-200 4 rs /ampoule
- 200-300 6 rs/ampoule
Points to remember:
- Starting from first ampoule
- Quarterly target to be achieved for the brand
- Quarterly incentive to be reimbursed
- Incentive amount to be calculated from the first ampoule
Reminders
Quarterly LBLs- 25/ME
Posters / Silence boards for hospitals- 20/ME
THANK YOU