1499 DEFINING THE RATE OF TACHYPHYLAXIS IN PATIENTS USING DAILY CLOMIPHENE CITRATE

Abstract

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-Surgical Therapy1 Apr 20121499 DEFINING THE RATE OF TACHYPHYLAXIS IN PATIENTS USING DAILY CLOMIPHENE CITRATE Clarisse R. Mazzola, Nina Logmanieh, Darren J. Katz, and John P. Mulhall Clarisse R. MazzolaClarisse R. Mazzola New York City, NY More articles by this author , Nina LogmaniehNina Logmanieh New York City, NY More articles by this author , Darren J. KatzDarren J. Katz New York City, NY More articles by this author , and John P. MulhallJohn P. Mulhall New York City, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2021AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Clomiphene citrate (CC) has become an increasingly recognized pharmacotherapy for men with hypogonadism (HG). With a half-life of 5 days, concern has been expressed regarding tachyphylaxis. Clinical experience has demonstrated that this concern is real. This analysis was performed to define the prevalence of this phenomenon. METHODS Men with a diagnosis of HG, defined as two separate early morning total testosterone (TT) levels <300 ng/dl with ≥3 ‘yes' responses on the Morley questionnaire (MQ) were counseled about therapeutic options including transdermal and intramuscular testosterone as well as CC. Those opting for CC therapy constituted the study population. Demographic and comorbidity data were recorded as well as physical and laboratory characteristics. Patients were treated with CC 25mg daily and if necessary, were uptitrated to CC 50mg daily. Laboratory testing was conducted 4 weeks after commencement and every six months thereafter. Response was defined as an increase of ≥200 ng/dl in TT and a TT ≥400ng/dl. Tachyphylaxis was defined as return to 50ng/dl within baseline TT level ≥6 months after commencement of CC therapy. Student t-test was used to compare baseline and treatment TT levels. Chi-square analysis was used to compare MQ changes. RESULTS 116 men with mean age = 40±12 years were studied. Mean pre-treatment testicular volume = 15±4 mls. 42/116 had a varicocele. Mean baseline T and LH levels were 211±112 ng/dl and 6±3.6 IU/ml. Mean peak TT level on CC = 441±230 ng/dl. 66% met the responder definition, with a mean increase in TT levels = 230±114 (201-502) ng/dl. In CC responders, the mean peak LH rise was 5±2.4 IU/ml. 52% of men had improvement in ≥3 symptoms on the MQ (p<0.01). 7% (5 patients) met the definition of tachyphylaxis at a time point ≥ 6 months after starting CC. This was accompanied by a worsening in the symptoms on the MQ (p<0.05). 4/5 patients were switched to QOD CC dosing and 3/4 had a significant increase (<200ng/dl) in TT levels. Comparing those who did and did not develop tachyphylaxis, there were no significant differences in patient age, testicular volumes or varicocele presence between groups. CONCLUSIONS Daily CC dosing is associated with a low but distinct incidence of tachyphylaxis. There does not appear to be any reliable predictor of such tolerance. Changing patients to every other day dosing is a highly effective means of addressing this tachyphylactic response. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e607 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clarisse R. Mazzola New York City, NY More articles by this author Nina Logmanieh New York City, NY More articles by this author Darren J. Katz New York City, NY More articles by this author John P. Mulhall New York City, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...