General Considerations: The work-up and treatment of candidates for Clomiphene citrate therapy should be supervised by physicians experienced in management of gynecologic or endocrine disorders. Patients should be chosen for therapy with Clomiphene citrate only after careful diagnostic evaluation. The plan of therapy should be outlined in advance. Impediments to achieving the goal of therapy must be excluded or adequately treated before giving Clomiphene citrate.
Many patients will respond to 50 mg daily for 5 days. In the determination of a recommended starting dose schedule, efficacy must be balanced against potential adverse effects. For example, the data available so far suggest that ovulation and pregnancy are slightly more attainable on 100 mg/day for 5 days than on 50 mg/day for 5 days.
As the dosage is increased, however, ovarian hyperstimulation and other adverse affects may be expected to increase. Furthermore, although the data do not yet establish a relationship between dosage and multiple births, it would seem reasonable on pharmacologic grounds that such a relationship does exist.