Chemocare.com uses generic names in all descriptions of drugs. Nolvadex is the trade name for tamoxifen. In some cases, health care professionals may use the trade name Nolvadex when referring to the generic drug name tamoxifen.

Drug type: Tamoxifen is a hormone therapy. This medication is classified as an “anti-estrogen”

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Tamoxifen

What Tamoxifen Is Used For?

Tamoxifen may be given as adjuvant therapy (treatment after successful surgery) in women or men with lymph node negative or lymph node positive breast cancer. Cancers with positive estrogen and progesterone receptors are more likely to benefit from tamoxifen. Tamoxifen reduces the risk of getting breast cancer in the opposite breast.

Tamoxifen may be prescribed in metastatic (cancer that has spread) breast cancer in both women and men.

Tamoxifen may be prescribed in women with ductal carcinoma in situ (DCIS) who have completed surgery and radiation therapy. Tamoxifen may reduce the risk of invasive breast cancer. Risks and benefits of tamoxifen therapy should be discussed in this setting.

Tamoxifen may be prescribed for women at high risk of breast cancer to reduce the incidence of developing breast cancer. Risks and benefits of tamoxifen therapy should be discussed in this setting.

Tamoxifen may also be prescribed for treatment of ovarian cancer.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Tamoxifen Is Given:

Tamoxifen is a pill, given by mouth. The pill should be swallowed whole.

Tamoxifen should be taken at about the same time each day with a full glass of water. If you miss a dose, do not take a double dose the next day.

The amount of tamoxifen that you will receive depends on many factors, including your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose, schedule and duration of treatment.

Side Effects:

Important things to remember about the side effects of tamoxifen:

Most people do not experience all of the side effects listed.

Side effects are often predictable in terms of their onset and duration.

Side effects are almost always reversible and will go away after treatment is complete.

There are many options to help minimize or prevent side effects.

There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking tamoxifen:

  • Hot flashes (see sexuality)
  • Vaginal discharge (see sexuality)
  • Swelling (fluid retention in feet, ankles, or hands)
  • Loss of libido (particularly in men) (see sexuality)

These side effects are less common side effects (occurring in about 10-29%) of patients receiving tamoxifen:

  • Nausea
  • Menstrual irregularities
  • Vaginal bleeding
  • Weight loss
  • Mood changes (see anxiety and/or depression)

A rare, but serious side effect of tamoxifen is blood clots, including deep vein thrombosis (DVT) and pulmonary embolus. You should seek emergency help and notify your health care provider immediately if you develop sudden chest pain and shortness of breath. Notify your health care provider within 24 hours if you notice that one leg is swollen, red, painful and/or warm to touch and the other is not.

A rare, but serious side effect of tamoxifen can be the development of uterine cancer. Women who have not had a hysterectomy should have regular pap smears and gyn examinations. Abnormal vaginal bleeding should be reported to your health care provider.

Your fertility, meaning your ability to conceive or father a child, may be affected by tamoxifen. Please discuss this issue with your health care provider.

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Seek emergency help immediately and notify your health care provider, it you experience the following symptoms:

  • Sudden shortness of breath and/or chest pain
  • The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:
  • Swelling, redness and/or pain in one leg or arm and not the other
  • New breast lumps
  • Excessive vaginal discharge or bleeding, menstrual (period) pain or irregularities
  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Depression (interfering with your ability to carry on your regular activities)
  • Changes in vision
  • Always inform your health care provider if you experience any unusual symptoms.

Work ethics

Tamoxifen is FDA approved for the treatment of hormone-positive or hormone receptor unknown breast cancer, or for the prevention of breast cancer in women at a high risk of developing breast cancer It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Tamoxifen is classified as an anti-estrogen. A significant portion of breast cancer is stimulated to grow by the female hormone, estrogen. Tamoxifen binds to places on the cell where estrogen would normally bind, blocking estrogen from binding. The blocking of estrogen from binding to a cell by tamoxifen removes the growth stimulatory effects of estrogen on the cancer.

How is tamoxifen given (administered)? Tamoxifen is given orally, as a pill and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient.

Tamoxifen may increase symptoms of cancer including bone or tumor pain, a condition called“tumor flare”. Symptoms typically occur during the first couple of weeks of treatment.  Patients experiencing these symptoms after this period should contact their healthcare provider.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with tamoxifen.  Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.

Tamoxifen can increase the risk of some serious events including uterine cancer, blood clots or stroke. Patients will be monitored for blood clots. Symptoms of blood clots include redness, pain or swelling of one extremity and not the other, or sudden chest pain with difficulty in breathing. Patients experiencing these symptoms should contact their healthcare provider immediately. Patients should have routine follow-up with their gynecologist.

What are the common (occur in 30% or more of patients) side effects of treatment with tamoxifen?

