Tamoxifen and SSRIs

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thesedays
thesedays Member Posts: 9
edited August 2019 in Hormonal Therapy - Before, During, and After

I should preface this by saying that I'm a licensed pharmacist, although I'm not currently practicing.


I saw my oncologist for the first time last week, and he prescribed tamoxifen for me. I have taken paroxetine (Paxil) for about 20 years for mild OCD, and he wanted to take me off the Paxil because it can interfere with the liver's conversion of tamoxifen to a more active metabolite. He actually suggested Effexor, about which I have heard numerous horror stories, and I told him that I would not take it. We did compromise on me reducing the dose from 20mg to 10mg.


Has anyone else had their oncologist suggest anything like this? I knew about the interaction beforehand, but only because I'd consulted Dr. Google.

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  • Michelle_in_cornland
    Michelle_in_cornland Member Posts: 1,689
    edited November 2017

    Welcome. Here is a recent update from BMJ in 2016. There are other SSRI's that cause less interference. Talk to your psych doctor and have them work with onc doctor. Come up with plan for future. If you have radiation, then see if you can postpone starting Tamoxifen until you are finished and recovered. It is much easier to transition from treatment to treatment, than to layer treatments. Could you potentially reduce paxil and supplement with tricyclic that is not contraindicated with Tamoxifen? You have time to really think it through. You can even try Tamoxifen with Paxil and see if you tolerate the Tamoxifen first, before changing your stable drug routine. You might consider an AI, but those have other side effects. If you are stable on Paxil, def think twice before going off of it. Do you have a nottingham score and grade for your tumor?

    http://www.bmj.com/content/354/bmj.i5309

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  • gb2115
    gb2115 Member Posts: 1,894
    edited November 2017

    Yes my oncologist said there are only certain ones you can take... I believe effexor is the safest in regards to not interfering with tamoxifen (which is something you want to work properly if you are going to take it).

    I need to be on anxiety meds but am winging it without them and holding steady so that I don't have to go on effexor. Might give in and take it someday though.

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  • thesedays
    thesedays Member Posts: 9
    edited November 2017

    The Oncotype score is in process and I'll find out in about 2 weeks.

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  • llamalady
    llamalady Member Posts: 47
    edited November 2017

    thesedays - my oncologist said the same thing. I was on Paxil as well for menopause symptoms. I started it in Feb. and found my lump in March. So this summer after lumpectomy and radiation my Onc said I needed to change the Paxil and gave me a list of replacements. Like you, I was not big on switching to Effexor. Lexapro was on the list of acceptable SSRI's so I switched to that. I switched about mid July and I started Tamoxifen the first of August. I had absolutely no problem with the switch and can not tell any difference between the Paxil and the Lexapro. I was on 20mg Paxil and did an immediate switch to 10mg Lexapro - no weaning off. I had mild jitters- like too much caffeine for about 48 hours, that was all. Also I have had absolutely no negative side effects from the Tamoxifen. If anything I feel better than I have felt in a long time :-) Hope this helps!

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  • Nancy2581
    Nancy2581 Member Posts: 1,234
    edited November 2017

    I second the lexapro. I have been taking it since I was diagnosed in 2014. I started with 10mg (standard dose) and about a year ago dropped to 5 mg only. Seems to work for me. Have been on tamoxifen since January 2015

    Nanc

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  • fcancer2020
    fcancer2020 Member Posts: 5
    edited August 2019

    Greetings,

    I've recently been diagnosed with HR+ S2 & DCIS - after taking Paroxetine (Paxil). I began taking it in Jan 2019 & found a lump in early May. I have no gene indicators nor family history. I have since undergone a double mastectomy.

    I am looking to start a class action lawsuit as not only are most health care providers unaware of the link between Paxil & development of breast cancer - but it is not listed as a possible danger or side effect. Had I known there was a risk I would have never taken it.

    Please reach out to me if you are interested in pursuing a case. I believe there are many of us out there with the same diagnosis because of this drug. We should have been given the opportunity to make an informed decision. If we can Google numerous research studies showing a direct link between Paxil & HR+ breast cancer - how did Pharma not know????

    I wish you the best in your recovery.

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