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Clomiphene Citrate
Clomiphene citrate is a selective estrogen receptor modulator (SERM) commonly used to treat infertility in women. It works by stimulating ovulation in women who do not ovulate regularly, such as those with polycystic ovary syndrome (PCOS) or other hormonal imbalances. It is also prescribed off-label to treat male infertility by improving testosterone production. Clomiphene citrate is often a first-line treatment for ovulatory disorders due to its effectiveness and ease of use.
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Frequently Asked Questions
How does clomiphene citrate help with infertility?
Clomiphene citrate stimulates ovulation by increasing the production of FSH and LH, which are essential for egg development and release.
Can clomiphene citrate cause multiple pregnancies?
Yes, clomiphene citrate increases the risk of twins (5-10%) and, rarely, triplets or higher-order multiples.
How long can I take clomiphene citrate?
Most doctors recommend limiting clomiphene citrate treatment to six cycles to reduce the risk of side effects and complications.
What should I do if I miss a dose?
Contact your doctor if you miss a dose. Do not double up unless specifically instructed by your healthcare provider.
Comprehensive Drug Guide
How Does Clomiphene Citrate Work?
Clomiphene citrate works by blocking estrogen receptors in the hypothalamus, which causes the body to perceive lower levels of estrogen. This stimulates the release of gonadotropin-releasing hormone (GnRH), leading to increased secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones help the ovaries develop and release mature eggs, thereby inducing ovulation.
Common Dosages
- Oral tablets: 50 mg
Typical Dosing
- For ovulation induction in women: The usual starting dose is 50 mg once daily for 5 days, starting on the 3rd, 4th, or 5th day of the menstrual cycle. The dose may be increased to 100 mg or 150 mg in subsequent cycles if ovulation does not occur.
- For male infertility: Dosages typically range from 25 mg to 50 mg taken daily or every other day, as prescribed by a healthcare provider.
Typical Dosing
FDA Approved Indications
- Ovulatory dysfunction in women trying to conceive
- Anovulation (absence of ovulation)
Off-label uses include:
- Male infertility due to low testosterone or hormonal imbalances
- Luteal phase defects in women
Who Shouldn't Take Clomiphene Citrate?
- Known hypersensitivity to clomiphene or any of its components
- Pregnancy
- Liver disease
- Uncontrolled thyroid or adrenal dysfunction
- Ovarian cysts not associated with polycystic ovary syndrome
Advice From The Pharmacist
- Take clomiphene citrate exactly as prescribed, following your doctor’s instructions regarding timing and dosage.
- Monitor for ovulation using ovulation predictor kits, basal body temperature, or other methods as advised by your healthcare provider.
- Be aware of potential side effects, including hot flashes, bloating, and mood swings.
- If you experience severe abdominal pain or visual disturbances, contact your doctor immediately.
- Avoid alcohol and stay well-hydrated while on clomiphene citrate.
Side Effects of Clomiphene Citrate
Common Side Effects
- Hot flashes
- Bloating
- Nausea
- Headaches
- Breast tenderness
- Mood swings
Uncommon/Severe Side Effects
- Ovarian hyperstimulation syndrome (OHSS): Symptoms include severe abdominal pain, rapid weight gain, and difficulty breathing.
- Visual disturbances: Blurred or double vision.
- Multiple pregnancies: Increased risk of twins or triplets.
Risks and Warnings of Clomiphene Citrate
- Ovarian Hyperstimulation Syndrome (OHSS): In rare cases, excessive ovarian stimulation can cause fluid accumulation and abdominal discomfort.
- Visual disturbances: Stop taking clomiphene citrate and consult your doctor if you experience vision changes.
- Multiple pregnancies: Clomiphene citrate increases the chance of twins or higher-order multiples, which may carry additional health risks.
- Long-term use: Prolonged use beyond six cycles may increase the risk of ovarian cancer; consult your doctor if treatment extends beyond this period.
Interactions with Clomiphene Citrate
Common Drug Interactions
- Hormonal medications: Avoid combining clomiphene citrate with other fertility drugs without consulting your healthcare provider.
- Herbal supplements: Some supplements, such as those affecting hormonal balance, may interfere with clomiphene citrate’s efficacy.
Common Food Interactions
- Alcohol: May exacerbate side effects like dizziness or nausea.
Alternatives to Clomiphene Citrate
- Letrozole (Femara): An aromatase inhibitor used for ovulation induction, particularly in women with PCOS.
- Gonadotropins: Injectable FSH or LH for more advanced fertility treatment.
- Metformin: Used for ovulation induction in women with insulin resistance and PCOS.
- Natural methods: Lifestyle modifications, including weight management and dietary changes, to improve ovulation.
