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tamoxifen and Paxil
Hi all. My question is in regards to the CYP2D6 gene test. I had it done and found out I'm a intermediate/extensive metabolizer. My dx was DCIS, 4mm, grade 2, non-comedic, micropapillary and cribriform. I did not have radiation. I was recommended tamoxifen, though. I want to try it, but I'm also on Paxil for panic attacks. It has been a life savor. I read that the SSRI's will lower the effectiveness of tamoxifen. How much will they lower it? I would love not to get off the paxil, but do not want to risk an invasive breast cancer. My dx was made by mammo with calcifications. Thank you in advance.
Actually yes. Hubby was super understanding about all the changes, but was first to speak up and very insistent that the doc FIX it!!
Even at work I tell 'em I've had chemo brain, prego brain, chemo brain, I've been nuked, put back together again and NOW I have toddlers and take Tamoxifen!!! How do you expect me to remember ANYTHING and be productive 'cause I'm chasing missing brain cells! And makeup? Who has time for makeup, besides my daugters have put it on themselves. And you want me to look nice? This is nice. Who has time to iron?! At least my shoes match...well they did before my youngest decided to help. Oh, attitude? Well, I just smile. At least I don't go before a customer anymore, but I hear I might get to be help desk here after a while. Hmmmm better make sure I take my Effexor.
Then I add that at least I'm happy about all of this because I'm taking Effexor!
Gotta have a sense of humor. There are times when I do remember something and just stare into space with a goofy smile of amazement that something remains upstairs after 3 years of life.
That's pretty typical for me around here. Thankfully the Tamoxifen and hopefully the Effexor are all temporary. I have 3 years 8 months remaining. But, who's counting?
PS...weren't you asking about tamoxifen and arthritis? My mom, again lucky woman, has serious arthritis in her neck, hands, shoulders, knees... she made it through 5 years of tamoxifen without any issues (that we know of). She was taking Celebrex for her neck which is the worst. She has recently found some additional arthritis on her lower back, but that's probably just age. She's 68. Although she has slowed down considerably (walking speed wise), she can still haul my two toddlers around better than most women.
May you follow in her footsteps and come out without having known a hot flash, irritability, or any other wonderful side-effect.
Take care,
Lisa
Even at work I tell 'em I've had chemo brain, prego brain, chemo brain, I've been nuked, put back together again and NOW I have toddlers and take Tamoxifen!!! How do you expect me to remember ANYTHING and be productive 'cause I'm chasing missing brain cells! And makeup? Who has time for makeup, besides my daugters have put it on themselves. And you want me to look nice? This is nice. Who has time to iron?! At least my shoes match...well they did before my youngest decided to help. Oh, attitude? Well, I just smile. At least I don't go before a customer anymore, but I hear I might get to be help desk here after a while. Hmmmm better make sure I take my Effexor.
Then I add that at least I'm happy about all of this because I'm taking Effexor!
Gotta have a sense of humor. There are times when I do remember something and just stare into space with a goofy smile of amazement that something remains upstairs after 3 years of life.
That's pretty typical for me around here. Thankfully the Tamoxifen and hopefully the Effexor are all temporary. I have 3 years 8 months remaining. But, who's counting?
PS...weren't you asking about tamoxifen and arthritis? My mom, again lucky woman, has serious arthritis in her neck, hands, shoulders, knees... she made it through 5 years of tamoxifen without any issues (that we know of). She was taking Celebrex for her neck which is the worst. She has recently found some additional arthritis on her lower back, but that's probably just age. She's 68. Although she has slowed down considerably (walking speed wise), she can still haul my two toddlers around better than most women.
May you follow in her footsteps and come out without having known a hot flash, irritability, or any other wonderful side-effect.
Take care,
Lisa
This is SO true!!!!! However, you can claim the reverse if he says you are being b*tchy. It's the MEDS!
Ah but if I ask my Hubby, he could use it to his advantage and say I am moodier than normal and put too much down to my "mood" rather than there being a very valid reason for my mood - as in him annoying me!!!
My husband wanted me to tell you to ask your husband, SO, best friend, whether or not you are getting too irritable and moody. He says that he noticed it LONG before I did!!!
Best of luck to you!
Lisa (I'm lhughes69 at home and lhughes from work)
Best of luck to you!
Lisa (I'm lhughes69 at home and lhughes from work)
Amen to the spending time at home with the kids! I just went back into the rat race myself after 3 years off having babies and getting rid of cancer.
I think I starting having problems before the end of the first month. The hot flashes hit first and then we noticed my mood swings. We had an appt with doc about a month or so into taking Tamoxifen. He prescribed Effexor to fix it all.
I will tell you that I did that I did not realize you were supposed to take Tamoxifen with food and my onc suggested I take it with breakfast. I was taking it at night before bedtime when I usually take my vitamins. Ooops!!!! I'm now taking it with breakfast and things are better.
I'll be thrilled for you if you are like my mom who also never had a lick of side effects. I'll be jealous, too!!!
Stay sane, cool, and not moody!
Lisa
I think I starting having problems before the end of the first month. The hot flashes hit first and then we noticed my mood swings. We had an appt with doc about a month or so into taking Tamoxifen. He prescribed Effexor to fix it all.
