What is clomiphene? Clomiphene is a non-steroidal fertility medicine. It causes the pituitary gland to release hormones needed to stimulate ovulation (the release of an egg from the ovary). Clomiphene is used to cause ovulation in women with certain medical conditions (such as polycystic ovary syndrome) that prevent naturally occurring ovulation. Clomiphene may also be used for purposes not listed in this medication guide. Warnings Do not use clomiphene if you are already pregnant. You should not use clomiphene if you have: liver disease, unexplained abnormal vaginal bleeding, an uncontrolled adrenal gland or thyroid disorder, an ovarian cyst (unrelated to polycystic ovary syndrome), or if you are pregnant. Before taking this medicine You should not use clomiphene if you are allergic to it, or if you have: unexplained abnormal vaginal bleeding; an ovarian cyst that is not related to polycystic ovary syndrome; past or present liver disease; a pituitary gland or other brain tumor; an untreated or uncontrolled problem with your thyroid or adrenal gland; or if you are pregnant. To make sure clomiphene is safe for you, tell your doctor if you have: endometriosis or uterine fibroids. Do not use clomiphene if you are already pregnant. Talk to your doctor if you have concerns about the possible effects of this medicine on a new pregnancy. Clomiphene can pass into breast milk and may harm a nursing baby. This medication may slow breast milk production in some women. Tell your doctor if you are breast-feeding a baby. Using clomiphene for longer than 3 treatment cycles may increase your risk of developing an ovarian tumor. Ask your doctor about your specific risk. Higher doses of clomiphene can also lead to visual disturbances, which may be irreversible, or a condition called ovarian hyperstimulation syndrome (OHSS). OHSS can be a life threatening condition. Symptoms include abdominal pain, bloating, nausea, weight gain, and trouble breathing. Fertility treatment may increase your chance of having multiple births (twins, triplets). These are high-risk pregnancies both for the mother and the babies. Ask your doctor about this risk. How should I take clomiphene? Use clomiphene exactly as directed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended. Your doctor will perform medical tests to make sure you do not have conditions that would prevent you from safely using clomiphene. Clomiphene is usually taken for 5 days, starting on the 5th day of your menstrual period. Follow your doctor's instructions. You will need to have a pelvic examination before each treatment cycle. You must remain under the care of a doctor while you are using this medicine. You will most likely ovulate within 5 to 10 days after you take clomiphene. To improve your chance of becoming pregnant, you should have sexual intercourse while you are ovulating. Follow your doctor’s instructions regarding timed intercourse. Your doctor may have you use over-the-counter ovulation tests or check 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, clomiphene should not be used for more than 3-6 treatment cycles (3 ovulatory 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 clomiphene. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose may result in nausea, vomiting, hot flashes, blurring or spots in your vision, or abdominal pain. 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. Clomiphene side effects Get emergency medical help if you have any signs of an allergic reaction to clomiphene: hives; difficult breathing; swelling of your face, lips, tongue, or throat. 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: stomach pain, bloating; nausea, vomiting, diarrhea; rapid weight gain, especially in your face and midsection; little or no urinating; or pain when you breathe, rapid heart rate, feeling short of breath (especially when lying down). Stop using clomiphene and call your doctor at once if you have: pelvic pain or pressure, enlargement in your pelvic area; vision problems; seeing flashes of light or "floaters" in your vision; increased sensitivity of your eyes to light; or heavy vaginal bleeding. Common clomiphene side effects may include: flushing (warmth, redness, or tingly feeling); breast pain or tenderness; headache; or breakthrough bleeding or spotting. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Clomiphene side effects (more detail) Dosing information Usual Adult Dose for Ovulation Induction: 50 mg orally once a day for 5 days. 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 clomiphene 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. However, if the patient fails to ovulate, a second course of 100 mg/day for 5 days may be given as early as 30 days following the initial course. A third course of 100 mg/day for 5 days may be given after 30 days, if necessary.   What other drugs will affect clomiphene? 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.

