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Tamoxifen

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VOL: 102, ISSUE: 08, PAGE NO: 33

GENERIC AND PROPRIETARY NAMES

 

GENERIC AND PROPRIETARY NAMES
- Tamoxifen.

 

 

- Nolvadex.

 

 

ACTION
- Tamoxifen is an oestrogen receptor antagonist.

 

 

CLASSIFICATION
- Hormone antagonist.

 

 

INDICATIONS
- Breast cancer.

 

 

- Anovulatory infertility.

 

 

CONTRAINDICATIONS
- Pregnancy.

 

 

CAUTIONS
- Occasional cystic ovarian swelling in premenopausal women.

 

 

- Breastfeeding.

 

 

- Porphyria.

 

 

- An increased incidence of endometrial changes, including hyperplasia, polyps and cancer, has been reported in association with tamoxifen treatment.

 

 

COMMON SIDE-EFFECTS
- Hot flushes.

 

 

- Vaginal bleeding.

 

 

- Vaginal discharge.

 

 

- Suppression of ovulation.

 

 

- Pruritus vulvae.

 

 

- Gastrointestinal upset.

 

 

- Headache.

 

 

- Tumour flare.

 

 

- Light-headedness.

 

 

- Decreased platelet count.

 

 

RARE SIDE-EFFECTS
- Fluid retention.

 

 

- Hypercalcaemia in some patients with bony metastases.

 

 

- Skin rash.

 

 

- Alopecia.

 

 

- Visual disturbance such as corneal changes, cataracts and retinopathy.

 

 

- Uterine fibroids.

 

 

- Neutropenia.

 

 

- Thromboembolic events.

 

 

- Hypersensitivity reactions.

 

 

INTERACTIONS
- When tamoxifen is used in combination with some anticoagulants a significant increase in anticoagulant effect may occur. Where such co-administration is initiated careful monitoring of the patient is recommended.

 

 

- When tamoxifen is used in combination with cytotoxic agents there is an increased risk of thromboembolic events.

 

 

ADMINISTRATION
- Tablets.

 

 

- Oral solution.

 

 

NURSING CONSIDERATIONS
- Tamoxifen is usually taken for 2-5 years - beyond this it has been shown to be of no benefit and may increase side-effects.

 

 

- The decision either to discontinue breastfeeding or discontinue tamoxifen should take into account the importance of the medicine to the mother.

 

 

- Menstruation is suppressed in a proportion of premenopausal women receiving tamoxifen.

 

 

- Some women have said they put on weight while taking tamoxifen.

 

 

PATIENT TEACHING
- Women should be advised not to become pregnant while taking tamoxifen and should use barrier contraceptive methods if sexually active.

 

 

- If patients have nausea they should try taking tamoxifen with food or just before bed.

 

 

- If a tablet is missed patients should take it as soon as they remember, then continue to take tablets as before.

 

 

- Any patients receiving or who have previously received tamoxifen should be advised to report promptly any abnormal vaginal bleeding, changes in vaginal discharge or lower abdominal pain as this may be suggestive of the presence of endometrial cancer.

 

 

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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