Tamoxifen and your liver

Tamoxifen can elevate the triglycerides in the body. Excess
triglycerides can collect in the liver and cause "fatty liver" which,
over time, leads to liver metabolism dysfunction. While Tamoxifen does
this, the main causes are alcohol (drinking it, that is) and metabolic
syndrome (obesity.) If you happen to drink, be overweight, and take
Tamox. -- that's a triple threat as far as developing an enlarged fatty
liver goes.

This does not have to have any symptoms, but it
could feel achy in its enlarged state. Most people don't even know if
they have this. Sometimes the liver enzymes will be elevated on a
metabolic profile blood test. Or if you are getting a CT or other
imaging as part of a follow-up, it might show up there.

The good
news is that the condition can be reversible for most people. Google
fatty liver and you will find information on diets/changes which can aid in
reversing the condition. If the pain is minor, you could easily cut out
alcohol, refined sugars, and carbs for a few weeks and see if your
liver feels any better; and then modify your diet accordingly going on
from there.

If you are really hurting, you should see a doctor
a.s.a.p.; otherwise, do mention it the next time you are in for a
follow-up exam.

Oh, and NO TYLENOL.  That would be the last thing an achy liver needs.

Niki - SO TRUE sometimes the cure can be just as bad as the disease. Now am reading that taking some anti-depressants can prevent tamoxifen from actively working in the body.  I give up. 

Rettemich:  Mine put me on Effexor for the hot flashes but the flashes actually got worse on it.  I also tried Gabapentin, but it was equally ineffective.  I'm glad the effexor helps you.  I'm going to try going back to tai chi a couple of times a week to see if that can help my mood.  

mrskimber47,  I don't think any doctor should ignore pain.  Pain is our body's signal that something is wrong.  Yes, you need to report all pain to the MO, and if the MO is not responsive to your concerns then try another doc, like your PCP.  

Like I said, some lifestyle changes can reverse fatty liver, but it also can progress and worsen.  If the liver gets inflamed (and maybe yours is already since it is hurting) it can lead to scarring, which is cirrhosis.  You don't want that, so find a doc who will help you nip this in the bud.

Unfortunately, so many meds out there are hard on the liver.  I know this thread is about Tamox. and the liver, but if you suspect your liver is doing poorly on Tamox., you really need to take into account all the meds you are taking or have had recently.  Yes, I realize there are some meds we really must stay on; but if a test or scan indicates a bad change in your liver, then it is time to re-evaluate the meds.  You can ask a lot of a healthy liver, but when it is having dysfunction, more care is needed.

mrskimber, Let us know how it goes at your doctor's appt.  I really want to know more about this issue.

edwards750, maybe, maybe not.  Many cases of fatty liver are symptomless.  If you are talking about a lower threshold of tolerance for alcohol, I think that is a rare side effect.  If you are talking about fatty liver, then let me clarify.  It is not the Tamox. + alcohol combo that causes fatty liver, per se.  Drinking a lot of alcohol can cause fatty liver by itself.  Having metabolic disorder can also do that.  Thirdly, Tamoxifen can do it too, even in the absence of anything else going on.  The last two examples are "non-alcoholic fatty liver."  My earlier comment was that if you have several of the variables going on at the same time, the chance of having liver disease will increase.  Just think of it as too many straws breaking the camels back (or liver, in this case.)

I'm saying that if you do wind up with a liver issue as a result of the drug treatment (and Tamox. is not the only one) for BC, it is only going to tax your liver more if you add alcohol to the mix.  

Also, consider this, when the liver function is reduced, you cannot metabolise fat calories from your diet properly, which often result in putting on more body weight.  For most of us that means more belly-fat.  Coincidentally, body fat creates its own estrogen...the last thing that any of us ER+ ladies need.  So, Tamox. can end up creating a situation of more estrogen being made, when it's supposed to be in there blocking estrogen receptors.  Kind of a cross purpose, if you ask me.  How many people are affected this way?  I don't know.  It is probably a minority of cases.  You know, like blood clots and endometrial cancer.  

What?  No one told you about the Tamox./liver connection?  Me either.  What else is new?

(Actually, although I took Tamox. for three years, I don't know if it played a part in my own fatty liver.  I think mine was a result of five mos. of chemo.  But that took place after the years of Tamox., so who knows what part Tamox. ultimately played.  Again, how much can one liver take, you know?)

mrskim, It is funny that everyone admits that Tamox. can put weight on people, but they never explained further that it could be an induced liver disease doing it.  Hmmm?  No, a specific treatment was not even mentioned.  I Googled for some diet tips and so I will try to cut my refined sugar and refined carbo intake as well as fats.  I don't have a speck of weight to lose but, hopefully, eating better can't hurt.  I think I have to give my liver time to rebound from the chemo.  The nurse who gave me the "fatty liver" info. seemed to think it would just take time to get back to normal.  So, my liver has about a year to shape up before I get another scan.  

I don't know if there is some "medicine" for fatty liver, but I am one of those that hates to use one medicine for something created by another.  That is why I will just try to baby my liver with a better diet.  I never drank much alcohol.  Now, I will just avoid it altogether.  I'm a little frustrated too because I just read that fructose (fruit) is not good for fatty liver.  Geez, I love all the summer fruits.  Is chemo/cancer taking away yet another thing from my life?  Terrible!

Anyway, FYI, the PAP test is for cervical cancer (slow growning and not nearly as dangerous and not related to BC,) so if you want to be cautious about endometrial cancer while on Tamox., the best way is to have an endometrial biopsy.  The biopsy (uncomfortable pinch for 5 sec.) can be done yearly, or less as you wish.  The second way to monitor the uterus is getting a transvaginal ultrasound (maybe 5-6 minutes of pressure, less than rough sex(*) and if you have had a kid, it's nothing,) which measures the thickening of the uterine lining.  You can get that yearly while on Tamox. or alternate it with the EBx.  The thinking is too much tickening is an overgrowth of cells, which as we know might include cancer cells.  TVU is not conclusive in the way that EBx is, but can be an indication of your uterus going off the rails.

(*)  Not that I'm an expert.  Just spicing up the post, really.

I second that emotion, edwards750!

Hi ladies,

While searching the web for Tamoxifen as a possible cause of liver disease, I stumbled unto your post and I'm wondering how many women are being diagnosed with fatty liver disease after having been on Tamoxifen.  I was on Tamoxifen for almost 3 years and was never told about the possible side effects. I drank moderately before starting the Tamoxifen and after starting it I would drink only on special occasions, birthdays, anniversaries, etc. Now I'm worried that it might have caused liver disease. 

In 2010 I was told I had elevated liver enzymes.  This was discovered because I was experiencing right side upper quadrant pain that radiated to the back.  An ultrasound was done and it did not show any issues with the liver. The pain and discomfort resolved after several months and the liver enzymes went back to normal. In 2013 the pain returned and continues a year later. The pain is there most of the time it alternates from front to back and sometimes is triggered by found.  I've tried elimination diets and nothing seems to make a difference.  My weight fluctuates and (pardon this) my bowel movements have changed. I've had ultrasounds, MRI, CT Scans and repeated Labs but nothing has been detected. No issues with Gallbladder. My gastro doctor pretty much wrote me off and said it must be IBS.  I don't believe this is IBS as the symptoms don't fit the IBS diagnosis. 

I feel my symptoms are liver related and wonder if anyone else has had similar experience.

Sorry for the long post.

Ophelia