What is clomipramine? Clomipramine is a tricyclic antidepressant that is used to treat symptoms of obsessive-compulsive disorder (OCD), such as recurrent thoughts or feelings and repetitive actions. Clomipramine is for use in adults and children at least 10 years old. Clomipramine may also be used for purposes not listed in this medication guide. Warnings You should not use clomipramine if you have recently had a heart attack. Do not use this medicine if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor. Before taking this medicine You should not use clomipramine if you are allergic to it, or if you have: you have recently had a heart attack; or you are allergic to antidepressants such as amitriptyline, amoxapine, trimipramine, desipramine, doxepin, imipramine, nortriptyline, or protriptyline. Do not use clomipramine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others. Tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone. Tell your doctor if you have ever had: liver disease; kidney disease; bipolar disorder (manic-depression), schizophrenia or other mental illness; alcoholism; a seizure or a head injury; heart disease; low blood pressure; narrow-angle glaucoma; overactive thyroid or adrenal gland tumor (pheochromocytoma or neuroblastoma); or urination problems. Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. These medicines may interact with clomipramine and cause a serious condition called serotonin syndrome. Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms. Tell your doctor if you are pregnant or plan to get pregnant. Taking this medicine during late pregnancy may cause withdrawal symptoms in the newborn. You should not breastfeed while using clomipramine. How should I take clomipramine? Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 4 weeks of treatment. Call your doctor if your symptoms do not improve, or if they get worse. If you need surgery, tell your surgeon you currently use clomipramine. You may need to stop for a short time. Do not stop using clomipramine suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine. Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use. What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of clomipramine can be fatal. Overdose symptoms may include irregular heartbeats, feeling restless or agitated, confusion, severe sweating, slow or jerky muscle movements, extreme drowsiness, slow breathing, feeling like you might pass out, seizure, or coma. What should I avoid while taking clomipramine? Avoid drinking alcohol. Dangerous side effects could occur. Avoid driving or hazardous activity until you know how clomipramine will affect you. Your reactions could be impaired. Clomipramine side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Seek medical treatment if you have a serious drug reaction that can affect many parts of your body. Symptoms may include: skin rash, fever, swollen glands, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Call your doctor at once if you have: low sodium level --headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady; blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights; confusion, extreme fear, thoughts of hurting yourself; pain or burning when you urinate; or a seizure (convulsions). Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea. Common side effects may include: feeling dizzy, drowsy, tired, or nervous; tremors, jerking muscle movements; sweating; changes in appetite or weight; urination problems; vision changes; or decreased sex drive, impotence, or difficulty having an orgasm. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Clomipramine side effects (more detail) Clomipramine dosing information Usual Adult Dose for Obsessive Compulsive Disorder: Initial dose: 25 mg orally once a day at bedtime Maintenance dose: 100 mg orally per day Maximum dose: 250 mg/day Comments: -The dose should be increased gradually, as tolerated, to 100 mg during the first 2 weeks. After the initial titration, the dose may be increased gradually over the next several weeks to a maximum of 250 mg/day. -During initial titration, this drug should be given in divided doses with meals to reduce gastrointestinal side effects. -During maintenance, the total daily dose may be given once a day at bedtime to minimize daytime sedation. -Dosage adjustments should be made to maintain the patient on the lowest effective dosage. Use: Treatment of obsessions and compulsions in patients with Obsessive-Compulsive Disorder (OCD) who have obsessions/compulsions that must cause marked distress, be time consuming, or significantly interfere with social/occupational functioning Usual Pediatric Dose for Obsessive Compulsive Disorder: 10 to 17 years: -Initial dose: 25 mg orally once a day at bedtime -Maintenance dose: May increase to 3 mg/kg or 100 mg orally per day, whichever is the smaller dose -Maximum dose: 3 mg/kg/day or 200 mg/day, whichever is the smaller dose Comments: -During initial titration, this drug should be given in divided doses with meals to reduce gastrointestinal side effects. -After titration, the total daily dose may be given once a day at bedtime to minimize daytime sedation. -Dosage adjustments should be made to maintain the patient on the lowest effective dosage. Use: Treatment of obsessions and compulsions in patients with OCD who have obsessions/compulsions that must cause marked distress, be time consuming, or significantly interfere with social/occupational functioning Detailed Clomipramine dosage information What other drugs will affect clomipramine? Using clomipramine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures. Many drugs can affect clomipramine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.