Human chorionic gonadotropin

Human chorionic gonadotropin is a special hormone that is part of the group of glycoproteins. Human chorionic gonadotropin was first studied by science at the beginning of the twentieth century, in 1920. Subsequent studies revealed that hCG in the female body begins to be produced during pregnancy. The hormone is a product of the synthesis of placental syncytiotrophoblast and is responsible for increasing the production of progesterone, the most important hormone responsible for maintaining pregnancy. Also, due to the action of the hormone, the body of a pregnant woman stops the processes that cause menstruation. Today, human chorionic gonadotropin can be measured through blood and urine tests. It is human chorionic gonadotropin that is taken into account as an indicator in a pregnancy test.

HCG is used in medical practice to induce ovulation in women. Laboratory and clinical practice shows that by extracting hCG from the urine of pregnant women, it is possible to produce drugs for the treatment of infertility.

Change in hCG level

A week after ovulation, having studied the blood test, an increased level of human chorionic gonadotropin can be noted. The hormone reaches its apogee after eight to twelve weeks of pregnancy, and then the percentage of produced glycoproteins begins to steadily decline, until the moment of birth. By tracking the dynamics of the increase and decrease in the amount of hCG in the body, it is possible to predict fairly accurate data on the course of pregnancy. If the pregnancy is multiple, the level of gonadotropin growth will be proportionally equal to the number of embryos. For example, if there are two fetuses in the uterus, the concentration of the gonadotropin hormone doubles.

Timely monitoring of changes in the level of human chorionic gonadotropin in the body allows us to establish the following conditions:

High hormone levels in pregnant women:

Human chorionic gonadotropin - what is the drug for?

Modern pharmacology obtains human chorionic gonadotropin by extracting the substance from the urine of pregnant women. It is used to activate the production of hormones in the ovaries, to support and stimulate spermatogenesis and the development of secondary sexual characteristics.

For the prevention and treatment of male diseases, human chorionic gonadotropin is prescribed for hypogenitalism, adiposogenital syndrome, and oligoasthenospermia. The hormone is also used for undescended testicles in the scrotum and sexual infantilism or eunuchoidism.

It is prohibited to use human chorionic gonadotropin with the following contraindications:

prostate and breast cancer;
renal dysfunction;
acute heart failure;
asthma;
epilepsy.

Buy Gonadotropin hCG lyophilisate for preparing intramuscular solution 500 IU No. 5 in pharmacies

Chorionic gonadotropin Buy Chorionic gonadotropin in pharmacies DOSAGE FORMS lyophilisate for the preparation of solution for intramuscular administration 500IU

MANUFACTURERS Moscow Endocrine Plant (Russia)

GROUP Gonadotropins and antigonadotropic drugs

COMPOSITION Active ingredient: human chorionic gonadotropin.

INTERNATIONAL NON-PROPENTED NAME Chorionic gonadotropin

SYNONYMS Pregnil, Horagon

PHARMACOLOGICAL ACTION Human chorionic gonadotropin (hCG) is a gonadotropic hormone that is produced by the placenta during pregnancy and then excreted unchanged by the kidneys. To obtain the drug, it is extracted from urine and purified. Necessary for normal growth and maturation of gametes in women and men, as well as for the production of sex hormones. Pharmacodynamics. It has a gonadotropic, follicle-stimulating and luteinizing effect. Luteinizing activity prevails over follicle-stimulating activity. Stimulates the development of genital organs and secondary sexual characteristics. In women, the drug causes ovulation and stimulates the synthesis of estrogens (estradiol) and progesterone. In men, it stimulates spermatogenesis, the production of testosterone and dihydrotestosterone. Pharmacokinetics. After intramuscular administration it is well absorbed. The half-life is 8 hours. The maximum concentration of hCG in the blood plasma is achieved after 4-12 hours. The half-life of human chorionic gonadotropin is 29-30 hours; in the case of daily intramuscular injections, accumulation of the drug may be observed. Chorionic gonadotropin is excreted by the kidneys. About 10-20% of the administered dose is found unchanged in the urine, the main part is excreted in the form of beta chain fragments.

