Can other drugs interfere with hormone therapy?

Certain drugs, including several commonly prescribed antidepressants (those in the category called selective serotonin reuptake inhibitors, or SSRIs), inhibit an enzyme called CYP2D6. This enzyme plays a critical role in the use of tamoxifen by the body because it metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself.

The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.

Many experts suggest that patients who are taking antidepressants along with tamoxifen should discuss treatment options with their doctors. For example, doctors may recommend switching from an SSRI that is a potent inhibitor of CYP2D6, such as paroxetine hydrochloride (Paxil®), to one that is a weaker inhibitor, such assertraline (Zoloft®), or that has no inhibitory activity, such as venlafaxine (Effexor®) or citalopram (Celexa®). Or they may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen.

Other medications that inhibit CYP2D6 include the following:

  • Quinidine, which is used to treat abnormal heart rhythms
  • Diphenhydramine, which is an antihistamine
  • Cimetidine, which is used to reduce stomach acid

People who are prescribed tamoxifen should discuss the use of all other medications with their doctors.

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Source: National Cancer Institute.

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