Gonadotropins (e.g., Fsh, Lh)Severe
Database
Significantly increased risk of severe ovarian hyperstimulation syndrome (OHSS) and multiple gestations due to additive or synergistic effects on ovarian stimulation.
Concurrent use is generally contraindicated or requires extreme caution and very close monitoring by a fertility specialist. Typically, these agents are used sequentially, not concurrently, to avoid overstimulation. If used sequentially, ensure careful monitoring of ovarian response before initiating the second agent.
Danazol suppresses gonadotropin release, which could theoretically antagonize the ovulation-inducing effects of clomiphene, potentially reducing its efficacy.
Avoid concurrent use if possible. If danazol is required, consider discontinuing clomiphene or using alternative ovulation induction strategies. Monitor for reduced efficacy of clomiphene.
LetrozoleModerate
Database
Increased risk of ovarian hyperstimulation syndrome (OHSS) and multiple gestations due to additive or synergistic effects on ovulation induction. Both drugs are used to stimulate ovulation.
Concurrent use is generally not recommended due to increased risk of OHSS and multiple gestations. If sequential use is considered, ensure adequate washout period and careful monitoring of ovarian response.
Oral ContraceptivesModerate
Database
Oral contraceptives suppress ovulation, directly counteracting the intended effect of clomiphene. This would render clomiphene ineffective.
Clomiphene should not be used concurrently with oral contraceptives. Patients must discontinue oral contraceptives before starting clomiphene treatment for ovulation induction.
TamoxifenModerate
Database
Increased risk of ovarian hyperstimulation syndrome (OHSS) and other estrogenic side effects due to additive or synergistic effects on estrogen receptors. Both drugs can stimulate ovulation.
Monitor closely for signs of OHSS and other estrogenic side effects. Consider lower doses of one or both drugs or separate administration if concurrent use is deemed necessary. Generally, concurrent use is avoided unless specifically indicated and carefully managed.
Corticosteroids (e.g., Prednisone)Mild
Database
Both clomiphene and corticosteroids can potentially affect glucose metabolism. While not a direct interaction, in patients predisposed to diabetes or with existing diabetes, there might be an additive effect on blood glucose levels.
Monitor blood glucose levels more closely in diabetic patients or those at risk for diabetes if both drugs are used concurrently. Adjust antidiabetic medication if necessary.
In women with PCOS, metformin can improve insulin sensitivity and ovulation. When combined with clomiphene, there may be an additive or synergistic effect on ovulation induction, potentially increasing the risk of OHSS or multiple gestations, though often beneficial for efficacy.
Monitor ovarian response carefully. While often used together beneficially in PCOS, the risk of OHSS and multiple gestations should be considered. Dosing of clomiphene may need adjustment.