More information on Tamoxifen and certain anti-depressants

mimivac
mimivac Member Posts: 2,143
edited March 2014 in Breast Cancer #1
Another article just came out on this issue. There seems to be quite a bit of evidence now that certain anti-depressants interfere with Tamoxifen effectiveness...

"News release
Popular Breast Cancer Drug Used with Certain Antidepressants Puts New Jersey Women at Risk
FRANKLIN LAKES, N.J., July 30 /PRNewswire-FirstCall/ -- A new analysis finds that women in New Jersey who take the breast cancer drug tamoxifen in conjunction with certain popular antidepressants may be at a higher risk for a breast cancer recurrence.

In May, Medco Health Solutions, Inc. (NYSE: MHS) and Indiana University School of Medicine released a study revealing that women using tamoxifen to prevent a recurrence of breast cancer who also use certain selective serotonin reuptake inhibitors (SSRI), for example Prozac (fluoxetine), Paxil (paroxetine) and Zoloft (sertraline), have up to twice the chance of having a recurrence of the disease.

In a separate New Jersey-specific analysis, Medco found that among nearly 2,000 tamoxifen patients in the state during 2008, 12 percent were also taking SSRIs, including those that could put them in the at-risk population.

"We've been aware that certain antidepressants, known as CYP2D6 inhibitor drugs, block the activation of tamoxifen chemically, but this evidence shows that these drugs are putting women in New Jersey and across the nation at a much higher risk for recurrent breast cancer," said Dr. Milayna Subar, National Practice Leader for Medco's Oncology Therapeutic Resource Center located at Medco's Willingboro, N. J. pharmacy. "Women taking tamoxifen along with an SSRI should speak with their doctor immediately to discuss modifications to their medication regimen to ensure they are getting the full benefit of their tamoxifen therapy."

Approximately 500,000 women take tamoxifen in the U.S., with 80,000 new patients starting on the treatment annually. Nearly 30 percent of women taking tamoxifen also use an antidepressant. Based on estimates from the Centers for Disease Control and Prevention, New Jersey is among the states with the highest breast cancer incidence and death rate in the country.

The study by Medco and Indiana University School of Medicine that was presented at the 2009 Annual Meeting of the American Society of Clinical Oncology (ASCO). It was the largest study to-date looking at how these drugs impact breast cancer recurrence rates when taken with tamoxifen.

Antidepressants are often prescribed when women receiving tamoxifen are depressed, or to treat hot flashes -- a common side effect of the breast cancer drug. Paxil, Prozac and Zoloft are among a group of antidepressant drugs known as CYP2D6 inhibitors. These drugs prevent the CYP2D6 enzyme from working properly, and cause less of the active form of tamoxifen, called endoxifen, from being produced, making the drug less effective at preventing breast cancer. Women taking tamoxifen along with certain SSRIs have a 2-fold increased risk of breast cancer recurrence compared to women not taking these drugs together.

Tamoxifen

Tamoxifen is one of the oldest and most widely used treatments for reducing the risk of breast cancer recurrence among women with estrogen-dependent tumors. The drug works by blocking the estrogen receptors in the breast cells and can reduce the risk of a breast cancer recurrence by up to 50 percent. It's the only anti-estrogen available for prevention of breast cancer recurrence in pre-menopausal women and is one of several anti-estrogens used to treat post-menopausal breast cancer patients.

Medco Therapeutic Resource Center in Willingboro, N.J.

Willingboro, New Jersey is home to the world's largest automated pharmacy and is the current site of the Medco Therapeutic Resource Center (TRC) for oncology patients. Medco's TRCs focus on the specialized treatment of patients with chronic and complex conditions, including centers for cardiovascular diseases, diabetes, immunologic and pulmonary conditions. Nearly half of the company's 2,600 pharmacists are specialists deployed across the TRCs where they provide disease-specific therapy management for those patients who account for 96 percent of pharmacy spending and 75 percent of this country's medical costs.

About Medco

Medco Health Solutions, Inc. (NYSE: MHS) is pioneering the world's most advanced pharmacy and its clinical research and innovations are part of Medco making medicine smarter™ for more than 60 million Americans.

With more than 20,000 employees dedicated to improving patient health and reducing costs for a wide range of public and private sector clients, and 2008 revenue exceeding $51 billion, Medco ranks 45th on the Fortune 500 list and is named among the world's most innovative, most admired and most trustworthy companies.

For more information, go to http://www.medcohealth.com.

This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements involve risks and uncertainties that may cause results to differ materially from those set forth in the statements. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. We undertake no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this press release should be evaluated together with the risks and uncertainties that affect our business, particularly those mentioned in the Risk Factors section of the Company's Annual Report on Form 10-K and Quarterly Reports on Form 10-Q filed with the Securities and Exchange Commission.

SOURCE Medco Health Solutions, Inc.

