ShareThis

Friday, June 5, 2009

SSRIs and Tamoxifen: Does the Combination Increase Recurrence?

Prozac Linked to Suicide Attempts and Violence




As recently reported by CTV: {excerpts from the article; data presented at ASCO May 31/09}

ORLANDO, Fla. — Breast cancer survivors risk having their disease come back if
they use certain antidepressants while also taking the cancer prevention drug
tamoxifen, worrisome new research shows...The new study, reported Saturday at a
cancer conference in Florida (ASCO), is the largest to look at the issue. It found that
using these interfering drugs -- including Prozac, Paxil or Zoloft -- can
virtually wipe out the benefit tamoxifen provides...Breast cancer recurred in
about seven per cent of women on tamoxifen alone, and in 14 per cent of women
also taking other drugs that could interfere -- mainly the antidepressants Paxil
and Prozac, and, to a lesser extent, Zoloft...No greater breast cancer risk was
seen in women taking the antidepressants Celexa, Lexapro or Luvox with
tamoxifen, and there are reasons to think that other antidepressants may be safe
as well, Epstein said..."This is a very controversial area," said Dr. Claudine
Isaacs, a breast specialist at Georgetown University's Lombardi Comprehensive
Cancer Center. "Until these data are absolutely clear, I would avoid drugs that
impact on tamoxifen metabolism."


From OncocologySTAT:
"SRIs, however, can also inhibit the 2D6 enzyme that converts tamoxifen to its
main active metabolite, endoxifen, thus possibly decreasing its efficacy."


Massachusetts General Hospital Centre For Women's Health posted an article in June '08 regarding interactions between tamoxifen and antidepressants. I discovered this post when searching for solutions after detecting the interaction via Micromedex/Lexicomp.
{Click here for link to article}.

The following table from the above mentioned article provides some guidance when faced with such a dilemma:

CPY2D6 Inhibitors

Strong Inhibitors (Should be avoided if
possible):

Paroxetine
Fluoxetine
Bupropion
Duloxetine

Moderate Inhibitors:
Sertraline
Citalopram/Escitalopram
Doxepin

Weak Inhibitors (Use not restricted by treatment with
tamoxifen):

Venlafaxine
Desvenlafaxine


If antidepressants are indicated in the treatment of a woman currently
taking tamoxifen, the following treatment recommendations have been made:
*If possible, avoid antidepressants, including fluoxetine and paroxetine, that are
strong inhibitors of the CPY2D6 enzyme (see the list of inhibitors above)
*If the antidepressant is being used solely for the management of hot
flushes, other agents, such as gabapentin, may be used instead
*If it is not possible to avoid these antidepressants, another option for postmenopausal women
only would be to switch from tamoxifen to an aromatase inhibitor, if medically
appropriate


Please post your comments below or email me at: chrisral@cancerboard.ab.ca

* Thanks to Scott Edwards, PharmD for the link to the CTV News article.

Read more...

Monday, June 1, 2009

Introducing...The Information Resource Blog For Oncology Professionals

At The Chemists



Welcome and thanks for visiting Onco-P.R.N. - The oncology blog with a focus on all things oncology pharmacy/pain/palliative care-related. It is intended to be an information resource for those pharmacist and relevant health care professionals involved in whatever fashion with cancer care. Stay tuned for the latest and greatest links and information with respect to: oncology medications, continuing education, pharmaceutical care initiatives, pain and symptom control, supportive care topics, and whatever else that might fit into the theme.

I am a clinical pharmacist at the Tom Baker Cancer Centre in Calgary, Alberta, Canada. I currently practice in our outpatient Pain and Symptom Control Clinic, am also a member of our provincial IV committee, as well as spending time in rotation whether it be in the dispensary or the processing or checking IV regimens and orders.

Please post comments below (or email me at cral66@gmail.com ) for suggestions on information or links you would like to share or for me to post, or comments in general.

It is also recommended you sign up as a "Follower" by clicking on the relevant link on the left side (It is the sixth heading from the top). The process is easy and you can even use an existing google or yahoo account, amongst others. This will help establish a network of oncology pharmacists (or others with an interest in this area).

I'll end off my inaugural post with a link to an article discussing how a commonly used chemotherapeutic agent can erase finger prints! {Click on the link below.}
"Cancer drug erases fingerprints." {from BBC News}
I wonder if some criminal minds reading this might be already formulating ideas on how to make use of this!

Read more...
Related Posts Plugin for WordPress, Blogger...

About Onco-PRN

Welcome and thanks for visiting Onco-P.R.N. - The oncology website with a focus on all things oncology pharmacy/pain/palliative care-related. It is intended to be an information resource for those pharmacist and relevant health care professionals involved in whatever fashion with cancer and palliative care. Stay tuned for the latest and greatest links and information with respect to: oncology medications, continuing education, pharmaceutical care initiatives, pain and symptom control, supportive care topics, and whatever else that might fit into the theme.

*Note: This website is not affiliated with Alberta Health Services (AHS) or CAPhO and the opinions expressed herewithin are that of the author(s).

Pharmacy History

"The earliest known compilation of medicinal substances was ARIANA the Sushruta Samhita, an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC. However, the earliest text as preserved dates to the 3rd or 4th century AD.
Many Sumerian (late 6th millennium BC - early 2nd millennium BC) cuneiform clay tablets record prescriptions for medicine.[3]

Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, and the Edwin Smith Papyrus of the 16th century BC.

The earliest known Chinese manual on materia medica is the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui tomb, sealed in 168 BC. Further details on Chinese pharmacy can be found in the Pharmacy in China article."

From Wikipedia: http://en.wikipedia.org/wiki/Pharmacy#History_of_pharmacy

Journal of Palliative Medicine - Table of Contents

  © Blogger templates Newspaper III by Ourblogtemplates.com 2008

Back to TOP