Clomiphene is no longer being manufactured for sale in Canada. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

This medication belongs to the class of medications known as ovulatory agents. It is used as a fertility medication by women who are having trouble becoming pregnant because ovulation is not occurring in a normal manner. It works by causing ovulation to occur.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended starting dose of clomiphene is 50 mg daily for 5 days.

If you have had no recent uterine bleeding, it may be started at any time. If bleeding occurs (spontaneous or progestin-induced) prior to therapy, clomiphene is started on or about Day 5 of the cycle. This cycle may be repeated 3 or 4 times. If ovulation does not occur in the first cycle after using the medication, a dose of 100 mg daily for 5 days can be used for the next cycle as directed by your doctor.

The maximum dose for this medication is 100 mg daily for 5 days. It is recommended not to use this medication for more than 6 cycles of treatment.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule.. If you forget to take the medication until the time of the next dose, double your dose and take both tablets at the same time. If you miss more than 1 dose, contact your doctor. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Each round, white, bevelled-edge, scored tablet, with "S" on one side, contains 50 mg of clomiphene citrate.

Do not take this medication if you:

• are allergic to clomiphene or any ingredients of the medication
• are pregnant
• have a hormone-dependent tumour (tumours that can be stimulated to grow by sex hormones such as estrogen)
• have abnormal vaginal bleeding of unknown cause
• have fibroid tumours of the uterus
• have liver disease or have had reduced liver function in the past
• have ovarian cysts (not associated with polycystic ovary)
• have thrombophlebitis (inflammation of a vein with formation of a blood clot)
• have depression

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal bloating
• breast discomfort
• constipation
• diarrhea
• dizziness or lightheadedness
• hair loss
• headache
• heavy menstrual periods or bleeding between periods
• hot flashes
• increased appetite
• increased menstrual pain
• itchiness
• nausea or vomiting (not severe or continuing)
• nervousness
• sensation of spinning
• tiredness
• trouble sleeping
• vaginal dryness
• weight gain

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abdominal or lower stomach pain
• blurred vision
• cataracts
• double or decreased vision, or other vision problem
• fast, pounding or irregular heartbeat
• occurrences of "flashes of light"
• sensitivity of eyes to light
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• sudden and severe headaches
• symptoms of liver problems (e.g., yellow eyes or skin, abdominal pain, poor appetite, dark urine, or pale stools)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
• signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
• symptoms of a severe allergic reaction (hives, shortness of breath, swelling of the face or throat)
• symptoms of ovarian hyperstimulation syndrome (difficulty breathing, abdominal or pelvic pain or discomfort, bloating, nausea, vomiting, diarrhea, decreased amount of urine, rapid weight gain)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Ectopic pregnancy: There is an increased chance of ectopic pregnancy (i.e., the baby develops in one of the fallopian tubes instead of in the uterus) in women who conceive following clomiphene therapy. It is important to have an early ultrasound to ensure that the baby is developing inside the uterus.

Following instructions: It is extremely important to understand your treatment and to follow instructions closely. Be sure to ask your doctor any questions you might have.

Multiple births: Clomiphene can cause multiple follicles to mature and release more than one egg in a cycle. This in turn, increases the possibility of multiple births. The incidence of multiple pregnancy (including twins, triplets, quadruplets, and quintuplets) can be up to 10 times greater when conception occurs during a cycle in which clomiphene therapy is taken.

Ovarian cysts: With clomiphene therapy, there is the possibility of ovarian cyst formation. Women should notify their doctor of any abdominal or pelvic pain, weight gain, discomfort, or bloating after taking clomiphene.

Ovarian enlargement and ovarian hyperstimulation syndrome (OHSS): These conditions may occur with clomiphene therapy. Early warning signs include abdominal or pelvic pain, bloating, nausea, vomiting, diarrhea, and weight gain. Notify your doctor immediately if any of these symptoms occur after taking clomiphene.

Women with ovarian hyperstimulation syndrome (OHSS) may also have difficulty breathing and pass decreased amounts of urine. Your doctor will conduct regular pelvic examinations between 2 and 3 weeks after starting each course of therapy.

Vision changes: Blurring of vision or other sight problems (such as afterimages, spots, flashes, double vision, or sensitivity to light) may occasionally occur while taking clomiphene or shortly after therapy finishes. These types of sight problems may make it more dangerous to drive or operate machinery, particularly under conditions where light varies. If you experience such effects, stop taking the medication and contact your doctor.

Pregnancy: Clomiphene should not be taken during pregnancy.

Breast-feeding: It is not known if clomiphene passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Clomiphene may also reduce the amount of milk produced by breast-feeding mothers. Talk to your doctor about whether you should continue breast-feeding.

Children: This medication is intended for use by women of childbearing age and therefore, the safety and effectiveness of this medication have not been established for children.

Seniors: This medication is intended for use by women of childbearing age and therefore, the safety and effectiveness of this medication have not been established for seniors.

Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.