  • Hot flashes
  • Fluid retention characterized by swelling of ankles, feet, hands or face
  • Vaginal discharge
  • Itching in vaginal area
  • Weight changes
  • Reduced sex drive

What are the less common (occur in 10% to 29% of patients) side effects of treatment with tamoxifen?

  • Nausea
  • Vaginal bleeding
  • Depression, mood changes
  • Weight loss
  • Menstrual irregularities
  • Skin changes

This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.

Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.

What are the possible late side effects of treatment with tamoxifen? Patients treated with tamoxifen have a slightly increased risk of developing uterine cancer. Patients experiencing unusual vaginal bleeding, pelvic pain or pressure should tell their healthcare provider.

What can patients do to help alleviate or prevent discomfort and side effects?

  • Pay careful attention to the physician’s instructions and inform the physician of any side effects.
  • Maintain adequate rest and nutrition.
  • Wear sunscreen and protective clothing and try to minimize sun exposure.
  • Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
  • To reduce hot flashes, patients should wear cool clothing and remain in a cool environment if possible.
  • Eat small meals frequently to help alleviate nausea.

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.

• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.

• Patients should inform their physician if they have ever had blood clots that required medical treatment.

• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.

• Patients taking warfarin may require extra blood tests for monitoring and dose may need to be changed.

• Patients should check with their physician before starting any new drug or nutritional supplement.

• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.

• If an oral dose is missed, do not double up on doses.  Patients should contact their doctor in this event.

• Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.

When should patients notify their physician?

  • Swelling, tenderness, redness of one extremity and not the other
  • Sudden chest pain and difficulty in breathing
  • Coughing up blood
  • Unusual vaginal bleeding or discharge
  • Menstrual irregularities
  • Pelvic pain or pressure
  • Swelling of ankles, feet, hands or face
  • Severe or prolonged depression, mental changes
  • Dizziness or lightheadedness
  • Headache
  • Severe or prolonged anxiety
  • Changes in vision
  • Severe weakness
  • Difficulty walking or speaking
  • Skin rash, hives or itching

What is a package insert?

A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers.  A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.

Important Limitations of Use

The information provided above on the drug you have selected is provided for your information only and is not a substitute for consultation with an appropriate medical doctor. We are providing this information solely as a courtesy and, as such, it is in no way a recommendation as to the safety, efficacy or appropriateness of any particular drug, regimen, dosing schedule for any particular cancer, condition or patient nor is it in any way to be considered medical advice. Patients should discuss the appropriateness of a particular drug or chemotherapy regimen with their physician.

As with any printed reference, the use of particular drugs, regimens and drug dosages may become out-of-date over time, since new information may have been published and become generally accepted after the latest update to this printed information. Please keep in mind that health care professionals are fully responsible for practicing within current standards, avoiding use of outdated regimens, employing good clinical judgment in selecting drugs and/or regimens, in calculating doses for individual patients, and verifying all dosage calculations.

Precautions:

Before starting tamoxifen treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.

Let your health care professional know if you have ever had a blood clot that required medical treatment.

Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (tamoxifen may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).

For both men and women: Do not conceive a child (get pregnant) while taking tamoxifen. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.

Do not breast feed while taking this medication.

self care

Self-Care Tips:

Do not stop taking this medication unless your healthcare provider tells you. You may be on it for as long as 5 years.

If you are experiencing hot flashes, wearing light clothing, staying in a cool environment, and putting cool cloths on your head may reduce symptoms. Consult your health care provider if these worsen, or become intolerable

This medication causes little nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.

Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.

In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.

Get plenty of rest.

Maintain good nutrition.

If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your health care professional while you are taking tamoxifen, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) may also be ordered by your doctor.

Women will need a gynecologic (GYN) examination before therapy, and during therapy, at regular intervals. Discuss the appropriate schedule with your health care provider.

How Tamoxifen Works:

Hormones are chemical substances that are produced by glands in the body, which enter the bloodstream and cause effects in other tissues. For example, the hormone testosterone, made in the testicles and is responsible for male characteristics such as deepening voice and increased body hair. The use of hormone therapy to treat cancer is based on the observation that receptors for specific hormones that are needed for cell growth are on the surface of some tumor cells. Hormone therapy can work by stopping the production of a certain hormone, blocking hormone receptors, or substituting chemically similar agents for the active hormone, which cannot be used by the tumor cell. The different types of hormone therapies are categorized by their function and/or the type of hormone that is affected.

Tamoxifen is an antiestrogen. Antiestrogens bind to estrogen receptor site on cancer cells thus blocking estrogen from going into the cancer cell. This interferes with cell growth and eventually leads to cell death. The following are antiestrogen medications.

Tamoxifen, toremifene

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

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