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Indicationsanovulatory infertility-see notes above Cautionssee notes above; polycystic ovary syndrome (cysts may enlarge during treatment, also risk of exaggerated response to usual doses), ovarian hyperstimulation syndrome, uterine fibroids, ectopic pregnancy, incidence of multiple births increased (consider ultrasound monitoring), visual symptoms (discontinue and initiate ophthalmological examination) CSM AdviceThe CSM has recommended that clomifene should not normally be used for longer than 6 cycles (possibly increased risk of ovarian cancer) Contra-indicationsovarian cysts, hormone-dependent tumours or abnormal uterine bleeding of undetermined cause Hepatic impairmentavoid in severe liver disease Pregnancyexclude pregnancy before treatment; possible effects on fetal development Breast-feedingmay inhibit lactation Side-effectsvisual disturbances (withdraw), ovarian hyperstimulation (withdraw), hot flushes, abdominal discomfort, occasionally nausea, vomiting, depression, insomnia, breast tenderness, headache, intermenstrual spotting, menorrhagia, endometriosis, convulsions, weight gain, rashes, dizziness, hair loss
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