Need some advice regarding Tamoxifen and other drug interactions

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faerywings
faerywings Member Posts: 173
edited June 2014 in Hormonal Therapy - Before, During, and After

First off, i understand that no one can give medical advice, but I really need somewhere to get some of my thoughts out there. Maybe someone has been in a similar situation and can share their experience.

Background is that I have Late Stage Lyme Disease and have been on abx since 2008. I see an amazing Lyme dr, one of the top in her field. I am on a lot of meds and supplements to help treat the disease as well as to help keep a lot of the symptoms in check. 

I had DCIS, lumpectomy and rads. I saw the MO on Monday to discuss HT.I am 45, pre- (peri?) menopausal so he said that my only Rx option was Tamoxifen. However, it interacts with several of my meds. I brought the info to my Lyme dr yesterday and she tried to get some more info online about what she could change in my meds. I had only done some research to see what was up, and I got a lot of conflicting info, as she did as well. (Effexor-- BTW-- new research is showing that it can lessen the effectiveness of Tam.) Coincidentally, the MO called my lyme dr while we were in her office looking up this info. 

Lyme dr tried to explain what she was finding, and he was very set that only Tam would do. So now I am at an impasse. I am not sure if I should go for a second opinion, but since Tam is the only drug that is for pre-menopausal women, I am not sure if I will get any different answers. I know that some drs are willing to go "off label" but others are not. Or maybe I should just try an alternative therapy? I looked in the  Alt. Therapy forum but nothing stood out  to me for my case. 

I truly wish that a dr would sit down and say, based on your age, your dx, you have a x% chance of recurrence with Tam and an x% w/o. He was throwing numbers around about how if I get a recurrence in the right breast it would be this and 50% more likely to be invasive. But those are averages, I wish I could find out specifics.

Well, it looks like I was able to get some of my thoughts out in a semi-coherent way! LOL Hope that someone can chime in and maybe steer me to some good info. TIA!!!

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited June 2014

    Hi faerywings - If you haven't already check out cancermath, predict (In the UK), and sign up for Adjuvant Online. Other than that the only other recurrence predictor I know is the oncotype test for DCIS. 

    Also could you possibly attach the link re: new Effexor research. I'd be very interested in seeing that.

    Thanks so much!

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited June 2014

    Has your oncologist considered the possibility of using Lupron to shut down your ovarian function so that you can use an aromatase inhibitor (anastrazole, letrozole, or exemestane)? Do these drugs pose any problem or interaction problems? If you use the risk calculators farmerlucy mentioned in her post you can manipulate the info to include taking hormonal therapy or not. For cancer math I like the pictogram display, for PREDICT take note that tumor size is in millimeters so multiply x10 for the right size.

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  • faerywings
    faerywings Member Posts: 173
    edited June 2014

    Hi Lucy, I will look up that information. I never got any sort of oncotype score, perhaps b/c the cancer was so small and contained?

    This was the study that my Lyme dr found: http://www.medpagetoday.com/MeetingCoverage/SABCS/36392

    She was reading this to the MO and he wanted nothing to do with it, and referenced her to a study from 2009. As a Lyme Literate dr, she is very big on keeping up with research, and was shocked that he would dismiss a more recent study for an older one. Obviously, one study is not the be-all-end-all, but it should at least be taken into consideration, which he would not do.

    SpecialK, I will keep that option in mind, although since he was so adamant about Tam being the only option, I am not very encouraged. 

    Thanks ladies! 

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  • faerywings
    faerywings Member Posts: 173
    edited June 2014

    Well, the good news is that mortality-wise, I am good to go, sans HT, for 15 years. :)

    AdjOnline wouldn't let me, Faery, MD, (tee-hee!) get past the Java screen. I am not so much concerned about dying as I am with an invasive recurrence. I will keep on looking. Thanks again

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited June 2014

    faery - Tamoxifen is your only option if you remain pre-menopausal, but the other three drugs are usable, as long as they are considered safe for you from the Lyme perspective, if you are put into menopause by ovarian suppression, and if the drug for that is safe as well.  Something to discuss with both docs.

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited June 2014

    Your pharmacist is your expert on drug interactions, much more so than your doctors.

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited June 2014

    Faery - thanks for the study link. Yeah, I'm a doctor too for adjuvant online! 

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  • Moderators
    Moderators Member Posts: 25,912
    edited June 2014

    faerywings, this article about tamoxifen from the main Breastcancer.org site talks about medicines to avoid while taking tamoxifen. It does acknowledge that the list isn't complete, and may change over time (last updated Sep 26, 2013), but is a starting place. 

    Best wishes,

    • The Mods

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