Symptoms: Mild to moderate toxicity: Includes flushing abdominal pain, ovarian enlargement, pelvic pain, nausea, vomiting, visual blurring, spots or flashes, and scotomata. Mild ovarian hyperstimulation symptoms include nausea, vomiting, diarrhea, and weight gain.
Severe toxicity: Severe ovarian hyperstimulation syndrome may include gross ovarian enlargement, ascites, dyspnea, oliguria, pleural effusion, pericardial effusion, anasarca, acute abdominal pain, hypotension, renal failure, pulmonary edema, intraperitoneal and ovarian hemorrhage, ovarian torsion, deep venous thrombosis, respiratory distress, electrolyte imbalances, hypovolemia, hypoproteinemia, hemoconcentration, and shock.
Maximal enlargement of the ovary may not occur until several days after discontinuation of the course of Clomifene citrate. Female patients of reproductive age who have taken an overdose should be observed for 2 or 3 weeks for ovarian enlargement.
Treatment: Most exposures are mild and require only supportive care. In severe toxicity, support respiratory and cardiovascular function as needed. For patients with severe ovarian hyperstimulation syndrome, initiate intravenous hydration, monitor fluid input and output, and initiate deep venous thrombosis prophylaxis.