Tamoxifen
Selective estrogen receptor modulator (SERM). Adjuvant and metastatic treatment of hormone receptor-positive breast cancer (Nolvadex).
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WHAT IS TAMOXIFEN?
Detailed overview
Tamoxifen is the first clinically major SERM, developed by AstraZeneca (Nolvadex, FDA 1977). In ER+ breast cancer adjuvant treatment with 5-10 year protocol, reduces relapse risk by 50% (EBCTCG 2011 Lancet PMID 21684593). In premenopausal women, aromatase inhibitors (anastrozole, letrozole) ineffective, so tamoxifen is first-line SERM. Side effect profile: thromboembolism (DVT, PE 2-3x rise), endometrial cancer risk (~2x), menopausal-like symptoms (hot flashes). ER+ DCIS prevention and high-risk primary prevention FDA-approved (NSABP-P1 trial).
Data console
Lab data
Safety
Side effects, stop signs, contraindications
Side effects · 8
- Venous thromboembolism (deep vein thrombosis, pulmonary embolism) and stroke, 2-3x increased risk, a serious boxed-style warning, higher around immobilization or surgery. Seek emergency care for one-sided leg swelling, sudden breathlessness or chest pain.
- Endometrial changes: hyperplasia, polyps, endometrial carcinoma and rarely uterine sarcoma, roughly 2x cancer risk, a serious warning. Any abnormal vaginal bleeding must be investigated.
- Menopause-like symptoms: hot flushes, sweating, mood swings, vaginal discharge or dryness, menstrual irregularities, reduced libido. Among the most common, affecting 40-60% of patients.
- Ocular effects: cataract, retinopathy and rarely corneal deposits, visual disturbance. New or worsening vision problems warrant an ophthalmology review.
- Hepatic effects: hepatic steatosis (fatty liver), raised liver enzymes, rarely serious hepatotoxicity (cholestasis, hepatitis). Periodic liver function monitoring is advised.
- Tumour flare at treatment start: transient bone or tumour pain, hypercalcemia, due to bone metastases. Often a sign of efficacy but requires monitoring.
- Reduced efficacy when combined with strong CYP2D6 inhibitors: fluoxetine, paroxetine and bupropion lower active endoxifen levels and thus the antitumour effect. These should be avoided where possible.
- Other common effects: nausea, abdominal discomfort, fluid retention and edema, fatigue, headache, rash, and reduced blood counts (leukopenia, thrombocytopenia).
Contraindications · 3
- Pregnancy (category D, fetal damage)
- Active thromboembolism (DVT, PE) or within-1-year history
- Untreated endometrial hyperplasia
Studies
Related research and clinical findings
Relevance of breast cancer hormone receptors and outcomes of 5 years of tamoxifen (EBCTCG)
Early Breast Cancer Trialists' Collaborative Group.
Tamoxifen for prevention of breast cancer (NSABP-P1)
Fisher B, Costantino JP, Wickerham DL et al.
CYP2D6 genotype and tamoxifen efficacy
Goetz MP, Sangkuhl K, Guchelaar HJ et al.
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Educational drug info from official sources (PubMed, FDA, EMA). Does NOT replace medical consultation or the SmPC. Talk to your doctor!
The information here is for educational and scientific purposes only. Medication use requires medical consultation and a prescription. The indications, dose ranges, and side effects listed here do NOT replace the official Summary of Product Characteristics (SmPC) or consultation with a physician. Do not start or stop any medication on your own. In an emergency, call your local emergency number.