Clomiphene

FDA label

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Renal Undefined

Hepatic Contraindicated in liver disease or history of hepatic dysfunction

2nd course (100 mg/day x5 days) may begin as early as 30 days after the previous course; discontinue if no ovulation after 3 courses

Instructions

• If progestin-induced or spontaneous bleeding: start on/about cycle day 5; may start any time if no recent uterine bleeding
• Exclude pregnancy, ovarian enlargement, or cysts before each cycle
• Do not exceed 100 mg/day x5 days; long-term cyclic therapy not recommended beyond ~6 cycles

Contraindications

• Pregnancy (no benefit)
• Liver disease or history of hepatic dysfunction
• Abnormal uterine bleeding of undetermined origin
• Ovarian cysts or enlargement not due to PCOS
• Uncontrolled thyroid or adrenal dysfunction
• Organic intracranial lesion (e.g., pituitary tumor)

Cautions

• Ovarian hyperstimulation syndrome (esp. PCOS)
• Visual symptoms (blurred vision, floaters, scotomata) - may be prolonged/irreversible; discontinue if they occur
• Multiple pregnancies
• Ovarian enlargement/cyst formation
• Possible increased ovarian tumor risk with prolonged use

Adverse reactions

• Ovarian enlargement
• Vasomotor flushes
• Abdominal/pelvic discomfort, distention, bloating
• Nausea and vomiting
• Breast discomfort
• Visual symptoms
• Headache
• Abnormal uterine bleeding

Pregnancy Contraindicated in pregnancy (no benefit); animal data show increased embryo-fetal loss and malformations

Lactation Undefined