Clomiphene Citrate

Gonadotrophin including Other Ovulation Stimulant · Anti-oestrogen

Indications

Female infertility due to oligomenorrhoea or secondary amenorrhoea (e.g. associated with polycystic ovarian disease). Male infertility.

Dosage

Female: Adults: 1 tab daily for 5 consecutive days, starting on fifth day of menstruation (preferably on 2nd day) or at any time (normally preceded by a progestogen induced withdrawal bleed) if cycles have ceased. Second course of 100 mg daily for 5 days, may be given in the absence of ovulation. Most patients who are going to respond will do so to first course; 3 course should constitute adequate therapeutic trial. Long-term cyclical therapy not recommended. Male infertility: Adults: 25 mg/day for 25 days with 5 days rest, or 100 mg every Monday, Wednesday, Friday. Children: Not applicable.

Adverse Effects

Ovarian hyperstimulation (withdraw), hot flushes, abdominal discomfort, visual blurring (withdraw), insomnia, breast tenderness, headache, intermenstrual spotting, menorrhagia, endometriosis, convulsions, weight gain, rashes, dizziness, hair loss, ovarian enlargement, GI upset, urticaria, alopecia, fatigue, jaundice, abnormal LFTs, anxiety.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: Liver dysfunction. Large ovarian cyst. Endometrial carcinoma. Undiagnosed uterine bleeding. Uncontrolled thyroid or adrenal dysfunction in the presence of an organic intracranial lesion such as pituitary tumour. Precautions: Patients sensitive to pituitary gonadotrophins (e.g. polycystic ovary disease), multiple pregnancies, blurring or other visual symptoms can occur, ovarian hyperstimulation syndrome and abdominal pain. Uterine fibroids, depression, risk factors for thrombophlebitis.

Interactions

Danazol, oestradiol.

Advice to Patient

Wear cool dress, stay in cool room, take sufficient rest to prevent hot flashes. Contact prescriber if there is difficulty in breathing, sudden headache, pain/swelling/warmth/redness in calves, breast discomfort, breast enlargement in male, irregular menstrual bleeding, blurring of vision, photophobia, changes in vision, stomach disturbances, fever.

Pharmacokinetics

Onset of action: Ovulation: 5-10 days following course of treatment. Duration: Effects are cumulative; ovulation may occur in the cycle following the last treatment. Absorption: Readily absorbed. Metabolism: Hepatic. Half-life elimination: Approx. 5 days. Time to peak, plasma: Approx. 6 hrs. Excretion: Primarily faeces (42%). Urine (8%).

Brands with this active ingredient

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