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:

Which of the following antidepressant should be AVOIDED with Tamoxifen treatment?

Tamoxifen requires the following two rate-limiting enzymes for conversion to its active metabolites (endoxifen and 4-hydroxytamoxifen)

  1. Cytochrome P450 2D6
  2. 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.

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