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Binds with estrogen receptors in cytoplasm, increasing secretion of folliclestimulating hormone, luteinizing hormone, and gonadotropin in hypothalamus and pituitary gland. • As appropriate, review all other significant and life-threatening adverse reactions. • Inform patient that drug increases risk of multiple births, which heightens maternal risk. for 5 days starting any time in patients with no recent uterine bleeding; or 50 mg/day P. CNS: nervousness, insomnia, dizziness, light-headedness CV: vasomotor flushing EENT: visual disturbances GI: nausea; vomiting; abdominal discomfort, distention, and bloating GU: breast tenderness, ovarian enlargement, multiple pregnancies, birth defects in resulting pregnancies, ovarian hyperstimulation syndrome, uterine bleeding Instruct patient to immediately report signs and symptoms of ovarian hyperstimulation syndrome, including nausea, vomiting, diarrhea, abdominal or pelvic pain, and swelling in hands or legs. • Advise patient not to take drug if she is or may become pregnant. If ovulation doesn't occur, increase to 100 mg/day P. If patient doesn't respond after three courses, no further doses are recommended. Start next course of therapy as early as 30 days after previous course. 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They are structurally similar and are classified as selective modulators of estrogen receptors with mixed agonistic and antagonistic properties. This means that in certain tissue, they block the action of estrogen by binding to a receptor, while in other tissues could act as a real estrogen receptors activating. In men, both drugs act as anti-estrogens in their ability to interfere with estrogen negative feedback on the hypothalamus and stimulate the increased production of Gn RH (gonadotropin-releasing hormone). This will result in increased production of luteinizing hormone by the pituitary gland, which in turn can increase the production of testosterone by the testes. 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