INDICATIONS FOR USE In women: ovarian dysfunction (anovulatory), amenorrhea; maintaining the corpus luteum phase. In men and boys: hypogonadotropic hypogonadism; delayed puberty due to insufficiency of the gonadotropic function of the pituitary gland; cryptorchidism not due to anatomical obstruction; insufficiency of spermatogenesis, oligo-asthenospermia, azoospermia; when conducting a differential diagnostic test for anorchism and cryptorchidism in boys; when performing a Leydig functional test to assess testicular function in hypogonadotropic hypogonadism before starting long-term stimulating treatment.

CONTRAINDICATIONS Hypersensitivity to hCG or to any component of the drug; hormone-dependent malignant tumors of the genital organs and mammary gland currently or suspected of them (ovarian cancer, breast cancer, uterine cancer in women and prostate cancer, breast carcinoma in men); organic lesions of the central nervous system (CNS) (tumors of the pituitary gland, hypothalamus); deep vein thrombophlebitis; hypothyroidism; adrenal insufficiency; hyperprolactinemia; children under 3 years of age. In boys: premature puberty. In men: infertility not associated with hypogonadotropic hypogonadism. In women: abnormal formation of the genital organs, incompatible with pregnancy; fibrous tumor of the uterus, incompatible with pregnancy; primary ovarian failure; infertility not associated with anovulation (for example, tubal or cervical origin); bleeding or spotting from the vagina of unknown etiology; pregnancy and breastfeeding period.

SIDE EFFECTS Immune system disorders: In rare cases, a generalized rash or fever may occur. General disorders and injection site conditions: When using human chorionic gonadotropin, injection site reactions may occur, such as bruising, pain, redness, swelling and itching. Allergic reactions have been reported in some cases, most of which include pain and/or rash at the injection site; increased fatigue. Among women. Metabolic and nutritional disorders: edema. Mental disorders: irritability, anxiety, depression. Nervous system disorders: headache, dizziness. In men and boys. Endocrine system disorders: premature puberty. Skin and subcutaneous tissue disorders: acne. Genital and breast disorders: treatment with human chorionic gonadotropin can sporadically cause gynecomastia; prostatic hyperplasia, enlarged penis, increased sensitivity of the nipples of the mammary glands in men, enlarged testicles in the inguinal canal with cryptorchidism.

INTERACTION It is necessary to avoid combined use of the drug with high doses of glucocorticosteroids. No other drug interactions were noted.

METHOD OF APPLICATION AND DOSAGE After adding the solvent to the lyophilisate, the reconstituted solution of human chorionic gonadotropin is administered intramuscularly, slowly. The prepared solution cannot be stored, since further preservation of the sterility of the solution is not guaranteed. The dosages indicated are approximate; treatment should be adjusted by the doctor individually depending on the desired response to the drug. In women: for anovulatory cycles, human chorionic gonadotropin is prescribed starting from the 10-12th day of the menstrual cycle, 3000 IU 2-3 times with an interval of 2-3 days or 1500 IU 6-7 times every other day; to maintain the corpus luteum phase, two to three repeated injections of the drug at a dose of 1500 IU to 5000 IU each can be given within 9 days after ovulation or embryo transfer (for example, on days 3, 6 and 9 after ovulation induction). In men and boys: for hypogonadotropic hypogonadism - 1000-2000 IU of the drug 2-3 times a week. In case of infertility, it is possible to combine human chorionic gonadotropin with an additional drug containing follitropin (follicle-stimulating hormone) 2-3 times a week. The course of treatment should continue for at least 3 months before any improvement in spermatogenesis can be expected. Testosterone replacement therapy must be suspended during this treatment. When improvement in spermatogenesis is achieved, in some cases, isolated use of human chorionic gonadotropin is sufficient to maintain it; with delayed puberty caused by insufficiency of the gonadotropic function of the pituitary gland - 1500 IU 2-3 times a week. The course of treatment is at least 6 months; for cryptorchidism not caused by anatomical obstruction: at the age of 3 to 6 years - 500-1000 IU twice a week for 6 weeks; over the age of 6 years - 1500 IU twice a week for 6 weeks. The course of treatment can be repeated if necessary; for insufficiency of spermatogenesis, oligoasthenospermia, azoospermia, 500 IU is prescribed in combination with menotropin (75 IU follicle-stimulating hormone + 75 IU luteinizing hormone) daily, or 2000 IU every 5 days in combination with menotropin (150 IU follicle-stimulating hormone + 150 IU luteinizing hormone) 3 times per week for 3 months. If there is no response to treatment, 2000 IU is prescribed 2-3 times a week with menotropin (150 IU follicle-stimulating hormone + 150 IU luteinizing hormone) 3 times a week for 3-12 months. Once improvement in spermatogenesis is achieved, subsequent therapy in some cases can be carried out only with maintenance doses of human chorionic gonadotropin; for the purpose of differential diagnosis of cryptorchidism and anorchism in boys, human chorionic gonadotropin is administered intramuscularly in a single dose of 100 IU/kg, the concentration of testosterone in the blood serum is determined before the test and 72-96 hours after injection of the drug. In the case of anorchidism, the test will be negative, indicating the absence of testicular tissue; in the case of cryptorchidism, even if only one testicle is present, the test will be positive (5-10-fold increase in testosterone concentration). If the test is weakly positive, a search for the gonad (abdominal ultrasound or laparoscopy) is necessary, since there is a high risk of malignancy.

