Medically reviewed on July 2, Clomid clomiphene citrate tablets USP is an orally administered, nonsteroidal, ovulatory stimulant designated chemically as 2-[p- 2-chloro-1,2-diphenylvinyl phenoxy] triethylamine citrate 1: Taking clomid after 40 is represented structurally as:. Clomiphene citrate is a white to pale yellow, taking clomid after 40 odorless, crystalline powder. It is freely soluble in methanol; soluble in ethanol; slightly soluble in acetone, water, and chloroform; and insoluble in ether.
Each white scored tablet contains 50 mg clomiphene citrate USP. The tablet also contains the following inactive ingredients: Clomid is a drug of considerable pharmacologic potency. With careful selection and proper management of the patient, Clomid has been demonstrated to be a useful therapy for the anovulatory patient desiring pregnancy. Clomiphene citrate is capable of interacting with estrogen-receptor-containing tissues, including the hypothalamus, pituitary, ovary, endometrium, vagina, and cervix.
It may compete with estrogen for estrogen-receptor-binding sites and may delay replenishment of intracellular estrogen receptors. Clomiphene citrate initiates a series of endocrine events culminating in a preovulatory gonadotropin surge and subsequent follicular rupture.
The first endocrine event in response to a course of clomiphene therapy is an increase in the release of pituitary gonadotropins.
This initiates steroidogenesis and folliculogenesis, taking clomid after 40, resulting in growth of the ovarian follicle and an increase in the circulating level of estradiol.
Following ovulation, plasma progesterone and estradiol rise and fall as they would in a normal ovulatory cycle. Available data suggest that both the estrogenic and antiestrogenic properties of clomiphene may participate in the initiation of ovulation. The two clomiphene isomers have been found to have mixed estrogenic and antiestrogenic effects, taking clomid after 40, which may vary from one species to another.
Some data suggest that zuclomiphene has greater estrogenic activity than enclomiphene. Clomiphene citrate has no apparent progestational, androgenic, or antiandrogenic effects and does not appear to interfere with pituitary-adrenal or pituitary-thyroid function. Although there is no evidence of a "carryover effect" of Clomid, spontaneous ovulatory menses have been noted in some patients after Clomid therapy.
Based on early studies with 14 C-labeled clomiphene citrate, the drug was shown to be readily absorbed orally in humans and excreted principally in the feces.
Some 14 C label was still present in the feces 6 weeks after administration. Subsequent single-dose studies in normal volunteers showed that zuclomiphene cis has a longer half-life than enclomiphene trans.
Detectable levels of zuclomiphene persisted for longer than a month in these subjects. This may be suggestive of stereo-specific enterohepatic recycling or sequestering of the zuclomiphene. Thus, it is possible that some active drug may remain in the body during early pregnancy in women who conceive in the menstrual taking clomid after 40 during Clomid therapy.
There were a total of pregnancies reported during the clinical trial period. Of those pregnancies, information on outcome was only available for of the cases. Table 1 summarizes the outcome of these cases. Of the reported pregnancies, the incidence of multiple pregnancies was 7. Of the twin pregnancies for which sufficient information was available, taking clomid after 40, the ratio of monozygotic to dizygotic twins was about 1: Table 1 reports the survival rate of the live multiple births.
A sextuplet birth was reported after completion of original clinical studies; none of the sextuplets survived each weighed less than galthough each appeared grossly normal. The following fetal abnormalities have been reported subsequent to pregnancies following ovulation induction therapy with Clomid during clinical trials.
Congenital heart lesions, Down syndrome, club foot, congenital gut lesions, hypospadias, microcephaly, harelip and cleft palate, congenital hip, hemangioma, undescended testicles, polydactyly, conjoined twins and teratomatous malformation, patent ductus arteriosus, amaurosis, taking clomid after 40, arteriovenous fistula, inguinal hernia, umbilical hernia, syndactyly, pectus excavatum, myopathy, dermoid cyst of scalp, omphalocele, spina bifida occulta, ichthyosis, taking clomid after 40, and persistent lingual frenulum.
The overall incidence of reported congenital anomalies from pregnancies associated with maternal Clomid ingestion during clinical studies was within the range of that reported for the general population. Clomid is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. Impediments to achieving pregnancy must be excluded or adequately treated before beginning Clomid therapy, taking clomid after 40.
Ovarian Hyperstimulation Syndromeamenorrhea-galactorrhea syndrome, glucophage advanced guestbook 2.3.3 amenorrhea, post-oral-contraceptive amenorrhea, and certain cases of secondary amenorrhea of undetermined etiology.
Properly timed coitus in relationship to ovulation is important. A basal body temperature graph or other appropriate tests may help the patient and her physician determine if ovulation occurred.
Once ovulation has been established, each course of Clomid should be started on or about the 5th day of the cycle. Long-term cyclic therapy is not recommended beyond a total of about six cycles including three ovulatory cycles.
Clomid is indicated only in patients with demonstrated ovulatory dysfunction who meet the conditions described below:. In addition, patients selected for Clomid therapy should be evaluated in regard to the following:, taking clomid after 40. There are no adequate or well-controlled studies red meat alcohol and cancer demonstrate the effectiveness of Clomid in the treatment of male infertility.
In addition, testicular tumors and gynecomastia have been reported in males using clomiphene. The cause and effect relationship between reports of testicular tumors and the administration of Clomid is not known.
Although the medical literature suggests various methods, there is no universally accepted standard regimen for combined therapy ie, Clomid in conjunction with other ovulation-inducing drugs, taking clomid after 40. Similarly, there is no standard Clomid regimen for ovulation induction in in vitro fertilization programs to produce ova for fertilization and reintroduction.
