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clomiphene citrate (clomifene (UK))
Pharmacologic class: Chlorotrianisene derivative
Therapeutic class: Fertility drug, ovulation stimulant
Pregnancy risk category X
Binds with estrogen receptors in cytoplasm, increasing secretion of folliclestimulating hormone, luteinizing hormone, and gonadotropin in hypothalamus and pituitary gland. These actions induce ovulation.
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.
• Male sterility (controversial)
• Hepatic disease
• Organic intracranial lesions
• Uncontrolled thyroid or adrenal dysfunction
• Ovarian cyst
• Abnormal uterine bleeding or bleeding of undetermined origin
• Obtain pregnancy test before therapy begins.
• Be aware that patient should undergo pelvic and eye examinations before starting therapy.
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
• Monitor patient for bleeding and other adverse reactions.
☞ 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.