Clomid (Clomiphene Citrate)
Also sold as: Clomid, Fertomid, Siphene, Ovofar, Clominor
Pregnancy
Cat X
Lactation
Avoid
Schedule
H
Forms
Tablet 25mg, 50mg, 100mg
Indications
- Ovulation induction in anovulatory infertility (first-line for PCOS-related anovulation)
- Unexplained infertility (empirical ovarian stimulation)
- Luteal phase defect
- Male infertility with hypogonadotropic hypogonadism (off-label — increases LH/FSH → testosterone)
Adult Dosing
Ovulation induction
50 mg PO once daily for 5 days (Day 2–6 of cycle, or Day 3–7)
Start with 50 mg. If no response (no ovulation by Day 14–18), increase to 100 mg in next cycle. Use follicular tracking (USS) in clinic. Maximum 6 cycles before considering other treatment.
PCOS ovulation induction
50–150 mg PO for 5 days (Day 2–6 of cycle)
Resistance common in PCOS — adjuncts: metformin, letrozole (now preferred over clomiphene in PCOS — PCOSACT trial)
Pediatric Dosing
Only for women of reproductive age
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | No dose adjustment required — hepatically metabolised and faecally excreted |
Hepatic Adjustment
Avoid in hepatic disease
Pregnancy & Lactation
Pregnancy: Category X
CONTRAINDICATED in pregnancy — ovulation inducer, not for use in confirmed pregnancy. Confirm patient is not pregnant before each cycle. Possible association with ovarian cancer (long-term use > 12 cycles — avoid excessive cycles).
Lactation: Avoid
Not indicated in breastfeeding women (breastfeeding suppresses ovulation — fertility treatment context)
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| No significant drug interactions | Relatively few drug interactions — SERM with limited CYP interaction profile | Minor |
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Side Effects
Common
- Hot flushes (vasomotor — SERM effect)
- Abdominal discomfort/bloating
- Breast tenderness
- Nausea
- Visual disturbances (blurred vision, flashes — stop drug if visual symptoms)
- Mood swings, irritability
- Multiple pregnancy risk (twins 7–10%; triplets < 1%)
Serious / Discontinue If
- Ovarian hyperstimulation syndrome (OHSS — abdominal pain, distension, rapid weight gain, nausea; usually mild with clomiphene; severe OHSS more common with gonadotrophins)
- Visual disturbances (may be irreversible — stop clomiphene if visual symptoms develop)
- Multiple pregnancy (premature birth, NICU risk)
- Ovarian cyst formation
Contraindications
- Liver disease
- Ovarian cysts (other than PCOS polycystic morphology)
- Undiagnosed uterine bleeding
- Hormone-dependent tumours
- Visual disturbances on previous clomiphene
- Pregnancy
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Fertomid 50mg | Cipla | 10 tab ₹125 |
| Siphene 50mg | Serum Institute | 10 tab ₹115 |
| Clomid 50mg | Sanofi | 10 tab ₹185 |
| Ovofar 50mg | Pharmos | 10 tab ₹95 |
Monitoring Required
- Day 10–14 follicular USS (transvaginal — monitors follicle development, size, endometrial thickness)
- Mid-luteal phase progesterone (Day 21 — confirms ovulation; > 30 nmol/L indicates ovulatory cycle)
- LH surge (urine LH kit or blood LH — to time intercourse/IUI)
- BMI monitoring (obesity reduces response)
Patient Counseling Points
- Take tablets at the same time each day for all 5 days (usually Day 2 or Day 3 of your period)
- Track your cycle — attend USS scan as instructed by your fertility specialist
- Hot flushes are common and temporary — similar to mild menopause symptoms
- ⚠️ Stop immediately and see your doctor if you develop blurred vision, flashes, or double vision — rare but serious
- Twin or triplet pregnancy is possible (7–10% chance with clomiphene) — discuss implications
- Clomiphene is recommended for a maximum of 6 cycles — discuss next steps if not successful (letrozole, IVF)
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Clinically reviewed by: Dr. Anitha Krishnamurti, DGO, DNB (Obstetrics & Gynaecology), Senior Consultant
Last reviewed: 2026-04-01
References
- ESHRE PCOS Guidelines 2023
- ASRM Ovulation Induction Guidelines
- PCOSACT Trial (NEJM 2014)
- BNF — Clomiphene
- FOGSI Infertility Management Guidelines