clomiphene citrate

clomiphene citrate (clomifene (UK))

Clomid, Serophene

Pharmacologic class: Chlorotrianisene derivative

Therapeutic class: Fertility drug, ovulation stimulant

Pregnancy risk category X

Action

Binds with estrogen receptors in cytoplasm, increasing secretion of folliclestimulating hormone, luteinizing hormone, and gonadotropin in hypothalamus and pituitary gland. These actions induce ovulation.

Availability

Tablets: 50 mg

Indications and dosages

➣ Ovarian failure

Adults: 50 mg/day P.O. for 5 days starting any time in patients with no recent uterine bleeding; or 50 mg/day P.O. starting on fifth day of menstrual cycle. If ovulation doesn't occur, increase to 100 mg/day P.O. for 5 days. Start next course of therapy as early as 30 days after previous course. If patient doesn't respond after three courses, no further doses are recommended.

Off-label uses

• Male sterility (controversial)

Contraindications

• Hepatic disease

• Organic intracranial lesions

• Uncontrolled thyroid or adrenal dysfunction

• Ovarian cyst

• Abnormal uterine bleeding or bleeding of undetermined origin

• Pregnancy

Precautions

None

Administration

• Obtain pregnancy test before therapy begins.

• Be aware that patient should undergo pelvic and eye examinations before starting therapy.

Adverse reactions

CNS: nervousness, insomnia, dizziness, light-headedness

CV: vasomotor flushing

EENT: visual disturbances

GI: nausea; vomiting; abdominal discomfort, distention, and bloating

GU: breast tenderness, ovarian enlargement, multiple pregnancies, birth defects in resulting pregnancies, ovarian hyperstimulation syndrome, uterine bleeding

Interactions

None significant

Patient monitoring

• Monitor patient for bleeding and other adverse reactions.

Patient teaching

See Instruct patient to immediately report signs and symptoms of ovarian hyperstimulation syndrome, including nausea, vomiting, diarrhea, abdominal or pelvic pain, and swelling in hands or legs.

• Tell patient to report bleeding.

• Advise patient not to take drug if she is or may become pregnant.

• Inform patient that drug increases risk of multiple births, which heightens maternal risk.

• As appropriate, review all other significant and life-threatening adverse reactions.