Clomiphene citrate exerts its therapeutic effects by modulating estrogen receptors in the hypothalamus and pituitary gland. Its mechanism of action includes:

1. Estrogen Receptor Antagonism in the Hypothalamus:
   • Clomiphene blocks estrogen receptors in the hypothalamus, preventing the negative feedback of estrogen.
   • This leads to increased secretion of gonadotropin-releasing hormone (GnRH).
2. Stimulation of FSH and LH Release:
   • Increased GnRH stimulates the anterior pituitary gland to release more FSH and LH.
   • FSH promotes the growth and maturation of ovarian follicles, while LH triggers ovulation.
3. Ovulation Induction:
   • By enhancing FSH and LH levels, clomiphene helps restore normal ovulation in women with anovulatory cycles.

Clomid is primarily used for the following conditions:

1. Ovulation Induction:
   • Used to treat infertility in women with anovulatory disorders, such as polycystic ovary syndrome (PCOS).
2. Unexplained Infertility:
   • May be used as a first-line treatment for couples with unexplained infertility.
3. Male Infertility (Off-Label):
   • Occasionally used to treat male infertility due to hormonal imbalances.
4. Assisted Reproductive Technology (ART):
   • Used in conjunction with other fertility treatments, such as intrauterine insemination (IUI).

The dosage of clomiphene citrate varies depending on the condition being treated. Always follow the prescribing physician's instructions.

Common Dosages:

• Ovulation Induction:
  • Initial dose: 50 mg orally once daily for 5 days, starting on day 2–5 of the menstrual cycle.
  • Dose adjustments: If ovulation does not occur, the dose may be increased to 100 mg daily for 5 days in subsequent cycles.
  • Maximum dose: 150 mg daily for 5 days.
• Male Infertility (Off-Label):
  • Dosage varies; typically 25 mg daily for 25 days, followed by a 5-day break.

Administration Tips:

• Take the medication at the same time each day to maintain consistent levels in the body.
• Do not crush or chew the tablet; swallow it whole with water.
• Regular monitoring (e.g., ultrasound, hormone levels) is recommended to assess ovarian response and prevent complications.

Clomiphene citrate is generally well-tolerated, but some patients may experience side effects. These can include:

Common Side Effects:

• Hot flashes
• Abdominal discomfort or bloating
• Nausea
• Breast tenderness
• Headache
• Mood swings

Rare but Serious Side Effects:

• Ovarian Hyperstimulation Syndrome (OHSS): A condition characterized by enlarged ovaries and fluid accumulation in the abdomen. Symptoms include severe pelvic pain, nausea, vomiting, and shortness of breath.
• Multiple Pregnancies: Increased risk of twins or higher-order multiples.
• Visual Disturbances: Blurred vision, light sensitivity, or other visual changes.
• Ovarian Torsion: A rare but serious condition where the ovary twists on itself, causing severe pain.

If any severe side effects occur, discontinue use and seek medical attention immediately.

Before using clomiphene citrate, inform your healthcare provider if you have:

• Ovarian cysts or enlarged ovaries (not due to PCOS)
• Liver disease
• Abnormal vaginal bleeding
• Thyroid or adrenal gland disorders
• Allergies to clomiphene citrate or any of its components

Special Populations:

• Pregnancy: Clomiphene citrate is contraindicated during pregnancy as it may harm the fetus. It is classified as Pregnancy Category X.
• Breastfeeding: The safety of clomiphene during breastfeeding is unknown. Consult your doctor before use.
• Elderly Patients: Not applicable, as clomiphene is used in women of reproductive age.

Clomiphene citrate may interact with other medications, altering their effectiveness or increasing the risk of side effects. Notable interactions include:

1. Gonadotropins:
   • Concurrent use with gonadotropins (e.g., FSH, LH) may increase the risk of ovarian hyperstimulation syndrome (OHSS).
2. Aromatase Inhibitors:
   • Drugs like letrozole may be used as an alternative to clomiphene for ovulation induction.
3. Thyroid Hormones:
   • Clomiphene may alter thyroid function tests, requiring dose adjustments in patients on thyroid hormone replacement.
4. CYP2D6 Inhibitors:
   • Drugs like fluoxetine and paroxetine may reduce the metabolism of clomiphene, increasing its levels and side effects.

Always inform your healthcare provider about all medications, supplements, and herbal products you are taking.

Generic Names in Pharmacy

Clomiphene citrate (the active ingredient in Clomid)