Tamoxifen is a general name for a drug with the brand name of Nolvadex. It is approved by the FDA for the treatment of breast cancer, and the prevention of breast cancer in high risk patients. Although tamoxifen can be an effective and important drug for breast cancer treatment, there are many potential side effects and drug interactions associated with tamoxifen.
What is Tamoxifen
Tamoxifen is an oral medication (a pill) that works on hormone receptive or hormone positive breast cancer. It is a SERM, which means it serves to block or activate the hormone estrogen, depending on the type of cell the estrogen is impacting. This is useful in breast cancer treatment for hormone receptive breast cancer, because tamoxifen blocks estrogen from acting on breast cells. Tamoxifen also activates estrogen in liver cells or bone cells, so it can help to lower cholesterol or strengthen bones and prevent osteoporosis in post-menopausal women with low estrogen levels.
Benefits
Tamoxifen has proven very successful at treating cancers, since it first received FDA approval in 1998, especially in pre-menopausal women and post-menopausal women who can't take an aromatase inhibitor (another form of hormone therapy).
Tamoxifen can be used as a form of neo-adjuvant therapy, administered before surgery to shrink hormone receptive tumors so the tumor can be removed surgically.
Tamoxifen is used in women with early-stage breast cancer that is hormone receptor positive. It is offered as a form of treatment after surgery, chemotherapy and radiation. Its purpose is not to cure cancer in these women (surgery, chemotherapy and radiation are curative treatments) but to prevent recurrence.
Pre-menopausal women who take tamoxifen after early stage breast cancer have a 40 percent to 50 percent reduced risk of recurrent breast cancer than women not prescribed tamoxifen. Post-menopausal women have a 30 to 50 percent reduced risk. Tamoxifen also reduces the chances of cancers originating in the other breast by 50 percent.
Tamoxifen is also prescribed in women with Stage IV metastatic breast cancer. Stage IV breast cancer is incurable, but women whose cancer is hormone receptive can sometimes be put into remission (become dormant) by tamoxifen. Tamoxifen can also slow the growth of metastatic breast cancers, or even cause the cancer to shrink- prolonging longevity.
Patients who have not developed breast cancer, but who are at a high risk for doing so, may also be prescribed tamoxifen. This includes women who are carriers of the BRAC-1 gene that has been linked to breast cancer, along with women with a strong family history of breast cancer and/or pre-cancerous califications in the breast.
Drug Interactions
As a hormone inhibitor, tamoxifen can adversely react with a number of different medications. These medications can prevent tamoxifen from working properly. Medications include Prozac, Paxil, Wellbutrin, Cardioquin, Cymbalta, Zoloft, Benadryl, Mellaril, Cordarone, Desyrel and Tagemt. If you are on tamoxifen, you should check with a doctor before taking any over-the-counter or prescription drugs to ensure the medication does not interfere with the beneficial effects of tamoxifen.
Side Effects
Tamoxifen may have many serious side effects. The most serious risks include blood clot, smoke and an increased risk of endometrial cancer. Symptoms of these serious side effects include abnormal vaginal bleeding, abnormal vaginal discharge, pelvic pain, swelling or tenderness in the legs, chest pain, difficulty breathing, numbness or weakness in the extremities, speech problems, comprehension problems, dizziness or headaches. Common side effects include bone pain, pain in the tumor, hot flashes, digestive upset, tiredness, irritability, depression, headaches, hair loss or thinning, irritated skin, constipation, or reduced sex drive.
Dosage
Tamoxifen is given in pill form. Some women take it for three to five years, and then switch to another hormone inhibitor (usually an aromatase inhibitor). Other women may take tamoxifen for five years or longer. The specific length of time and dosage depends on the patient.
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