I will tell you that I did that I did not realize you were supposed to take Tamoxifen with food and my onc suggested I take it with breakfast. I was taking it at night before bedtime when I usually take my vitamins. Ooops!!!! I'm now taking it with breakfast and things are better.
I'll be thrilled for you if you are like my mom who also never had a lick of side effects. I'll be jealous, too!!!
Stay sane, cool, and not moody!
Lisa
Hiya,
Ok I have been on Tamoxifen for 13 days now and am waiting for something to happen - nothing!! Now, don't get me wrong, I would be thrilled if it stays that way, but I think it is too good to be true considering the amount of possible side effects and the fact that I got breast cancer in the first place. How long were you on Tam before you got the sympthoms of hot flahes and mood swings? I have noticed that I am a bit more irritable the past week or so, but I have put this down to having the side effects of low calcium levels in my blood and going back to work fulltime. One of the benefits of the breast cancer was that I spent much more time at home and had even more quality time with my kids, I miss that. I am now back in the rat race to earn a crust for my family and all the associated pressures as well as being tired obviously as I got out of the habit of taxing my brain daily. Anyway, hope you get a chance to answer this question.
Ok I have been on Tamoxifen for 13 days now and am waiting for something to happen - nothing!! Now, don't get me wrong, I would be thrilled if it stays that way, but I think it is too good to be true considering the amount of possible side effects and the fact that I got breast cancer in the first place. How long were you on Tam before you got the sympthoms of hot flahes and mood swings? I have noticed that I am a bit more irritable the past week or so, but I have put this down to having the side effects of low calcium levels in my blood and going back to work fulltime. One of the benefits of the breast cancer was that I spent much more time at home and had even more quality time with my kids, I miss that. I am now back in the rat race to earn a crust for my family and all the associated pressures as well as being tired obviously as I got out of the habit of taxing my brain daily. Anyway, hope you get a chance to answer this question.
I've been on Tamoxifen for over a year now after diagnosis of Stage 3 breast cancer. They put me on Effexor (an SSRI) to help with the lovely side-effects of Tamoxifen...awful hot flashes (I'm premenopausal, by the way) and horrendous mood swings (husband loved that one!). Would Effexor be an effective alternative for you? Both my oncologists said it was the best drug for the side-effects of Tamoxifen. I assume because they are the ones to prescribe both drugs that the combo is effective for prevention. Talk with your docs and get their opinions.
Hi.
There are a number of factors to consider in your case, but unfortunately no clear answers.
Yes, Paxil affects the metabolism of tamoxifen. But the observation is that it leads to accumulation of endoxifen, which is not the critical metabolite to determine action. So, the actual impact of the change in the levels of these individual tamoxifen metabolites is difficult to say.
Since you are an extensive metabolizer, this will offset the inhibitory effect of Paxil and it is possible that the Paxil may only make your metabolism equal with other women, and hence you may still obtain a benefit from tamoxifen.
Hence, there is no clear reason why you should not receive tamoxifen, pending further studies. But since, your case is one of prevention, perhaps you would lean more on safety than taking on risks.
You may wish to discuss with your doctor other hormonal therapies. For DCIS, only tamoxifen is indeed studied, but there are ongoing studies for aromatase inhibitors (for post-menopausal women). I'm not certain if there are studies for goserelin (for pre-menopausal women. You could inquire about enrolling in one of these studies if possible.
You should discuss with your doctor if you have sufficient risk to undergo genetic testing, as other preventive therapies (unfortunately some of these are surgical) are available for those with genetic risk.
At the end of the day, there is still sufficient merit in considering close follow-up and monitoring. If you catch the disease early enough, the chances of cure are excellent. So the superiority of taking a drug for prevention is not absolute.
My best to you.
There are a number of factors to consider in your case, but unfortunately no clear answers.
Yes, Paxil affects the metabolism of tamoxifen. But the observation is that it leads to accumulation of endoxifen, which is not the critical metabolite to determine action. So, the actual impact of the change in the levels of these individual tamoxifen metabolites is difficult to say.
Since you are an extensive metabolizer, this will offset the inhibitory effect of Paxil and it is possible that the Paxil may only make your metabolism equal with other women, and hence you may still obtain a benefit from tamoxifen.
Hence, there is no clear reason why you should not receive tamoxifen, pending further studies. But since, your case is one of prevention, perhaps you would lean more on safety than taking on risks.
You may wish to discuss with your doctor other hormonal therapies. For DCIS, only tamoxifen is indeed studied, but there are ongoing studies for aromatase inhibitors (for post-menopausal women). I'm not certain if there are studies for goserelin (for pre-menopausal women. You could inquire about enrolling in one of these studies if possible.
You should discuss with your doctor if you have sufficient risk to undergo genetic testing, as other preventive therapies (unfortunately some of these are surgical) are available for those with genetic risk.
At the end of the day, there is still sufficient merit in considering close follow-up and monitoring. If you catch the disease early enough, the chances of cure are excellent. So the superiority of taking a drug for prevention is not absolute.
My best to you.
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