Low dose Clomid & floaters

[davesavvy]

Does anyone know if the Clomid potential side effect of eye "floaters" is dose dependent? Would a low dose, say 12.5 mg, severely reduce the chance for floaters?

Any permanent side effect is very scary.

 

[Michael Scally MD]

See: https://thinksteroids.com/community/posts/672220 / https://thinksteroids.com/community/posts/665135

Regarding side effects, visual disturbances require immediate and prompt attention.In some cases, a migraine (headaches) equivalent may be diagnosed. In the more than 1000 patients I saw prescribed the SERMs tamoxifen and/or clomiphene, very few complained of visual disturbances or migraines/headaches. Tamoxifen was prescribed at 20-40 mg/day for no more than 45 days, while the clomiphene dose was 50-100 mg/day. In those that did, there was an immediate decrease in dose or discontinuation with almost daily follow up. None suffered any consequences.

The literature appears to indicate the visual side effects are related to dose and duration, although they may occur within a very short time. IMO, it is likely that the occurrence of persistent visual disturbance secondary to SERMs is underestimated. The following article is the best I can dig up discussing the drug-induced visual changes.

Because symptoms may not coincide temporally with the first course of clomiphene, the patient or the consulting physician may not suspect a possible causal relationship. The current prescribing information recommends discontinuing treatment if visual symptoms develop; however, clinicians may often disregard this advice owing to the reportedly benign nature of the visual disturbance. IMO, a mistake.


Toler SM. Oxidative Stress Plays an Important Role in the Pathogenesis of Drug-Induced Retinopathy. Exp Biol Med 2004;229(7):607-15. http://ebm.rsmjournals.com/cgi/content/full/229/7/607 (Oxidative Stress Plays an Important Role in the Pathogenesis of Drug-Induced Retinopathy -- Toler 229 (7): 607 -- Experimental Biology and Medicine)

Several pharmaceutical agents have been associated with rare but serious retinopathies, some resulting in blindness. Little is known of the mechanism(s) that produce these injuries. Mechanisms proposed thus far have not been embraced by the medical and scientific communities. However, preclinical and clinical data indicate that oxidative stress may contribute substantially to iatrogenic retinal disease. Retinal oxidative stress may be precipitated by the interaction of putative retinal toxins with the ocular redox system. The retina, replete with cytochromes P450 and myeloperoxidase, may serve to activate xenobiotics to oxidants, resulting in ocular injury. These activated agents may directly form retinal adducts or may diminish ocular reduced glutathione concentrations. Data are reviewed that suggest that indomethacin, tamoxifen, thioridazine, and chloroquine all produce retinopathies via a common mechanism--they produce ocular oxidative stress.


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