OVERDOSE The drug is characterized by extremely low toxicity. In women, an overdose may cause ovarian hyperstimulation syndrome (OHSS). Depending on the severity (based on clinical and laboratory symptoms), several types of OHSS are distinguished. Mild OHSS: abdominal discomfort, mild abdominal pain, ovarian size is usually less than 8 cm; Moderate OHSS: breast tenderness, moderate abdominal pain, nausea and/or vomiting, diarrhea, ultrasound signs of ascites, slight or moderate enlargement of ovarian cysts, ovarian size is usually 8-12 cm; Severe OHSS: weight gain, in rare cases thromboembolism, clinical signs of ascites (sometimes hydrothorax), oliguria, hemoconcentration, hematocrit greater than 45%, hypoproteinemia, large ovarian cysts (prone to rupture), ovarian size usually greater than 12 cm Principles of treatment of OHSS. Mild degree: bed rest; drinking plenty of mineral water; monitoring the patient's condition. Moderate and severe degrees (only in hospital settings): monitoring the function of the cardiovascular system (CVS), respiratory system, liver, kidneys, electrolyte and water balance (diuresis, weight dynamics, changes in abdominal circumference); control of hematocrit level; crystalloid solutions intravenously (to restore and maintain circulating blood volume (CBV)); colloidal solutions intravenously - 1.5-3 l/day (while maintaining hemoconcentration) and persistent oliguria; hemodialysis (with the development of renal failure); corticosteroids, antiprostaglandins, antihistamines (to reduce capillary permeability); for thromboembolism - low molecular weight heparins (fraxiparine, clexane); plasmapheresis - 1-4 sessions with an interval of 1-2 days (improving the rheological properties of blood, normalizing the acid-base state (ABS) and gas composition of the blood, reducing the size of the ovaries); paracentesis and transvaginal puncture of the abdominal cavity for ascites. Hospitalization in a hospital is necessary for the development of moderate and severe OHSS. Men and boys may develop gynecomastia; in boys, behavioral changes similar to those observed during the first phase of puberty are possible; degeneration of the gonads (with unreasonably long-term use for cryptorchidism), atrophy of the seminiferous tubules (due to inhibition of the production of follicle-stimulating hormone (FSH) as a result of stimulation of the production of androgens and estrogens); decrease in the number of sperm in the ejaculate (with drug abuse in men). Long-term use of the drug may lead to increased side effects.

SPECIAL INSTRUCTIONS Use caution. Persons with risk factors for thrombosis (personal or family history, severe obesity (body mass index >30 kg/m2) or thrombophilia). In men and boys with latent or overt heart failure, renal dysfunction, hypertension, epilepsy or migraine (or with a history of these conditions); in prepubertal boys; in patients with bronchial asthma. If you have one of the listed diseases, be sure to consult your doctor before taking the drug. Use during pregnancy and breastfeeding. The use of the drug during pregnancy and breastfeeding is contraindicated. The use of gonadotropin increases the risk of developing venous or arterial thromboembolism, so it is necessary to evaluate the benefits of in vitro fertilization therapy in patients at risk. It should also be noted that pregnancy itself is also accompanied by an increased risk of thrombosis. The likelihood of multiple pregnancies increases. During treatment with the drug and for 10 days after stopping treatment, human chorionic gonadotropin may affect the values of immunological tests for the concentration of hCG in the blood plasma and urine, which can lead to a false-positive pregnancy test result. Treatment of male patients with human chorionic gonadotropin leads to an increase in androgen production, therefore, patients at risk should be under strict medical supervision, since exacerbation of the disease or relapse can sometimes be the result of increased androgen production. HCG promotes premature closure of the epiphyses or premature puberty. Skeletal development must be regularly monitored. In men, the drug is ineffective with high levels of follicle-stimulating hormone. Unreasonably long-term use of the drug for cryptorchidism, especially if surgery is indicated, can lead to degeneration of the gonads. Long-term administration may lead to the formation of antibodies to the drug. Impact on the ability to drive vehicles and machinery. During the treatment period, it is necessary to refrain from driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

