Tamoxifen, under the brand names Nolvadex (Tamoxifen Pills) and Sultamox (Tamoxifen Syrup), is one of the oldest and most widely used hormones and selective estrogen receptor blockers used to treat certain types of breast cancer in both men and women. If you want to know more about the uses, how to use, side effects and important points of this anti-estrogen drug, stay with us until the end of the article.
Important points before taking tamoxifen
Taking tamoxifen may increase the risk of uterine cancer, liver cancer, stroke or blood clots in the lungs, which can be fatal. Do not use tamoxifen in the following cases:
- Allergy to tamoxifen;
- Use of anastrozole and letrozole;
- History of blood clots in the arteries or lungs;
- Use of blood thinners such as warfarin (coumadin).
Consult your doctor before taking tamoxifen:
- High triglycerides;
- History of cataracts;
- History of liver disease;
- History of stroke or blood clot;
- In case of chemotherapy or radiation therapy.
If you are taking tamoxifen to reduce the risk of breast cancer, you should take the first dose during your period. You should also take a pregnancy test before taking the medicine to make sure you are not pregnant. Your doctor may order a mammogram to make sure you have serious side effects, or may ask you to have initial tests and breast self-assessments. Liver function should also be evaluated. You should see your doctor regularly.
Uses of tamoxifen
Tamoxifen disrupts estrogen function. Certain types of breast cancer need estrogen to grow. Tamoxifen is used to treat some types of breast cancer in both men and women. It is also used to reduce the risk of breast cancer in women at high risk (such as a family history of breast cancer).
How to take tamoxifen
If your cancer has spread to other parts of the body, your bone pain or illness may flare up when you start taking tamoxifen. In some cases, this may be a good sign of a response to medication. These symptoms include increased bone pain, increased tumor size, or even the formation of a new tumor. These symptoms usually go away quickly. If any of these symptoms go away, see a doctor right away.
Dosage of tamoxifen
Tamoxifen for the treatment of breast cancer in adults
- Metastatic breast cancer (published) in men and women: 20 to 40 mg orally daily for 5 years. Doses above 20 mg should be taken in separate doses (morning and evening). It is used in premenopausal women as an alternative to oophorectomy or ovarian radiation therapy and is more suitable for people with estrogen receptor-positive tumors.
- Dosage for breast surgery and radiation therapy: 20 mg orally daily for 5 years. It is used locally for people with ductal carcinoma to prevent the cancer from spreading to other parts of the body.
- To reduce the incidence of breast cancer in women at high risk for breast cancer: 20 mg orally daily for 5 years.
- Taking tamoxifen As an adjunct medicine For breast cancer: 20 mg once daily or 10 mg twice daily for a maximum of 5 years. It is used to treat positive nodular breast cancer in postmenopausal women, followed by other treatments such as full or partial mastectomy, axillary surgery, or breast radiation therapy.
Tamoxifen for children with McCain-Albright syndrome and precocious puberty
- Girls 2 to 10 years old with McCain-Albright syndrome and precocious puberty: Once daily 20 mg orally for a maximum of 12 months.
Forget the dose
Take the missed dose as soon as you remember. If you are close to the next dose, skip the missed dose and avoid taking twice as much medicine. To prevent forgetfulness, you can take the medicine at a specific time each day.
If you have an overdose of tamoxifen and have symptoms such as fainting, irregular heartbeat, gait imbalance or shortness of breath, call the emergency room immediately (115).
Side effects of tamoxifen
Call the emergency room if you have symptoms of an allergic reaction to tamoxifen, including hives, difficulty breathing, swelling of the face, lips, tongue, and throat. Tamoxifen may increase the risk of stroke or blood clots. See your doctor in the following cases:
- Stroke symptoms: Sudden numbness or weakness, severe headache, slurred speech, difficulty seeing or balancing;
- Symptoms of blood clots in the lungs: Chest pain, cough or sudden shortness of breath, dizziness, bloody cough;
- Symptoms of a blood clot in the body: Pain, swelling or heat in one leg.
See a doctor immediately in the following cases:
- New mass in the breast;
- Pain or pressure in the pelvic area;
- Changes in menstrual periods;
- Unusual bleeding or vaginal discharge;
- Blurred vision, pain or redness of the eyes, seeing halos around the light;
- High blood calcium: Confusion, fatigue, nausea, vomiting, loss of appetite, constipation, increased thirst or urination, weight loss;
- Liver problems: Nausea, upper stomach pain, itching, tiredness, loss of appetite, dark urine, gray stools, jaundice.
Common side effects
- Muscular pain;
- Leg cramps;
- Thinning hair;
- Change of mood;
- skin dryness;
- Swelling, weight gain;
- Bleeding or vaginal discharge;
- Increased tumor or bone pain;
- Numbness or tingling of the skin;
- Decreased sexual ability or desire in men.
