Adverse Reactions to SERMs

Ovarian enlargement is the most common side effect of clomiphene use. The occurrence of multiple births following ovulation induction with clomiphene is 4 to 9%; 90% of these multiple births are twins. Since clo-miphene is teratogenic, therapy should be discontinued if there is a chance that conception has occurred. Rarely, irreversible ocular toxicities have been reported with clomiphene use.

Nausea, vomiting, and hot flashes may accompany tamoxifen administration. Tamoxifen may cause a transient flare of tumor growth and increased pain due to bone metastases. These reactions are thought to be due to an initial estrogenic action of this drug. Mild or tran sient depression of platelet counts often occurs in patients receiving tamoxifen. At very high doses, generally no longer used in cancer treatment, ocular toxicity has been reported. There is a slight risk of hepatocellular carcinoma in humans receiving long-term (5 years) tamoxifen therapy as well as a slightly (0.4%) elevated incidence of endometrial cancer.

Raloxifene and clomiphene use is associated with an increased frequency of vasomotor disturbances (hot flashes) and thromboembolism formation.

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