STORAGE CONDITIONS Store in a place protected from light, out of reach of children at a temperature not exceeding 20 C.

What is human chorionic gonadotropin in the male body?

The hormone is practically not present in a man’s body; high levels of gonadotropin in tests indicate a deviation from the norm or the use of appropriate medications. Basically, the use of human chorionic gonadotropin is used during the prevention of testicular atrophy during a course of anabolic steroids.

When using HCG independently, and not according to a doctor’s prescription based on tests, the following side effects are observed:

estrogen levels increase;
gynecomastia;
acne;
retention of water and salts in the body;
sebaceous plugs;
changes in water balance;
completeness;
During adolescence, bone growth stops.

The use of the hormone is prescribed strictly according to the indications of the attending physician. In this case, the doctor is obliged to inform the patient about the likelihood of the formation of oncological processes that can form during therapy in rare cases. Prescribing a course of gonadotropin is occasionally used to correct the balance of testosterone levels during menopause in men.

Problems with hCG are not uncommon. However, nowadays medicine has a sufficiently high level of development to provide assistance for such pathologies. By contacting the IVF Center clinic in Yekaterinburg, you will receive treatment from highly qualified specialists and examination using the most modern equipment.

Chorionic gonadotropin (vial 500 units No. 5 + solution)

A country

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Active substance

Chorionic gonadotropin

Compound

The active substance is human chorionic gonadotropin.

pharmachologic effect

Human chorionic gonadotropin (hCG) is a gonadotropic hormone that is produced by the placenta during pregnancy and then excreted unchanged by the kidneys. To obtain the drug, it is extracted from urine and purified. Necessary for normal growth and maturation of gametes in women and men, as well as for the production of sex hormones. Pharmacodynamics. It has a gonadotropic, follicle-stimulating and luteinizing effect. Luteinizing activity prevails over follicle-stimulating activity. Stimulates the development of genital organs and secondary sexual characteristics. In women, the drug causes ovulation and stimulates the synthesis of estrogens (estradiol) and progesterone. In men, it stimulates spermatogenesis, the production of testosterone and dihydrotestosterone. Pharmacokinetics: After intramuscular administration, it is well absorbed. The half-life is 8 hours. The maximum concentration of hCG in the blood plasma is achieved after 4-12 hours. The half-life of human chorionic gonadotropin is 29-30 hours; in the case of daily intramuscular injections, accumulation of the drug may be observed. Chorionic gonadotropin is excreted by the kidneys. About 10-20% of the administered dose is found unchanged in the urine, the main part is excreted in the form of beta chain fragments.

Indications for use

In women: ovarian dysfunction (anovulatory), amenorrhea; maintenance of the corpus luteum phase. In men and boys: hypogonadotropic hypogonadism; delayed puberty due to insufficiency of the gonadotropic function of the pituitary gland; cryptorchidism not caused by anatomical obstruction; insufficiency of spermatogenesis, oligo-asthenospermia, azoospermia; when conducting a differential diagnostic test for anorchidism and cryptorchidism in boys; when conducting a functional Leydig test to assess testicular function in hypogonadotropic hypogonadism before starting long-term stimulating treatment.