See your doctor if any of these effects persist or get worse.
You may experience hot flashes or night sweats while taking tamoxifen. Research shows that cancer is less likely to come back in these cases, which means that tamoxifen works well; However, consult your doctor about this.
These are not a complete list of side effects of the drug. Talk to your doctor about other side effects and get the necessary advice. Some people may not experience any of these side effects. Your doctor will prescribe tamoxifen depending on the benefits of the medication and the side effects.
Drug interaction with tamoxifen
Some medicines may interfere with the function of tamoxifen and should not be taken together. Drug interactions may reduce the effectiveness of the drug or increase the risk of side effects. Do not start or stop taking any medicine arbitrarily and do not change the dose of the medicine. Tell your doctor about all prescription, over-the-counter medications, vitamins, and herbal products.
The following medications may interact with tamoxifen:
- Blood thinners such as warfarin;
- Hormonal methods of fertility control such as birth control pills, patches or contraceptives.
The following medications may interfere with the removal of tamoxifen from the body:
- Antidepressants (such as fluoxetine, paroxetine);
- Epilepsy medications (such as caramazpin, phenobarbital, primidone).
Use in special cases
- Do not use tamoxifen if you are pregnant. This medicine may harm the fetus. Use contraceptive methods while taking this medicine and 2 months after the end of the treatment period. To prevent pregnancy, use only contraceptives such as condoms, diaphragms, vaginal caps, contraceptive sponges, and avoid hormonal contraceptive methods such as pills, ampoules, implants, skin tags, and vaginal rings.
- Avoid breastfeeding your baby while taking this medicine and 3 months after the last dose.
- Men taking tamoxifen should use reliable fertility control methods during treatment and for 6 months after stopping.
Benefits of using tamoxifen
The benefits of using this drug are as follows:
- Reduce the risk of breast cancer in women who have a high risk of breast cancer but have not yet been diagnosed;
- 40 to 50 percent reduction in the risk of recurrence of cancer in postmenopausal women and 30 to 50 percent in the premenopausal period;
- Reduce or stop the progression of hormone-receptor-positive breast cancer (metastasis) in postmenopausal women or earlier;
- Reduce the risk of developing new cancer in other types of breast cancer by about 50%;
- Size reduction in hormone receptor-positive breast cancer before surgery.
Tips on taking tamoxifen
- This drug may interfere with certain tests, such as a thyroid test, and cause a false result. In any case, inform your doctor about taking tamoxifen;
- Regularly perform clinical examinations, mammograms and monthly breast self-assessments while using this medicine;
- Store at room temperature away from moisture, heat, frost and light;
- Measure tamoxifen syrup with a suitable syringe or dose;
- Take the medicine according to the doctor’s prescription and instructions on the medicine;
- Discard tamoxifen syrup 3 months after opening the container;
- You can take this medicine without food or with it;
- Sometimes the drug lasts for 5 to 10 years.
Brand names of tamoxifen in Iran
The following is one of the brands of tamoxifen in Iran:
- Tamoxifen Iran Hormone Tablets 10 and 20 mg Noluamon Made by Iran Homoon Pharmacy.
Frequently Asked Questions
How does tamoxifen work?
Tamoxifen is an anti-estrogen drug that binds to the natural estrogen receptors on the cell to inhibit the stimulatory effects of estrogen for cancer growth.
What are the delayed side effects of tamoxifen?
People who take this medicine for a long time may be more likely to develop uterine cancer. See your doctor if you have vaginal bleeding or pelvic pain and pressure.
What can we do to prevent the side effects of tamoxifen?
- Drink plenty of fluids. Talk to your doctor about fluid intake;
- Wear as thin clothing as possible to keep you warm and keep your environment cool;
- Regularly perform tests and clinical examinations to diagnose side effects of the drug;
- Avoid heavy meals, take in nutrients, and get enough rest to prevent the symptoms of vomiting.
What happens if we do not take tamoxifen tablets?
Studies show that if 30% of the dose is not taken, the risk of dying from breast cancer increases to 16%.
What are the alternative drugs to tamoxifen to reduce the risk of breast cancer?
- Raloxifene, which is prescribed only for postmenopausal women and does not increase the risk of endometrial or uterine cancer. It may reduce the risk of invasive breast cancer by up to 40%;
- Aromatase inhibitors such as anastrozole and exemestane, which can lower estrogen levels in postmenopausal women.
Do you and those around you have experience with tamoxifen? How long have you used this medicine and what were its benefits and side effects? If you wish, you can write your experience and opinion in the comments section and share this article with your friends through social networks.