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Clomiphene

    DEA Class; Rx

    Common Brand Names; Clomid, Serophene

    • Selective Estrogen Receptor Modulators

    Binds to estrogen receptors, induces ovulation by increase output of pituitary gonadotropins

    Indicated for treatment of Treatment of Ovulatory Failure

    Pregnancy

    Liver disease or history of liver disease

    Undiagnosed abnormal uterine bleeding

    Uncontrolled thyroid or adrenal dysfunction

    Endometrial cancer

    Ovarian cysts not due to PCOS

    Presence of organic intracranial lesion, including pituitary tumor

    Ovarian enlargement (14%)

    Vasomotor flushing (10%)

    Abdominal discomfort (6%)

    Blurred vision (1.5%)

    Breast discomfort (2%)

    Nausea/vomiting (2%)

    Body as a whole: Fever, tinnitus, weakness

    Cardiovascular: Arrhythmia, chest pain, edema, hypertension, palpitation, phlebitis, pulmonary embolism, shortness of breath, tachycardia, thrombophlebitis

    Central nervous system: Migraine headache, paresthesia, seizure, stroke, syncope

    Dermatologic: Acne, allergic reaction, erythema, erythema multiforme, erythema nodosum, hypertrichosis, pruritus, urticaria

    Genitourinary: Endometriosis, ovarian cyst (ovarian enlargement or cysts could, as such, be complicated by adnexal torsion), ovarian hemorrhage, tubal pregnancy, uterine hemorrhage; reduced endometrial thickness

    Hepatic: Transaminases increased, hepatitis, pancreatitis

    Musculoskeletal: Arthralgia, back pain, myalgia

    Careful attention should be given to selection of candidates for therapy; pelvic examination is necessary prior to treatment and before each subsequent course

    Uterine fibroids, pituitary or ovarian failure may occur

    Potential for multiple births, especially at 100 mg dosage

    Use should be supervised by a practitioner with training and thoroughly familiar with infertility problems and their management

    Risk of visual disturbance (like scotoma & photopsia); patients should be warned that visual symptoms may render activities such as driving a car or operating machinery more hazardous than usual, particularly under conditions of variable lighting; while etiology of visual symptoms is not yet understood, patients with any visual symptoms should discontinue treatment and have complete ophthalmological evaluation carried out promptly

    Cases of hypertriglyceridemia reported; preexisting or family history of hyperlipidemia and use of higher than recommended dose and/or longer duration of treatment are associated with risk of hypertriglyceridemia; periodic monitoring of plasma triglycerides is recommended in patients with preexisting or family history of hyperlipidemia; pretreatment screening of triglyceride levels is recommended in patients initiating therapy

    Cases of pancreatitis reported

    Prolonged use of clomiphene citrate tablets USP may increase risk of a borderline or invasive ovarian tumor

    Presence of organic intracranial lesion, including pituitary tumor

    Use in pregnant women is contraindicated, as treatment does not offer benefit in this population; to avoid inadvertent administration during early pregnancy, appropriate tests should be utilized during each treatment cycle to determine whether ovulation and/or pregnancy occurs; patients should be evaluated carefully to exclude ovarian enlargement or ovarian cyst formation between each treatment cycle; the next course of therapy should be delayed until these conditions have been excluded

    It is not known whether drug is excreted in human milk; because many drugs are excreted in human milk, caution should be exercised if drug is administered to a nursing woman; in some patients, therapy may reduce lactation

    Adults

    50 mg PO qDay initially for 5 days

    If no ovulation, treatment can be repeated as early as 30 days after previous therapy; exclude presence of pregnancy; use the lowest effective dose

    Dosage can be increased to 100 mg only in patients who do not respond to first course; lower doses of 12.5-25 mg qDay may be administered in women sensitive to the drug or who consistently develop large ovarian cysts

    Pediatric

    Not indicated

    Clomiphene 

    tablet

    • 50mg