Antidepressant & Tamoxifen use in Breast Cancer?
Depression and anxiety are common comorbidities in breast cancer patients. As a results patients with breast cancer may require treatment with antidepressants. For this reason, it is of clinical importance to have knowledge of drug interactions between antidepressants and breast cancer treatment Tamoxifen.
Tamoxifen is a selective estrogen receptor modulator (SERM). It has been FDA approved for the treatment of both early and advanced estrogen receptor-positive breast cancer in pre-and post-menopausal women and in men. Tamoxifen is also FDA approved for the prevention of breast cancer in women at high risk for breast cancer.
Let’s begin by answering this question first:
Tamoxifen requires the following two rate-limiting enzymes for conversion to its active metabolites (endoxifen and 4-hydroxytamoxifen)
- Cytochrome P450 2D6
- UGT 2B7
For this reason, we should avoid following antidepressants with CYP2D6 inhibition property:
- Fluoxetine (strong inhibitor)
- Paroxetine (strong inhibitor)
- Duloxetine (moderate inhibitor)
- Bupropion (strong inhibitor)
Hence the answer is: All of the Above.
FOR PEFA MEMBERS:
Read the lecture series on the use of psychopharmacology with following medical conditions:
- Antidepressants and Bleeding Risk.
- Antidepressants and Risk of Hyponatremia: Evaluation Management.
- High Prolactin Levels with (a) Antipsychotics, (b) Antidepressants.
- Risk of Seizures with (a) Antidepressants, (b) Antipsychotics
- Antidepressants and RLS (Restless Leg Syndrome) and PLM (Periodic Limb Movements)
- Tinnitus with Psychotropic medications.
- HIV/AIDS Psychopharmacology: (a) Antidepressants, (b) Anti-anxiety, (c) Mood stabilizers, (d) Antipsychotics, (e) Delirium management.
- Transplant Psychopharmacology
- Antidepressants use with Oncology treatment.
- Antidepressants use with Functional Dyspepsia.
- Pulmonary disease and use of (a) Antidepressants, (b) Benzodiazepines, (c) Antipsychotics.
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