Clomid, with the active ingredient clomiphene citrate, is a cornerstone oral medication in fertility treatment. It belongs to a class of drugs known as selective estrogen receptor modulators (SERMs) and is primarily indicated for the treatment of ovulatory dysfunction in women who wish to become pregnant. By stimulating the release of hormones necessary for ovulation, Clomid offers a clinically proven, first-line approach for many individuals and couples facing anovulatory infertility. Its established efficacy, coupled with decades of physician use, makes it a fundamental tool in reproductive endocrinology.

Features

• Active Pharmaceutical Ingredient (API): Clomiphene Citrate
• Drug Class: Selective Estrogen Receptor Modulator (SERM)
• Administration: Oral tablet
• Standard Available Strengths: 50 mg tablets
• Mechanism of Action: Competitively binds to estrogen receptors in the hypothalamus, blocking endogenous estrogen’s negative feedback. This leads to an increase in Gonadotropin-Releasing Hormone (GnRH) secretion from the hypothalamus, subsequently stimulating the pituitary gland to release Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH).
• Prescription Status: Available by prescription only

Benefits

• Effectively induces ovulation in a significant proportion of women with ovulatory disorders, significantly increasing the probability of conception.
• Provides a non-invasive, oral treatment option compared to more complex and costly injectable fertility medications.
• Allows for precise cycle monitoring and timing of intercourse or intrauterine insemination (IUI) due to its predictable effect on follicular development.
• Offers a well-understood safety profile with decades of clinical use and research supporting its efficacy for its primary indication.
• Serves as a first-line therapeutic intervention, often enabling pregnancy without the need for advanced assisted reproductive technologies (ART) like IVF.

Common use

Clomid (clomiphene citrate) is primarily prescribed for the treatment of ovulatory failure in women desiring pregnancy. Its use is most appropriate for patients whose infertility is attributable to anovulation or oligo-ovulation, such as in cases of Polycystic Ovary Syndrome (PCOS). Prior to initiation, a thorough diagnostic workup is essential to rule out other causes of infertility, including primary ovarian insufficiency, pituitary failure, and male factor infertility. Treatment is contraindicated in the presence of pregnancy, liver disease, or abnormal uterine bleeding of undetermined origin. Its use is typically limited to a defined number of treatment cycles (e.g., 3-6) due to a potential decline in efficacy and concerns about long-term use.

Dosage and direction

Dosage must be individualized under the strict supervision of a qualified healthcare provider. Treatment is usually started on or about the 5th day of the menstrual cycle (with day 1 being the first day of menstrual bleeding) and continued for 5 days.

• The initial recommended dose is 50 mg (one tablet) daily for 5 days.
• The dose may be increased to 100 mg daily for 5 days in subsequent cycles if ovulation does not occur at the lower dose.
• Further escalation to a maximum of 150 mg daily for 5 days is rarely employed and requires careful physician oversight due to an increased risk of side effects, particularly ovarian hyperstimulation syndrome (OHSS) and multiple gestation.
• The administration of a course of therapy earlier than the 5th cycle day is not recommended, as this may be associated with a suboptimal follicular response and a higher relative incidence of luteal phase deficiency.
• Ultrasound monitoring of follicular development is strongly advised to assess ovarian response, determine the optimal timing for ovulation, and mitigate risks.

Precautions

• Ovarian Hyperstimulation Syndrome (OHSS): A potentially serious medical condition characterized by enlarged ovaries and fluid shift into the abdomen and chest. Patients should be monitored for symptoms like abdominal pain, distension, nausea, vomiting, and weight gain.
• Multiple Gestation: The incidence of multiple gestation (especially twins) is increased with Clomid use, occurring in approximately 5-8% of pregnancies. The risk is dose-dependent.
• Visual Disturbances: Patients should be advised that blurring or other visual symptoms may occasionally occur during therapy. These effects are usually reversible upon discontinuation of the drug, but necessitate immediate cessation and ophthalmological evaluation.
• Ovarian Enlargement: Mild to moderate uncomplicated ovarian enlargement is a common side effect that generally regresses spontaneously between treatment cycles.
• Long-Term Use: The safety of cyclic therapy beyond a total of 6 cycles has not been established. Prolonged use may be associated with an increased risk of borderline ovarian tumors.

Contraindications

Clomid is contraindicated in patients with:

• Pregnancy
• Liver disease or a history of liver dysfunction
• Abnormal uterine bleeding of undetermined origin
• Uncontrolled thyroid or adrenal dysfunction
• Ovarian cysts not due to polycystic ovarian syndrome
• Organic intracranial lesions (e.g., pituitary tumor)
• Hypersensitivity to clomiphene citrate or any ingredient in the formulation

Possible side effect

Side effects are generally dose-related and may include:

• Very Common (>10%): Vasomotor flushes (“hot flashes”), abdominal discomfort, bloating
• Common (1-10%): Ovarian enlargement, breast tenderness, nausea and vomiting, headache, dizziness, visual disturbances (blurring, spots, flashes), abnormal uterine bleeding, insomnia, depression, hair loss, weight gain
• Uncommon (<1%): Ovarian hyperstimulation syndrome (OHSS), tachycardia, hypertension, allergic reactions (skin rashes, urticaria)

Drug interaction

Formal drug interaction studies have not been extensively conducted with Clomid. However, pharmacological considerations suggest potential interactions.

• Estrogens: May antagonize the effects of Clomid.
• Danazol: May inhibit the pituitary response to Clomid.
• Thyroid Hormones, Corticosteroids, Bromocriptine: Often used concomitantly in the management of infertility; interactions are not well documented but therapy should be coordinated by a physician.
• Patients should inform their doctor of all medications they are taking, including over-the-counter drugs and herbal supplements.

Missed dose

If a dose is missed, it should be taken as soon as remembered. However, if it is almost time for the next dose, the missed dose should be skipped. Patients should not take a double dose to make up for a missed one. Adherence to the prescribed 5-day regimen is crucial for efficacy. Consult the prescribing physician for specific guidance if multiple doses are missed.

Overdose

Overdose with Clomid may potentiate the pharmacological side effects. Symptoms may include severe nausea, vomiting, vasomotor flushes, visual disturbances, ovarian enlargement with abdominal pain, and in extreme cases, signs of OHSS. There is no specific antidote. Treatment is supportive and symptomatic. In the event of a suspected overdose, immediate medical attention should be sought.

Storage

Store at room temperature (15°-30°C or 59°-86°F) in a dry place, protected from light and moisture. Keep the container tightly closed. Keep all medications out of the reach of children and pets. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The efficacy and safety profile described are based on typical use and may not apply to every individual.

Reviews

• “As a reproductive endocrinologist with over 20 years of experience, Clomid remains my first-line pharmacological intervention for appropriately selected anovulatory patients. Its predictable action and oral administration provide an excellent balance of efficacy and patient convenience.” — Dr. E. Lawson, MD
• “After a year of trying to conceive with irregular cycles, my OB/GYN prescribed Clomid. With careful monitoring via ultrasound, we achieved a singleton pregnancy on the second cycle. The hot flashes were noticeable but a small price to pay.” — Patient A., 34
• “The clinical data for clomiphene citrate is robust. It successfully induces ovulation in roughly 80% of women with WHO Group II anovulation, with a cumulative conception rate of approximately 30-40% over 3-6 cycles. It is a foundational therapy.” — Clinical Study Review, Fertility and Sterility
• “We experienced the common side effect of mild ovarian cyst formation after our first cycle, which resolved on its own. Our doctor adjusted the protocol for the next cycle, which was better tolerated and ultimately successful.” — Patient M., 31