Clomiphene citrate

Adashi EY (1984) Clomiphene citrate mechanism(s) and site(s) of action - a hypothesis revisited. Fertil Steril 42 331-344... 

Kilic-Okman T, Kucuk M, Altaner S (2003) Comparison of the effects of letrozole and clomiphene citrate on ovarian follicles, endometrium, and hormone levels in the rat. FertilSteril 80 1330-1332... 

Messinis IE, Templeton A (1990) Anti-oestrogen effect of clomiphene citrate in oestrogen-treated, hypogonadal women. Hum Reprod 5 150-152... 

Miyake A, Tasaka K, Sakumoto T, Kawamura Y, Nagahara Y, Aono T (1983) Clomiphene citrate induces luteinizing hormone release through hypothalamic hormone-releasing hormone in vitro. Acta Endocrinol 103 289-292... 

Shimizu I, Terakawa N, Aono T, Tanizawa O, Matsumoto K (1986) Clomiphene citrate induces pituitary GnREl receptors in ovariectomized rats possible role in induction of ovulation. Acta Endocrinol 111 179-184... 

Clomiphene citrate is used as a mixture of E (58) and Z (60) isomers to treat infertility. Photolysis of a chloroform solution with a high-pressure mercury lamp gave the expected phenanthrenes (59) and (61), which were separated and identified by GC-MS. Study of the separate isomers (58) and (60) indicated that rapid cis-trans photoisomerization preceded ring closure so that each gave a mixture of phenanthrenes (60) and (61) (Scheme 2.2) [52],... 

Determination of cis-trans isomer ratio in clomiphene citrate... 

DETERMINATION OF CIS-TRANS ISOMER RATIO IN CLOMIPHENE CITRATE... 

Procedure Dissolve accurately 22.5 mg of /ram-clomiphene citrate and 52.5 mg of cis-clomiphene citrate (approx. 1 2.3) into 10 ml of DW in a clean 50 ml separating funnel. Add to it 1 ml solution of sodium hydroxide (5% w/v in DW). In the alkaline medium the base is liberated which is extracted successively with 3 portions of solvent ether (10 ml each). The combined ethereal layer is washed with two portions of DW (10 ml each). The resulting ethereal fraction is dried over anhydrous sodium sulphate, filter, evaporate to diyness carefully over an electric water-bath and dissolve the residue in 1 ml of CS2. Now, record the absorption curve in a 0.2 mm cell over the range 12.50 to 14.00 pm. Calculate the absorbance for the peaks at 13.16 and 13.51 pm respectively by employing the base-line method (see section 3. l. B in this chapter) between the minima at 12.66 and 13.89 pm. 

Finally, repeat the assay with a 1 1 mixture (75 mg) of cis and /raws-clomiphene citrates and also with clomiphene citrate (75 mg) as such. Thus, calculate the ratio as follows ... 

A systematic review of 4 studies in the Cochrane database concludes that clomiphene citrate (at doses between 50-250 mg per day) is an effective method of inducing ovulation and improves fertility in oligo-ovulatory women. However adverse effects include... 

A conventional treatment algorithm involving clomiphene citrate (CC) followed by FSH induction of ovulation may result in a 71% cumulative single-ton live birth rate. In attempts to improve treatment outcome further and reduce complication rates, new compounds such as insulin-sensitizing agents or aro-matase inhibitors (Letrozole) are currently used increasingly. 

Abdelmageed E, Fayed M, Sharaf M. Letrozole induction of ovulation in clomiphene citrate resistant polycystic ovary syndrome responders and non-responders. Middle East Fertility Soc J 2004 9 2. 

Ovulation stimulants, synthetic clomiphene citrate gonadorelin acetate... 

Recommended dosage and monitoring requirements According to Micromedex, the usual starting dose of Follistim is 150 to 225 lU per day injected intramuscularly or subcutaneously, adjusted accordingly on an individual basis. The initial dose of 75 lU per day for 7 to 14 days is employed in anovulatory women who have not responded to clomiphene citrate treatment. The initial dose of 150 lU per day, followed by a maintenance dose of 75 to 375 lU per day for 6 to 12 days, is employed for controlled ovarian hyperstimulation followed by assisted reproduction. 

Clomiphene citrate, a partial estrogen agonist, is closely related to the estrogen chlorotrianisene (Figure 40-3). This compound is well absorbed when taken orally. It has a half-life of 5-7 days and is excreted primarily in the urine. It exhibits significant protein binding and enterohepatic circulation and is distributed to adipose tissues. 

In another study, the adverse effects of the antiestrogenic effects of clomiphene citrate were hot flushes (10%), mood swings, depression, headaches (1%), pelvic pain (5.5%), nausea (2%), breast tenderness (2-5%), dryness and loss of hair (0.3%), visual symptoms, halos and streaks around lights (particularly at night), blurring, and scotoma (1.5%) (3). 

Greenland S, Ackerman DL. Clomiphene citrate and neural tube defects a pooled analysis of controlled epidemiologic studies and recommendations for future studies. Fertil Steril 1995 64(5) 936-41. 

Kistner RW. The use of clomiphene citrate in the treatment of anovulation. Semin Drug Treat 1973 3(2) 159-76. 

World Health Organization. A double-blind trial of clomiphene citrate for the treatment of idiopathic male infertility. Int J Androl 1992 15(4) 299-307. 

Matthews GJ, Goldstein M, Henry JM, Schlegel PN. Nonbacterial pyospermia a consequence of clomiphene citrate therapy. Int J Fertil Menopausal Stud 1995 40(4) 187-91. 

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