My sister has been taking Serophene (clomiphene citrate tablets) and still has not become pregnant, so her doctor increased the dosage. Her dosage was 100mg a day, and now it is 150mg. Her pharmacist was very concerned about this. The pharmacist told her that no one has ever taken this much, and their medical book gives the warning never to exceed 100mg, but it does not tell why. What are the repercussions of taking over 100mg of this drug?

Tracey

In order to answer this question meaningfully for your sister's case, I would need more information about your sister's age, fertility risk factors, laboratory test results, fallopian tube status, and more. For more general background, though, I can provide some guidelines that I use when prescribing clomiphene.

Clomiphene works best for women of normal weight who do not ovulate regularly. Other causes for absent or irregular menses must be considered before beginning the medication. When used in women who already have regular ovulatory cycles, it is rarely helpful and may actually decrease fertility. For women with unexplained infertility, the use of injectable medications to stimulate the growth of multiple eggs combined with intrauterine insemination (IUI) gives the best result. In younger women I will consider a few cycles of clomiphene and IUI.

Most successful cases occur within three or four cycles of treatment. In fact, 85 percent of the pregnancies occur in the first three months. Rarely will I recommend more than four months. Some physicians also recommend one or two months at 50mg, then one to two months at 100mg, increasing the dose every two months up to about 250mg each month. While 150mg is likely a safe dose to use, rarely is it effective if the cycle has been monitored at the lower doses. Monitoring requires checking the ovaries at the beginning of each month to ensure they are not enlarged. Then blood testing is done to check the LH/FSH response on or about cycle day 9 during the first month. Then urine LH testing is started; if there is no surge after five or six days, an ultrasound is performed to check and see whether follicles are growing. You can learn more about clomiphene therapy at my website.