What is the recommended dosing for Clomid (clomiphene citrate)?

Recommended Dosing for Clomid (Clomiphene Citrate)

The recommended dosing for Clomid (clomiphene citrate) is to start with 50 mg daily for 5 days, beginning on day 5 of the menstrual cycle, and only increase to 100 mg daily for 5 days if ovulation does not occur after the first course. 1

Standard Dosing Protocol

• Initial treatment should begin with a low dose of 50 mg daily (1 tablet) for 5 days, typically starting on or about the 5th day of the menstrual cycle 1
• If progestin-induced bleeding is planned or spontaneous uterine bleeding occurs, the regimen should start on approximately day 5 of the cycle 1
• In patients with no recent uterine bleeding, therapy may be started at any time 1
• When ovulation occurs at the 50 mg dosage, there is no advantage to increasing the dose in subsequent cycles 1

Dose Escalation

• If ovulation does not occur after the first course of therapy (50 mg daily for 5 days), a second course of 100 mg daily for 5 days should be given 1
• The second course may be started as early as 30 days after the previous one, after excluding pregnancy 1
• Increasing the dosage or duration beyond 100 mg/day for 5 days is not recommended 1
• The majority of patients who will respond to Clomid will do so after the first course of therapy 1

Duration of Treatment

• If ovulation does not occur after three courses of therapy, further treatment with clomiphene citrate is not recommended 1
• If three ovulatory responses occur but pregnancy has not been achieved, further treatment is also not recommended 1
• Long-term cyclic therapy is not recommended beyond a total of about six cycles 1

Special Considerations

• A low dosage or shorter duration of treatment is particularly recommended for patients with suspected unusual sensitivity to pituitary gonadotropin, such as those with polycystic ovary syndrome, to reduce risk of ovarian hyperstimulation syndrome 1
• For women who do not respond to standard protocols, alternative approaches such as the "stair-step" protocol may be considered, which can reduce time to ovulation by 32-53 days compared to traditional regimens 2
• The stair-step protocol involves starting with 50 mg for 5 days, then immediately increasing to 100 mg for 5 days if no response, and finally to 150 mg for 5 days if still no response, without waiting for a new cycle 2

Monitoring

• Appropriate tests to determine ovulation should be used during treatment 1
• Patients should be evaluated carefully between treatment cycles to exclude pregnancy, ovarian enlargement, or ovarian cyst formation 1
• Ovulation most often occurs 5-10 days after completing a course of clomiphene citrate 1
• Coitus should be timed to coincide with the expected time of ovulation 1

Treatment Outcomes

• At doses between 50-250 mg per day, clomiphene citrate is effective for inducing ovulation in oligo-ovulatory women 3
• After 3 ovulations with clomiphene citrate, approximately 50% of patients can be expected to conceive 4
• The dose-dependent ovulation rate is higher with the stair-step protocol (64% at 100 mg) compared to traditional regimens (22%) 2

Potential Risks

• Multiple pregnancy is a potential risk of clomiphene citrate treatment 3
• Patients should be monitored for ovarian hyperstimulation syndrome, particularly those with polycystic ovary syndrome 1
• Long-term use beyond six cycles is not recommended due to potential risks 1