Introduction
Tamoral is an anti-estrogens. It is used in the treatment of breast cancer. It is also used to reduce the risk of breast cancer in women with a high chance of developing it. This medicine helps to slow down the growth and multiplication of cancer cells.
Tamoral is also helpful in the treatment of infertility. It can be taken with or without food, but take it at the same time to get the most benefit. It should be taken as your doctor's advice. The dose and how often you take it depends on what you are taking it for. Your doctor will decide how much you need to improve your symptoms. Swallow the tablets whole with a drink of water. You should take this medicine for as long as it is prescribed for you.
The most common side effects of this medicine include nausea, skin rash, hot flushes, thinning of hair and tiredness. If these bother you or appear serious, let your doctor know. There may be ways of reducing or preventing them. Some side effects may mean you should inform your doctor immediately include vaginal bleeding, irregular menstrual period and vaginal discharge. It makes birth control pills less effective, hence use a condom and other preventive measures to avoid pregnancy.
Before taking this medicine, tell your doctor if you are on treatment of infertility or had a blood clot disorder. Your doctor should also know about all other medicines you are taking as many of these may make this medicine less effective or change the way it works. Tell your doctor if you are pregnant or breastfeeding. Your doctor may perform some blood tests to check liver function and calcium level in the body.
Side effects of Tamoral
Common
- Nausea
- Skin rash
- Hot flashes
- Thinning of hair
- Vaginal discharge
- Swelling
How to use Tamoral
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Tamoral may be taken with or without food, but it is better to take it at a fixed time.
How Tamoral works
Tamoral is a hormone-based medication. It works by binding to estrogen receptors and blocking the effects of estrogen (a natural female hormone) in the breast tissue. This slows down the growth and multiplication of breast cancer cells.
Administration
May be taken with or without food.
Adult Dose
Oral
Breast Cancer Treatment
20 mg daily as a single or in 2 divided doses. Max: 40 mg daily.
Continue with adjuvant therapy for at least 5 years
For women with ER-positive disease, continuing tamoxifen to 10 years rather than stopping at 5 years produces a further reduction in recurrence and mortality, particularly after year 10
Breast Cancer Prevention
Indicated to reduce the incidence of breast cancer in women at high risk for breast cancer; high risk is defined as women aged >35 years with a 5-year predicted risk of breast cancer >1.67% (calculated by the Gail Model)
Adult: 20 mg daily for 5 yr.
Data are limited for use >5 yr in the risk-reduction setting
Anovulatory infertility
Adult: 20 mg daily on days 2-5 of the menstrual cycle, increase if necessary in subsequent cycles. Max: 80 mg daily. Women w/ irregular menstruation: Initial course may begin on any day and a 2nd course may start 45 days later.
Contraindication
History of DVT or pulmonary embolism. Pregnancy and lactation. Concomitant coumarin-type anticoagulant therapy.
Mode of Action
Tamoxifen, a triphenylethylene derivative, produces a nuclear complex by competitively binding to oestrogen receptors on tumours and other tissue targets thus, decreasing DNA synthesis and inhibiting oestrogen effect. It is only cytostatic rather than cytotoxic due to accumulation of cell in G0 and G1 phases.
Precaution
Patient w/ leucopenia and thrombocytopenia, hyperlipidaemias. Monitoring Parameters Perform periodic CBC (e.g. platelet counts) and LFTs. Routine gynaecological monitoring and any abnormal symptoms (e.g. abnormal vag bleeding or discharge, pelvic pain, menstrual irregularities).
Lactation: not known if excreted in breast milk, do not nurse
Side Effect
>10%
Hot flashes (64%),Vaginal discharge (30%),Amenorrhea (16%),Menstrual changes (13%)
1-10%
Oligomenorrhea (9%),Cataracts (8%),Bone pain (6%),Nausea (5%),Cough (4%),Edema (4%),Fatigue (4%),Musculoskeletal pain (3%),Ovarian cyst (3%),Depression (2%),Abdominal cramps (1%),Anorexia (1%)
<1%
Angioedema,Corneal changes,Loss of libido,Endometrial cancer,Pancreatitis,Retinal vein thrombosis,Stroke,Uterine fibroids
Potentially Fatal: Blood dyscrasias, cholestasis, hepatitis, hypercalcaemia in patients with bone metastasis, thromboembolic events. Increased risk of endometrial cancer and uterine sarcoma.
Interaction
Increases dopaminergic effect of bromocriptine. Increased risk of thromboembolic events w/ cytotoxic drugs. Increased risk of bleeding w/ platelet aggregation inhibitors. May mutually reduce effects w/ hormone preparations particularly oestrogens (e.g. OCs). Reduced plasma levels w/ CYP3A4 inducers (e.g rifampicin) and CYP2D6 inhibitors. Increased plasma levels w/ CYP3A4 inhibitors.
Potentially Fatal: Significant increase in anticoagulant effect w/ coumarin-type anticoagulants (e.g. warfarin).