CONTACT: Jennifer Luddy of Medco, +1-201-269-6402, [email protected]; or Erin Drelick of Coyne Public Relations, +1-973-316-1665, [email protected]
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Comments

  • tasha_111
    tasha_111 Member Posts: 2,072
    BUGGERRRRRR
    So which one do I stop taking? Short term I can't survive without the Zoloft, Long term Tamoxifen?..are there any guarantees?


    Is there a safe alternative to zoloft?......I tried a few others and they didn't work at all well on me.....

    So many questions, So little time! Hugs, Thanks Mimi, Jxxxxxxxxx
  • Alexis F
    Alexis F Member Posts: 3,598
    Wow, Mimi! If you take
    Wow, Mimi! If you take tamoxifen and are on one of those antidepressants, your chance of a recurrence goes up twice? That is horrible! I am not on an antidepressant nor am I taking tamox. Thanks for this! Very important info!

    I hope everyone reads this and talks to their oncologist about it. A recurrence is not what anyone wants.
  • mimivac
    mimivac Member Posts: 2,143
    Tasha,
    I know it's very frustrating, isn't it? Have you tried Lexapro? I don't think it's on the list and it's known as a drug with fewer side effects. I did pretty well on a low dosage during treatment. Can you talk to your oncologist about switching to something that's not on the list? I think you should be able to get relief for depression without compromising your health in other ways. There must be a solution...
  • mimivac
    mimivac Member Posts: 2,143
    Antoher suggestion
    Or, Tasha, have you thought about taking an AI instead of Tamoxifen? Just another idea.
  • j916
    j916 Member Posts: 141
    Welbutrin
    i've been taking welbutrin XL and it's been helping quite a bit...
  • phoenixrising
    phoenixrising Member Posts: 1,508
    tasha_111 said:

    BUGGERRRRRR
    So which one do I stop taking? Short term I can't survive without the Zoloft, Long term Tamoxifen?..are there any guarantees?


    Is there a safe alternative to zoloft?......I tried a few others and they didn't work at all well on me.....

    So many questions, So little time! Hugs, Thanks Mimi, Jxxxxxxxxx

    Venlafaxine (Effexor) seems
    Venlafaxine (Effexor) seems to be the most common one used. I don't know if you've tried it or not. I had posted a link to the Flockhart chart that lists the specific cytochromes some time ago but here is a list of the inhibitors of 2D6.

    Strong Inhibitors

    bupropion
    fluoxetine
    paroxetine
    quinidine1

    Moderate Inhibitors

    duloxetine
    terbinafine

    Weak Inhibitors

    amiodarone
    cimetidine
    sertraline

    Others

    celecoxib
    chlorpheniramine
    chlorpromazine
    cinacalcet
    citalopram
    clemastine
    clomipramine
    cocaine
    diphenhydramine
    doxepin
    doxorubicin
    escitalopram
    goldenseal
    halofantrine
    histamine H1 receptor antagonists
    hydroxyzine
    levomepromazine
    methadone
    metoclopramide
    mibefradil
    midodrine
    moclobemide
    perphenazine
    ranitidine
    red-haloperidol
    ritonavir
    ticlopidine
    tripelennamine
  • phoenixrising
    phoenixrising Member Posts: 1,508
    Thank you Mimi for bringing
    Thank you Mimi for bringing this up. It's been an issue that's close to my heart since I had my gene tested and found I was not fully metabolizing Tamoxifen. The mayo clinic recommends all women have their gene tested before going on Tamoxifen. I think this is a really good idea but it seems to be taking some time to be accepted. This is likely the reason why Tamoxifen fails some women. Good to know.

    jan
  • Noel
    Noel Member Posts: 3,095 Member
    j916 said:

    Welbutrin
    i've been taking welbutrin XL and it's been helping quite a bit...

    This same kind of info has
    This same kind of info has been out for quite awhile now. Hasn't or didn't everyone's oncologist tell them about this before prescribing tamox or antidepressants for them? A recurrance is a horrible thing to risk. And, there is all of this proof now about tamox and certain antidepressants, I would hope everyone knows about it and has discussed it with their oncologist.

    Thanks Mimi for posting this. And, thanks Jan for posting that list!

    Hugs,

    Noel
  • phoenixrising
    phoenixrising Member Posts: 1,508

    Thank you Mimi for bringing
    Thank you Mimi for bringing this up. It's been an issue that's close to my heart since I had my gene tested and found I was not fully metabolizing Tamoxifen. The mayo clinic recommends all women have their gene tested before going on Tamoxifen. I think this is a really good idea but it seems to be taking some time to be accepted. This is likely the reason why Tamoxifen fails some women. Good to know.

    jan

    Lexapro is escitalopram and
    Lexapro is escitalopram and is listed as an "other" inhibitor. It seems that the category of "other" is very weak which might not make a difference if you are an over metabolizer, but might make a difference if you're metabolism is impaired.

    jan
  • mimivac
    mimivac Member Posts: 2,143

    Lexapro is escitalopram and
    Lexapro is escitalopram and is listed as an "other" inhibitor. It seems that the category of "other" is very weak which might not make a difference if you are an over metabolizer, but might make a difference if you're metabolism is impaired.

