Clomiphene
CLOMID
Pronunciation: KLOE-mi-feen
“Claw fiend’s Claw med”
eggs → ovulation stimulator
What it isSelective estrogen-receptor modulator that blocks hypothalamic feedback; ovulation induction.
Why this oneOral stimulation of endogenous gonadotropin release avoids the injections required by gonadotropin therapy.
What limits itMultiple pregnancy and antiestrogenic effects on cervical mucus and endometrium can offset ovulation; letrozole performs better in PCOS.
FDA-approved for
- ovulation induction (1967)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Ovulatory dysfunction (ovulation induction) | Adult female | 50 mg QD x5 days | 50 mg QD x5 days per cycle | 100 mg QD x5 days (2nd course if no ovulation) |
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
Available strengths
- tab 50 mg
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
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 50 mg | tab | 30 qd | $126.16 | offered |
Generic entry1988
NO BOXED WARNINGS
Principal riskMultiple pregnancy; antioestrogenic endometrial effect
Classes and tags
Clinical profile
Legacy pregnancy categoryX
Defining liabilityOvarian hyperstimulation, thrombosis and multiple gestation are the defining serious risks.