Ovarian Hyperstimulation Syndrome 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 dysfunction, 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, 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, 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 syndrome 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.

Precautions General Careful attention should be given to the selection of candidates for Clomid therapy. Information for Patients 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 potential risks: Visual Symptoms 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 instructed 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.

To minimize the risks associated with ovarian enlargement, the patient should be instructed to inform the physician of any abdominal or pelvic pain, weight gain, discomfort, or distention after taking Clomid see WARNINGS. Metabolism Disorders Cases of hypertriglyceridemia have been reported. Multiple Pregnancy Inform the patient that there is an increased chance of multiple pregnancy, including bilateral tubal pregnancy and coexisting tubal and intrauterine pregnancy, when conception occurs in relation to Clomid therapy.

The potential complications and hazards of multiple pregnancy should be explained. Spontaneous Abortion and Congenital Anomalies Inform the patient that the available data suggest no increase in the rates of spontaneous abortion miscarriage or congenital anomalies with maternal Clomid use compared to rates in the general population. During clinical investigation, the experience from patients with known pregnancy outcome Table 1 shows a spontaneous abortion rate of Among the birth anomalies spontaneously reported as individual cases since commercial availability of Clomid, the proportion of neural tube defects has been high among pregnancies associated with ovulation induced by Clomid, but this has not been supported by data from population-based studies.

Drug Interactions Drug interactions with Clomid have not been documented. Carcinogenesis, Mutagenesis, Impairment of Fertility Long-term toxicity studies in animals have not been performed to evaluate the carcinogenic or mutagenic potential of clomiphene citrate. Oral administration of Clomid to male rats at doses of 0. Oral doses of 0. Clomid use in pregnant women is contraindicated, as Clomid treatment does not offer benefit in this population. Available human data do not suggest an increased risk for congenital anomalies above the background population risk.

Patients should be evaluated carefully to exclude ovarian enlargement or ovarian cyst formation between each treatment cycle. The next course of Clomid therapy should be delayed until these conditions have been excluded. Human data The available human data from epidemiologic studies do not show any apparent cause and effect relationship between clomiphene citrate periconceptual exposure and an increased risk of overall birth defects, or any specific anomaly. However, due to the small number of cases of congenital anomalies occurring in clomiphene citrate treated women, these epidemiologic studies were only able to rule out large differences in risk.

The studies did not consider factors associated with female subfertility and were unable to adjust for other important confounders. In addition, available data do not support an increased rate of spontaneous abortion among subfertile women treated with clomiphene citrate for ovulation induction. Newborn mice and rats injected during the first few days of life also developed metaplastic changes in uterine and vaginal mucosa, as well as premature vaginal opening and anovulatory ovaries.

These findings are similar to the abnormal reproductive behavior and sterility described with other estrogens and antiestrogens. No permanent malformations were observed in those studies. Also, rhesus monkeys given oral doses of 1. Nursing Mothers It is not known whether Clomid is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised if Clomid is administered to a nursing woman.

To improve your chance of becoming pregnant, you should have sexual intercourse while you are ovulating. Your doctor may have you take your temperature each morning and record your daily readings on a chart. This will help you determine when you can expect ovulation to occur.

In most cases, Clomid should not be used for more than 3 treatment cycles. If ovulation occurs but you do not get pregnant after 3 treatment cycles, your doctor may stop treatment and evaluate your infertility further. Store at room temperature away from moisture, heat, and light. What happens if I miss a dose? Call your doctor for instructions if you miss a dose of Clomid. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at What should I avoid? This medication may cause blurred vision.

Be careful if you drive or do anything that requires you to be alert and able to see clearly. Clomid side effects Get emergency medical help if you have any signs of an allergic reaction to Clomid: Some women using this medicine develop a condition called ovarian hyperstimulation syndrome OHSS , especially after the first treatment.

OHSS can be a life threatening condition. Call your doctor right away if you have any of the following symptoms of OHSS: Stop using Clomid and call your doctor at once if you have: Common Clomid side effects may include: This is not a complete list of side effects and others may occur.

Call your doctor for medical advice about side effects. Therapy should be initiated on or near the 5th day of the menstrual cycle, but may be started at any time in patients without recent uterine bleeding.

If ovulation occurs and pregnancy is not achieved, up to 2 additional courses of Clomid 50 mg orally once a day for 5 days may be administered. Each subsequent course may be started as early as 30 days after the previous course and after pregnancy has been excluded. Most patients ovulate following the first course of therapy. Usual Adult Dose for Lactation Suppression: Generally, one course of therapy is sufficient.

Usual Adult Dose for Oligospermia: Therapy is generally given over a period of several months. What other drugs will affect Clomid? Other drugs may interact with clomiphene, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

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Patients without abnormal vaginal bleeding. Congenital heart lesions, Down syndrome, club foot, clomid 100mg yahoo, congenital gut lesions, hypospadias, microcephaly, harelip and cleft palate, congenital hip, hemangioma, undescended testicles, polydactyly, conjoined twins and teratomatous malformation, patent ductus arteriosus, amaurosis, arteriovenous fistula, inguinal hernia, umbilical hernia, syndactyly, pectus excavatum, myopathy, clomid 100mg yahoo, dermoid cyst of scalp, omphalocele, spina bifida occulta, ichthyosis, and persistent lingual frenulum. Each subsequent course may be started as early as 30 days after the previous course and after pregnancy has been excluded. Some patients with polycystic ovary syndrome who are unusually sensitive to gonadotropin may have an exaggerated response to usual doses of Clomid. These visual disturbances are usually reversible; however, cases of prolonged visual disturbance have been reported with some occurring after Clomid discontinuation. Also, clomid 100mg yahoo, rhesus clomid given oral doses of 1. This will help you determine when you can expect ovulation to occur. Nursing Mothers It is not known whether Clomid is excreted in human milk. Carcinogenesis, Clomid, Impairment of Fertility Long-term toxicity studies in animals have not been performed to evaluate the carcinogenic or mutagenic potential of clomiphene citrate. Endometrial biopsy should always be performed prior to Clomid therapy in this yahoo. Clomid clomiphene is a non-steroidal fertility medicine. The potential yahoos and hazards of multiple pregnancy should be explained. Information for Patients The purpose and risks of Clomid therapy should be presented to the patient before starting treatment. OHSS is a medical event distinct from uncomplicated ovarian enlargement. Precautions General Careful attention should be given to the selection of candidates for 100mg therapy. 100mg patient treated during clinical studies developed phosphenes and scotomata during prolonged Clomid administration, which disappeared by the 32nd day after stopping therapy.

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Call your doctor right away if you have any of the following symptoms of OHSS: Seek emergency medical attention or call the Poison Help yahoo at How should I take Clomid? Further information Remember, clomid 100mg yahoo, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Clomid only for the yahoo prescribed, clomid 100mg yahoo. 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 clomid of endometriosis and endometrial carcinoma increases with age as does the incidence of ovulatory disorders. Clomid is indicated withdrawal symptoms from fluoxetine in patients with demonstrated ovulatory dysfunction who meet the conditions described below: Always consult your healthcare provider to ensure the information displayed on this page applies to 100mg personal circumstances. Nursing Mothers It is not known whether Clomid is excreted in human milk. Pregnancy Pregnancy Category X Clomid use clomid pregnant women is contraindicated, clomid 100mg yahoo, as Clomid does not offer benefit in this population. Talk to your doctor if you have concerns about the possible effects of Clomid on 100mg new pregnancy. Patients should have adequate levels of endogenous estrogen as estimated from vaginal smears, endometrial biopsy, assay of urinary estrogen, or from bleeding in response to progesterone.

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