Mode of application

After adding the solvent to the lyophilisate, the reconstituted solution of human chorionic gonadotropin is administered intramuscularly, slowly. The prepared solution cannot be stored, since further preservation of the sterility of the solution is not guaranteed. The indicated dosages are approximate, treatment should be adjusted by the doctor individually depending on the required response to the administration of the drug. In women: for anovulatory cycles, human chorionic gonadotropin is prescribed starting from the 10-12th day of the menstrual cycle, 3000 IU 2-3 times with an interval of 2-3 days or 1500 IU 6-7 times every other day; to maintain the corpus luteum phase, two to three repeated injections of the drug can be given at a dose of 1500 IU to 5000 IU each within 9 days after ovulation or embryo transfer (for example, on 3, 6 and 9th day after ovulation induction). In men and boys: with hypogonadotropic hypogonadism - 1000-2000 IU of the drug 2-3 times a week. In case of infertility, it is possible to combine human chorionic gonadotropin with an additional drug containing follitropin (follicle-stimulating hormone) 2-3 times a week. The course of treatment should continue for at least 3 months before any improvement in spermatogenesis can be expected. Testosterone replacement therapy must be suspended during this treatment. When improvement in spermatogenesis is achieved, to maintain it, in some cases, isolated use of human chorionic gonadotropin is sufficient; for delayed puberty due to insufficiency of the gonadotropic function of the pituitary gland - 1500 IU 2-3 times a week. The course of treatment is at least 6 months; for cryptorchidism not caused by anatomical obstruction: at the age of 3 to 6 years - 500-1000 IU twice a week for 6 weeks; at the age of over 6 years - 1500 IU twice a week for 6 weeks. The course of treatment, if necessary, can be repeated; if spermatogenesis is insufficient, oligoasthenospermia, azoospermia, 500 IU in combination with menotropin (75 IU follicle-stimulating hormone + 75 IU luteinizing hormone) is prescribed daily, or 2000 IU every 5 days in combination with menotropin (150 IU follicle-stimulating hormone + 150 IU luteinizing hormone) 3 times a week for 3 months. If there is no response to treatment, 2000 IU is prescribed 2-3 times a week with menotropin (150 IU follicle-stimulating hormone + 150 IU luteinizing hormone) 3 times a week for 3-12 months. When an improvement in spermatogenesis is achieved, subsequent therapy in some cases can be carried out only with maintenance doses of human chorionic gonadotropin; for the purpose of differential diagnosis of cryptorchidism and anorchism in boys, human chorionic gonadotropin is administered intramuscularly in a single dose of 100 IU/kg, the concentration of testosterone in the blood serum is determined before the test and after 72 -96 hours after injection of the drug. In the case of anorchidism, the test will be negative, indicating the absence of testicular tissue; in the case of cryptorchidism, even if only one testicle is present, the test will be positive (5-10-fold increase in testosterone concentration). If the test is weakly positive, a search for the gonad (abdominal ultrasound or laparoscopy) is necessary, as there is a high risk of malignancy.

Interaction

It is necessary to avoid combined use of the drug with high doses of glucocorticosteroids. No other interactions with drugs have been noted.

Side effect

Immune system disorders: In rare cases, a generalized rash or fever may occur. General disorders and injection site conditions: When using human chorionic gonadotropin, reactions at the injection site, such as bruising, pain, redness, swelling and itching, may occur. Allergic reactions have been reported in some cases, most of which include pain and/or rash at the injection site; increased fatigue. In women. Metabolic and nutritional disorders: edema. Mental disorders: irritability, anxiety, depression. Nervous system disorders: headache, dizziness. In men and boys. Endocrine system disorders: premature puberty Disorders of the skin and subcutaneous tissues: acne. Disorders of the genital organs and breast: treatment with human chorionic gonadotropin can sporadically cause gynecomastia; prostatic hyperplasia, enlarged penis, increased sensitivity of the nipples of the mammary glands in men, enlarged testicles in the inguinal canal with cryptorchidism.

Contraindications

Hypersensitivity to hCG or to any component of the drug; hormone-dependent malignant tumors of the genital organs and breast currently or suspected of them (ovarian cancer, breast cancer, uterine cancer in women and prostate cancer, breast carcinoma in men); organic lesions of the central nervous system (CNS) (tumors of the pituitary gland, hypothalamus); deep vein thrombophlebitis; hypothyroidism; adrenal insufficiency; hyperprolactinemia; children under 3 years of age. In boys: precocious puberty. In men: infertility not associated with hypogonadotropic hypogonadism. In women: abnormal formation of the genital organs, incompatible with pregnancy; fibrous tumor of the uterus, incompatible with pregnancy; primary ovarian failure; infertility not associated with anovulation (for example, tubal or cervical origin); bleeding or spotting from the vagina of unknown etiology; pregnancy and period breastfeeding.

