Wellbutrin and tamoxifen

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Kjones13
Kjones13 Member Posts: 1,520
edited July 2016 in Stage IV/Metastatic Breast Cancer ONLY

my psychiatric np called and left a message that she got a notice from my insurance company (?!?!) that there is a drug interaction and I need to be taken off of Wellbutrin. Well I've been on those two together for over a year! Anyone know anything about this? I loathe insurance companies..

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  • exbrnxgrl
    exbrnxgrl Member Posts: 12,424
    edited July 2016

    https://www.verywell.com/antidepressants-that-inte...

    This article was updated in June 2016 and contains a chart about how various anti-depressants interact with Tamoxifen.

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  • Moderators
    Moderators Member Posts: 25,912
    edited July 2016

    Hi Kjones,

    Yes, according to the main Breastcancer.org site's page on Treatments for Depression and Mood Changes:

    "If you are taking tamoxifen, talk to your doctor about which antidepressants are safe for you to take. Some antidepressants -- including Paxil, Wellbutrin (chemical name: bupropion), Prozac (chemical name: fluoxetine), Cymbalta (chemical name: duloxetine), and Zoloft (chemical name: sertraline) -- interfere with the body's ability to convert tamoxifen into its active form, preventing you from getting the full benefit of tamoxifen. For more information, see our page on Tamoxifen."

    We hope this helps and we're so sorry you're just finding this out now!

    --The Mods

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  • JFL
    JFL Member Posts: 1,947
    edited July 2016

    Yes, the same thing happened to me (9 years ago). The psychiatrist at the cancer center took me off because, several months after he prescribed it to me for extreme fatigue, he learned the two drugs use the same enzyme to metabolize in your body - CYP2D6. Wellbutrin *could* decrease your body's ability to metabolize Tamoxifen. The news was cutting edge back then but I noticed it is listed in standard drug disclosures now.

    I feel for you. I LOVE Wellbutrin and was devastated to have to go off it. I recently resumed it a few weeks ago as I have had extreme sleepiness since I switched treatments. Although not helpful to you right now, it doesn't interact with other hormone therapies or chemo. If you switch meds in the future, you can go back on it.

    Did you ever have any luck with getting your MO to prescribe Provigil? I took that after I was kicked off Wellbutrin and it had similar effects on my energy levels. However, after a few months, my insurance started denying coverage of Provigil and I was switched to the newer version, Nuvigil (same manufacturer, Cephalon; Cephalon started hiking the price of Provigil when it was set to go off patent and offered the supposedly new and improved version, Nuvigil, for cheaper in an attempt to hook patients before a generic Provigil was produced). Nuvigil was fine but not as effective as Provigil for me. I assume there is a generic version of Provigil by now (modafinil) although I haven't checked. Cephalon was involved in extensive litigation fighting to prevent it from going generic and defending against lawsuits regarding price manipulation of Provigil.

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  • Kjones13
    Kjones13 Member Posts: 1,520
    edited July 2016

    thank you for your responses. Grr. I love Wellbutrin and I'm on Zoloft! Great...I would much rather stop taking the tamoxifen.

    Jfl-I was able to convince an np at my mo's office and she advocated for me to get Ritalin and it has been a life saver for me! I just need the 5mg in the morning to help me get going. The psychiatric np told me the chances of getting provigil was slim to none. We had gone through a lot of meds to get the right combo! And life has been really good since January and now I have to start all over?! Fatigue and depression suck! Sorry your new treatment is taking a toll. Hope it's working though

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  • JFL
    JFL Member Posts: 1,947
    edited July 2016

    KJones, it must be so disappointing to go back to the drawing board! Glad the Ritalin helped. My insurance company tried to get me to move to Adderal or Ritalin when Provigil was denied. I will keep those in mind for the future.

    My new med, Xeloda, is working great and I have had immediate results. Side effects are worth it. However, I don't think Xeloda is causing the sleepiness. My MO suggested a few weeks ago that it was probably the Cymbalta I was taking for joint pain. I had no side effects from Cymbalta while on hormone therapy/Ibrance. However, once I went off that and I started having a bit of hormones flowing through my body again, the sleepiness set in. My serotonin levels might have been too high when I had the assistance of producing more serotonin myself from my natural hormones. Anyway, I am loving the Wellbutrin but am struggling right now with Cymbalta withdrawal. It is awful. I tapered off the Cymbalta quickly as I was having a hard time keeping awake while driving, particularly when I was waiting at stop lights. I figured withdrawal symptoms are a bear but not as worrisome as driving safety!

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  • Kjones13
    Kjones13 Member Posts: 1,520
    edited July 2016

    I completely understand. I was having a similar issue taking my kids to school! Scary! It's crazy that not only do we have to worry about the side effects of cancer treatments, but also the drugs that we need to take to deal with those side effects! I'm so happy your treatment is working!

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