Indications & Dose: ANOVULATORY INFERTILITY PO Adult 20mg/day on 2-5 days of menstrual cycle, may increase to 80mg/day in subsequent cycles. In irregular menstruation, initial course may be begun on any day of menstrual cycle, if there is no response after 45 days starts with higher dose. If responds, subsequent courses may starts on 2nd day of cycle | BREAST CANCER Adjuvant therapy PO Adult 20mg/day in 2 divided doses or as single dose, max 40mg & continued for 5 yr | TO REDUCE BREAST CANCER INCIDENCE IN HIGH-RISK WOMEN PO Adult 20mg OD 5 yr

Precautions: Gynecologic effects, cataracts, thrombocytopenia, bone marrow suppression

ADR: Serious: HTN, arthritis, arthralgia, flushing, peripheral edema, angina, increases liver enzymes, thrombocytopenia, myalgia, cataract, anemia, osteoporosis, cardiovascular ischemia, vaginal hemorrhage, breast neoplasm, sinusitis, Others: abdominal pain, weight gain, constipation, anorexia, insomnia, dizziness, fatigue, headache, UTI, flu-like syndrome

DDI: Serious Allopurinol causes hepatotoxicity, Warfarin effects are increased, Anastrozole/Aminoglutethimide increases drug clearance, Rifampicin Increases drug metabolism, Doxorubicin/Cyclophosphamide/Methotrexate/Prednisone/Vincristine increases risk of thrombosis, Acitretin leads to bradycardia & prolongs QT interval, Phenytoin lowers drug level, SSRIs reduces drug metabolism

Diet: With/without food

Monitor: CBC, LFT, serum calcium, breast & gynecologic exams,ophthalmic exam, abnormal vaginal bleeding