Overdose

The drug is characterized by extremely low toxicity. In women with an overdose, ovarian hyperstimulation syndrome (OHSS) may occur. Depending on the severity (based on clinical and laboratory symptoms), several types of OHSS are distinguished. Mild OHSS: abdominal discomfort, mild abdominal pain, ovarian size is usually less than 8 cm; moderate OHSS: breast tenderness, moderate abdominal pain, nausea and/or vomiting, diarrhea, ultrasound signs of ascites, slight or moderate enlargement of ovarian cysts, ovarian size is usually 8 -12 cm; Severe OHSS: weight gain, in rare cases thromboembolism, clinical signs of ascites (sometimes hydrothorax), oliguria, hemoconcentration, hematocrit greater than 45%, hypoproteinemia, large ovarian cysts (prone to rupture), ovarian size, usually , more than 12 cm. Principles of treatment of OHSS. Mild degree: bed rest; drinking plenty of mineral water; monitoring the patient’s condition. Moderate and severe (only in a hospital setting): monitoring the function of the cardiovascular system (CVS), respiratory system, liver, kidneys, electrolyte and water balance (diuresis, weight dynamics, changes in abdominal circumference) ; control of hematocrit level; intravenous crystalloid solutions (to restore and maintain circulating blood volume (BCV)); intravenous colloid solutions - 1.5-3 l/day (while maintaining hemoconcentration) and persistent oliguria; hemodialysis (with the development of renal failure ); corticosteroids, antiprostaglandins, antihistamines (to reduce capillary permeability); for thromboembolism - low molecular weight heparins (fraxiparine, clexane); plasmapheresis - 1-4 sessions with an interval of 1-2 days (improving the rheological properties of blood, normalizing the acid-base state ( CBS) and blood gas composition, reduction in ovarian size); paracentesis and transvaginal puncture of the abdominal cavity for ascites. Hospitalization is necessary for the development of moderate and severe OHSS. Men and boys may develop gynecomastia; in boys, behavioral changes similar to those observed during the first phase of puberty are possible; degeneration of the gonads (with unreasonably long-term use for cryptorchidism), atrophy of the seminiferous tubules (due to inhibition of the production of follicle-stimulating hormone (FSH) as a result of stimulation of the production of androgens and estrogens); decrease in the number of sperm in the ejaculate (if the drug is abused in men). Long-term use of the drug may lead to increased side effects.

special instructions

With caution. Persons with risk factors for thrombosis (personal or family history, severe obesity (body mass index >30 kg/m2) or thrombophilia). In men and boys with latent or overt heart failure, renal dysfunction, arterial hypertension, epilepsy or migraine (or a history of these conditions); in prepubertal boys; in patients with bronchial asthma. If you have one of the listed diseases, be sure to consult your doctor before taking the drug. Use during pregnancy and breastfeeding. Use of the drug during pregnancy and breastfeeding is contraindicated. The use of gonadotropin increases the risk of developing venous or arterial thromboembolism Therefore, it is necessary to evaluate the benefits of in vitro fertilization therapy for patients at risk. It should also be noted that pregnancy itself is also accompanied by an increased risk of thrombosis. The likelihood of multiple pregnancies increases. During treatment with the drug and for 10 days after stopping treatment, human chorionic gonadotropin may affect the values of immunological tests for the concentration of hCG in the blood plasma and urine, which can lead to a false-positive pregnancy test result. Treatment of male patients with human chorionic gonadotropin leads to increased production of androgens, therefore, patients at risk should be under strict medical supervision, since exacerbation of the disease or relapse can sometimes be the result of increased production of androgens. HCG contributes to premature closure of the epiphyses or premature puberty. It is necessary to regularly monitor skeletal development. In men, the drug is ineffective with high levels of follicle-stimulating hormone. Unreasonably long-term use of the drug for cryptorchidism, especially if surgical intervention is indicated, can lead to degeneration of the gonads. Long-term administration can lead to the formation of antibodies to the drug. Impact on the ability to drive vehicles and machines. During the treatment period, you must refrain from driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Dispensing conditions in pharmacies

On prescription