Clomiphene

About Clomiphene

Clomiphene may compete with estrogen at its receptors, including in the hypothalamus and pituitary, and a course raises the release of pituitary gonadotropins, the hormones that lead to ovulation. The label approves it for ovulatory dysfunction in women who want to become pregnant, after other obstacles to pregnancy have been excluded or treated. Candidates must not be pregnant and must have no ovarian cysts, no abnormal vaginal bleeding and normal liver function, and a pelvic exam comes before each course. The first course is 50 mg a day for 5 days, started on or about day 5 of the cycle after bleeding, or at any time if there has been no recent bleeding. If ovulation does not occur, the next course can be 100 mg a day for 5 days, as early as 30 days after the last; higher doses are not recommended. If three courses bring no ovulation, or three ovulatory cycles no pregnancy, further treatment is not recommended and the patient is reevaluated, and long-term cyclic therapy beyond a total of about six cycles (including three ovulatory cycles) is not recommended.

There is no boxed warning. Blurring, spots or flashes in vision can occur; they are usually reversible, but prolonged and possibly irreversible problems have been reported, so any visual symptom means stopping treatment and getting a prompt eye examination, and the symptoms can make driving or operating machinery more hazardous. Ovarian hyperstimulation syndrome can progress quickly to a serious disorder, and deaths have been reported, so abdominal pain or swelling, nausea, vomiting, diarrhea or weight gain should be reported, and the lowest dose expected to work is used. Clomiphene must not be taken in pregnancy, with liver disease or past liver dysfunction, abnormal uterine bleeding of unknown cause, ovarian cysts or enlargement not due to polycystic ovary syndrome, uncontrolled thyroid or adrenal problems, or a pituitary tumor or other brain lesion. In trials, ovarian enlargement, hot flashes, abdominal or pelvic discomfort and bloating, nausea and vomiting, breast discomfort, visual symptoms, headache and abnormal uterine bleeding were the most common reactions.

Twins and other multiple pregnancies are more likely, and tubal pregnancies, including in both tubes or alongside a pregnancy in the uterus, have been reported. Ovulation most often occurs 5 to 10 days after a course, so the label advises timing intercourse to it and says a basal body temperature chart or other tests may help confirm that ovulation has occurred. Prolonged use may increase the risk of a borderline or invasive ovarian tumor. It is not known whether clomiphene passes into breast milk, and it may reduce milk production. The label says no adequate studies show it works for male infertility, that testicular tumors and breast enlargement have been reported in men taking it, and that it is not recommended for ovulation induction in IVF programs; prescribing it to men is not an FDA-approved use, and the prescriber decides.

Taking Clomiphene

How to take it

One or two tablets once a day for 5 days, as prescribed, usually starting around day 5 of the cycle, at about the same time each day. Ovulation most often follows 5 to 10 days after the last tablet, and the prescriber may ask for tests or a temperature chart to confirm it.

If you miss a dose

Take the missed dose as soon as you remember. If it is almost time for the next dose, call your doctor for directions; do not take a double dose.

Storage

In its closed original container at room temperature, protected from heat, light and moisture (not in the bathroom), out of reach of children.

Interactions to know about

The label says no drug interactions have been documented. Tell the prescriber about every medicine and supplement you take, and about any thyroid, adrenal or liver problem.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Clomiphene differs from pharmacy to pharmacy

Clomiphene comes in a single strength from several makers, so quotes for the same course differ by each pharmacy’s fee and markup and by whether it is on the pharmacy’s flat-price generic list. A course is five tablets at 50 mg or ten at 100 mg, and each fill carries its own dispensing fee.

A prescription that names Clomid and blocks substitution must be filled with Clomid; otherwise any rated generic can be dispensed.

Ways to pay less for Clomiphene without insurance

• Ask for generic clomiphene, and check that the prescription does not block substitution.
• Ask whether clomiphene is on the pharmacy’s flat-price generic list.
• Ask the prescriber how many cycles the prescription covers, and compare quotes for that quantity.
• Compare more than one pharmacy before your cycle starts, since each course begins on a set day.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Clomiphene

1. 1.On which day of my cycle do I start, and what should I do if I miss a dose?
2. 2.Which vision changes or abdominal symptoms mean I should stop and call?
3. 3.How will my ovulation be checked this cycle?
4. 4.Is it safe with my other medicines, supplements or thyroid treatment?

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