Clomiphene
(
Clomid)
is a triphenylethylene derivative distantly related to
diethylstilbestrol. It acts as a selective estrogen receptor modulator,
similar to tamoxifen and raloxifene. All three drugs are competitive
inhibitors of estrogen binding to estrogen receptors and have mixed
agonist and antagonist activity depending upon the target tissue.
The commercially available form of
Clomiphene
(
Clomid) is the dihydrogen citrate salt (clomiphene citrate). It contains two stereoisomers: zu-
clomiphene (38 percent) and en-clomiphene (62 percent), which were originally called the cis-isomer and trans-isomer, respectively. En-
clomiphene is cleared rapidly, while zu-
clomiphene has a long half-life. The two
clomiphene isomers have mixed estrogenic and antiestrogenic effects that vary among species. Zu-
clomiphene appears to have greater estrogenic activity than en-
clomiphene.
14C-labeled
clomiphene
citrate
is absorbed by the gastrointestinal tract. Fifty percent of the oral
dose is excreted after five days, but radioactivity from labeled
clomiphene appears in the feces up to six weeks after administration. However, the pharmacologic effect of
clomiphene
citrate is brief.
SIDE EFFECTS
Side effects of clomiphene include:
-Ovarian hyperstimulation, ranging from mild, with enlarged ovaries
and abdominal discomfort, to moderate, additionally causing nausea,
vomiting, or shortness of breath, to severe and life-threatening.
- Hot flashes
-Irritability
- Nausea, abdominal pain
- Headaches
- Thick cervical mucus, which sperm cannot travel through. This can
be reversed with medicine or bypassed with intrauterine insemination
-Breast tenderness
-Blurred vision
- Hair loss (very rare)
Women who become pregnant after
clomiphene
therapy
have an approximately 5% to 8% chance of multiple pregnancy. 3 This
compares to a 1% to 2% chance in the general North American and
European population. 2 Multiples resulting from
clomiphene treatment are almost exclusively twins. Triplets are rare.