The workup and treatment of candidates for CLOMID therapy should be supervised by physicians experienced in the management of gynecologic or endocrine disorders. Patients should be chosen for treatment with CLOMID only after careful diagnostic evaluation. The treatment plan should be outlined in advance.
Impediments to achieving the goal of treatment must be excluded or adequately treated before beginning CLOMID.
The therapeutic objective should be balanced with potential risks and discussed with the patient and others involved in the achievement of a pregnancy.
Ovulation most often occurs from 5 to 10 days after a course of CLOMID. Coitus should be timed to coincide with the expected time of ovulation. Appropriate tests to determine ovulation may be useful during this time.
Treatment of the selected patient should begin with a low dose, 50 mg daily (1 tablet) for five days.
The dose should be increased only in those patients who do not ovulate in response to cyclic 50 mg CLOMID.
A low dosage or duration of treatment course is particularly recommended if unusual sensitivity to pituitary gonadotropin is suspected, such as in patients with polycystic ovary syndrome.
If ovulation does not appear to occur after the first course of therapy, the second course of 100 mg daily (two 50 mg tablets given as a single daily dose) for five days should be given.
This course may be started as early as 30 days after the previous one after precautions are taken to exclude the presence of pregnancy.
Increasing the dosage or duration of therapy beyond 100 mg/day for five days is not recommended.
The majority of patients who are going to ovulate will do so after the first course of therapy. If ovulation does not occur after three sessions of treatment, further treatment with CLOMID is not recommended, and the patient should be reevaluated. If three ovulatory responses occur, but pregnancy has not been achieved, a new treatment is not recommended. If menses does not occur after an ovulatory response, the patient should be reevaluated. Long-term cyclic therapy is not recommended beyond a total of about six cycles.