    jan

    Lexapro info.
    Thanks, Jan. That's important to know. All these minefields to overcome...
  • lanie940
    lanie940 Member Posts: 490
    I have been taking
    I have been taking Wellbutrin, the generic Wellbutrin for many years. I'm newly diagnosed breast cancer, had a lumpectomy last Thursday. So, guess I'll continue on the generic Wellbutrin.
  • Akiss4me
    Akiss4me Member Posts: 2,188
    Thanks Mimi
    I thought this was an interesting article. I am from Willingboro and my parents still live there. Now I know what my mother was talking about. She was trying to tell me something about Medco and I totally did not get it. I forward the article to her to see if this is what she meant. Thanks for the info. :(-) Pammy
  • phoenixrising
    phoenixrising Member Posts: 1,508
    lanie940 said:

    I have been taking
    I have been taking Wellbutrin, the generic Wellbutrin for many years. I'm newly diagnosed breast cancer, had a lumpectomy last Thursday. So, guess I'll continue on the generic Wellbutrin.

    Lanie, Wellbutrin is the
    Lanie, Wellbutrin is the brand name for bupropion which is one of the strongest inhibitors. You may already know that but I thought I would mention it just in case.
  • lanie940
    lanie940 Member Posts: 490

    Lanie, Wellbutrin is the
    Lanie, Wellbutrin is the brand name for bupropion which is one of the strongest inhibitors. You may already know that but I thought I would mention it just in case.

    Thanks, yes, I saw that.
    Thanks, yes, I saw that. Fact is, my cousin in California was taking Tamox when she was on Wellbutrin, now she has cancer again, in her abdomen and possibly her bone marrow. I am so scared for her. She has a bone marrow biopsy on Monday. She is 64. I am hoping to not take Tamox since I am postmenopausal and have osteopenia now, maybe they may try me on something other than tamox. Problem is I took Fosamax and it gave me GERD. I wonder if Evista or maybe Arimidex, I don't know, I'll have to wait and see what my oncologist says.
  • Kylez
    Kylez Member Posts: 3,761 Member

    Lanie, Wellbutrin is the
    Lanie, Wellbutrin is the brand name for bupropion which is one of the strongest inhibitors. You may already know that but I thought I would mention it just in case.

    So, if you are on Wellbutrin
    So, if you are on Wellbutrin and on Tamoxifen, your chance of a recurrence is doubled?
  • susie09
    susie09 Member Posts: 2,930
    Akiss4me said:

    Thanks Mimi
    I thought this was an interesting article. I am from Willingboro and my parents still live there. Now I know what my mother was talking about. She was trying to tell me something about Medco and I totally did not get it. I forward the article to her to see if this is what she meant. Thanks for the info. :(-) Pammy

    Thanks Mimi and Jan for this
    Thanks Mimi and Jan for this info. I think this is so important for bc survivors and oncologist's to know and to discuss. I was shocked that with some of the antidepressants, like Paxil, Prozac, Wellbutrin, Lexapro and Zoloft, that your recurrance chance was doubled.

    Susie
  • Noel
    Noel Member Posts: 3,095 Member
    susie09 said:

    Thanks Mimi and Jan for this
    Thanks Mimi and Jan for this info. I think this is so important for bc survivors and oncologist's to know and to discuss. I was shocked that with some of the antidepressants, like Paxil, Prozac, Wellbutrin, Lexapro and Zoloft, that your recurrance chance was doubled.

    Susie

    All over the internet
    I am not on an antidepressant and I am still undecided on tamox, but, I read this. A lot has been written about this before. Scary stuff

    Hugs, Noel
  • Christmas Girl
    Christmas Girl Member Posts: 3,682 Member
    susie09 said:

    Thanks Mimi and Jan for this
    Thanks Mimi and Jan for this info. I think this is so important for bc survivors and oncologist's to know and to discuss. I was shocked that with some of the antidepressants, like Paxil, Prozac, Wellbutrin, Lexapro and Zoloft, that your recurrance chance was doubled.

    Susie

    Yes, thanks to both Mimi and Jan...
    ... for this really important info, on everyone's behalf.

    Kind regards, Susan
  • Kristin N
    Kristin N Member Posts: 1,968 Member

    Yes, thanks to both Mimi and Jan...
    ... for this really important info, on everyone's behalf.

    Kind regards, Susan

    This is all over the news.
    This is all over the news. I hope that anyone that is on any of those antidepressants and tamoxifen call their oncologist's and get something changed. It isn't worth a recurrence.

    Thank you Mimi for starting this and thank you Jan for your valueable input.

    Kristin
  • Jadie
    Jadie Member Posts: 723
    Thanks Mimi
    Thank you for posting this information. I was on tamoxifen and zoloft for about two years then switched to aromasin. I will ask my onc about this when I see him again. He is the one who switched the meds for me. ( I had to change onc because of insurance- booger)

    Tash if you are doing good with zoloft you might consider switching to al's like Mimi suggested. Effexor gave me hot flashes and I felt drousy on it.

    Hugs
    Jadie<3