Can a double dose of Gonadorelin (GnRH) be given?

From the Guidelines

I strongly advise against giving a double dose of Gonalef, as higher doses of gonadotrophins have similar pregnancy rates but increase multiple pregnancy rates, according to the most recent and highest quality study 1. When gonadotrophins are used in IUI, regimens with 75 IU or lower should be used because higher doses have similar pregnancy rates but increase multiple pregnancy rates 1.

Some key points to consider:

• Higher doses of gonadotrophins do not increase pregnancy rates but do increase the risk of multiple pregnancies 1.
• Clomiphene citrate or tamoxifen are acceptable alternatives to low dose gonadotrophins for low multiple pregnancy and birth rates and with lesser costs, although at a lower live birth rate than with gonadotrophins 1.
• The most common side effects of IUI in cycles with OS are multiple pregnancies and ovarian hyperstimulation syndrome (OHSS), which carry increased risks of pregnancy complications and diminished neonatal outcome 1.

It is essential to follow the prescribed dosage and consult a healthcare provider before making any changes to your medication regimen. Taking a double dose of Gonalef without consulting a healthcare provider first could potentially lead to increased side effects or toxicity, and may not provide any additional benefits in terms of pregnancy rates 1. If you have concerns about your current dosage or treatment plan, it is best to discuss them with your healthcare provider, who can properly evaluate your situation and make any necessary adjustments.

From the FDA Drug Label

The effectiveness of a 2-mL dose of CYSTORELIN delivering 100 mcg gonadorelin diactate tetrahydrate (86 mcg gonadorelin) for use with cloprostenol sodium to synchronize estrous cycles to allow for FTAI in lacating dairy cows and beef cows was also demonstrated through references to scientific literature. A total of 805 cows were administered gonadorelin (1 mL; 100 mcg gonadorelin as the acetate salt) Day 0: 100 mcg gonadorelin (as the acetate salt) or sterile water for injection Day 9: 100 mcg gonadorelin (as the acetate salt) or sterile water for injection

The recommended dose is 100 mcg of gonadorelin. There is no information in the label that supports giving a double dose.

• The label does mention a 2-mL dose but this is still 100 mcg of gonadorelin diactate tetrahydrate, not a double dose of the standard 1 mL; 100 mcg dose. 2

From the Research

Gonalef Double Dose Information

• There is no direct information available on "Gonalef" in the provided studies.
• However, the studies do provide information on the treatment of gonorrhoea, a bacterial infection, with different medications 3.
• One study, in particular, discusses the use of gepotidacin, a novel oral antibacterial, in the treatment of uncomplicated urogenital gonorrhoea 3.
• The study found that gepotidacin was non-inferior to ceftriaxone plus azithromycin in treating urogenital gonorrhoea, with a microbiological success rate of 92.6% 3.
• The dosage of gepotidacin used in the study was two 3000 mg doses administered 10-12 hours apart 3.
• There is no mention of "Gonalef" or its dosage in the provided studies, and it is unclear if it is related to the treatment of gonorrhoea or other conditions.
• The other studies provided do not appear to be relevant to the question, as they discuss multiple sclerosis 4 and cellular systems for degrading misfolded proteins 5.