Therefore, Clomid is not recommended for these uses. Clomid coumadin interaction with alcohol cranberry garlic contraindicated in patients with a known hypersensitivity or allergy to clomiphene citrate or to any of its ingredients.
Clomid use in pregnant women is contraindicated, as Clomid does not offer benefit in this population. Available human data do not suggest an increased risk for congenital anomalies above the background population risk when used as indicated. However, animal reproductive toxicology studies showed increased embryo-fetal loss and structural malformations in offspring. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential risks to the taking clomid after 40. Patients should be advised that blurring or other visual symptoms such as spots taking clomid after 40 flashes scintillating scotomata may occasionally occur during therapy with Clomid.
These visual symptoms increase taking clomid after 40 incidence with increasing total dose or therapy duration.
These visual disturbances are usually reversible; however, cases of prolonged visual disturbance have been reported with some occurring after Clomid discontinuation. The visual disturbances may be irreversible, especially with increased dosage or duration of therapy. Can diabetes affect your muscles should be warned that these visual symptoms may render such activities as driving a car or operating machinery more hazardous than usual, taking clomid after 40, particularly under conditions of variable lighting.
These visual symptoms appear to be due to intensification and prolongation of afterimages. Symptoms often first appear or are accentuated with exposure to a brightly lit environment. While measured visual acuity usually has not been affected, a study patient taking mg Clomid daily developed visual blurring on the 7th day of treatment, which progressed to severe diminution of visual acuity by the 10th day.
No other abnormality was found, taking clomid after 40, and the visual acuity returned to normal on the 3rd day after treatment was stopped. Ophthalmologically definable scotomata and retinal cell function electroretinographic changes have also been reported. A patient treated during clinical studies developed phosphenes and scotomata during prolonged Clomid administration, which disappeared by the 32nd day after stopping therapy. While the etiology of these visual symptoms is not yet understood, patients with any visual symptoms should discontinue treatment and have a complete ophthalmological evaluation carried out promptly.
The ovarian hyperstimulation syndrome OHSS has been reported to occur in patients receiving clomiphene citrate therapy for ovulation induction. OHSS may progress rapidly within 24 hours to several days and become a serious medical disorder. In some cases, OHSS occurred following cyclic use of clomiphene citrate therapy or when clomiphene citrate was used in combination with gonadotropins. Transient liver function test abnormalities suggestive of hepatic taking clomid after 40, which may be accompanied by morphologic changes on liver biopsy, have been reported in association with OHSS.
OHSS is a medical event distinct from uncomplicated ovarian enlargement. The clinical signs of this syndrome in severe cases can include gross ovarian enlargement, taking clomid after 40, gastrointestinal symptoms, ascites, dyspnea, oliguria, and pleural effusion. In addition, the following symptoms have been reported in association with this syndrome: The early warning signs of OHSS are abdominal pain and distention, nausea, taking clomid after 40, vomiting, diarrhea, and weight gain.
Elevated urinary steroid levels, varying degrees of electrolyte imbalance, hypovolemia, hemoconcentration, and hypoproteinemia may occur. Death due to hypovolemic shock, hemoconcentration, or thromboembolism has occurred. Due to fragility of enlarged ovaries in severe cases, abdominal and pelvic examination should be performed very cautiously.
If conception results, rapid progression to the severe form of the adrenal high blood pressure may occur. To minimize the hazard associated with occasional abnormal ovarian enlargement associated with Clomid therapy, the lowest dose consistent with expected clinical results should be used.
Maximal enlargement of the ovary, whether physiologic or abnormal, may not occur until several days after discontinuation of the recommended dose of Clomid. Some patients with polycystic ovary syndrome who are unusually sensitive to gonadotropin may have an exaggerated response to usual doses of Clomid. If enlargement of the ovary occurs, additional Clomid therapy should not be given until the ovaries have returned to pretreatment size, and the dosage or duration of the next course should be reduced.
Ovarian enlargement and cyst formation associated with Clomid therapy usually regresses spontaneously within a few days or weeks after discontinuing treatment.
The potential benefit of subsequent Clomid therapy in these cases should exceed the risk. Unless surgical indication for laparotomy exists, such cystic enlargement should always be managed conservatively. A causal relationship between ovarian hyperstimulation and ovarian cancer has not been determined. However, because a correlation between ovarian cancer and nulliparity, infertility, and age has been suggested, if ovarian cysts do not regress spontaneously, a thorough evaluation should be performed to rule out the presence of ovarian neoplasia.
Careful attention should be given to the selection of candidates for Clomid therapy. The purpose and risks of Clomid therapy should be presented to the patient before starting treatment. It should be emphasized that the goal of Clomid therapy is ovulation for subsequent pregnancy. The physician should counsel the patient with special regard to the following taking clomid after 40 risks:.
Advise that blurring or other visual symptoms occasionally may occur during or shortly after Clomid therapy. It should be made clear to the patient that, in some instances, visual disturbances may be prolonged, and possibly irreversible, especially with increased dosage or duration of therapy. Warn that visual symptoms may render such activities as driving a car or operating machinery more hazardous than usual, particularly under conditions of variable lighting see WARNINGS.
The patient should be me against the world-simple plan to inform the physician whenever any unusual visual symptoms occur. If the patient has any visual symptoms, treatment should be discontinued and complete ophthalmologic evaluation performed. Ovarian enlargement may occur during or shortly after therapy with Clomid.