Tamoxifen
For the Patient: Tamoxifen
Other names: APO-TAMOX®, GEN-TAMOXIFEN®,
NOLVADEX-D®, NOVO-TAMOXIFEN®,
TAMOFEN®
• Tamoxifen (ta-MOX-i-fen) is a drug that is used to treat many types of cancers.
Some cancers are hormone sensitive (estrogen or progesterone receptor positive)
and their growth can be affected by blocking the effect of the hormone estrogen.
Tamoxifen blocks the effect of estrogen produced by your body and decreases the
growth of hormone sensitive tumours. Tamoxifen may also have anti-cancer effects
not related to the hormone estrogen. It is a tablet that you take by mouth.
• Tell your doctor if you have ever had an unusual or allergic reaction to tamoxifen
before taking tamoxifen.
• It is important to take tamoxifen exactly as directed by your doctor. Tamoxifen may
be taken with food or on an empty stomach with a glass of water or juice. Tamoxifen
may be taken at any time of the day but should be taken at the same time each day.
• For once a day dosing: If you miss a dose of tamoxifen, take it as soon as you can if
it is within 12 hours of the missed dose. If it is over 12 hours since your missed dose,
skip the missed dose and go back to your usual dosing times.
• For twice a day dosing: Take your tamoxifen at evenly spaced times during the
day. If you miss a dose of tamoxifen, take it as soon as you can. Take the rest of the
day's dose at your usual time. If you remember at the time for the next dose, take
both doses and return to your usual dosing times.
• Other drugs such as warfarin (COUMADIN®) and rifampin (RIFADIN®, ROFACT®),
and some antidepressants such as paroxetine (PAXIL®) may interact with
tamoxifen. Tell your doctor if you are taking these or any other drugs as you may
need extra blood tests or your doses may need to be changed. Check with your
doctor or pharmacist before you start taking any new drugs.
• Because tamoxifen works by blocking the effects of estrogen in your body, it is
recommended that you avoid using estrogen replacement therapy such as
conjugated estrogens (PREMARIN®, C.E.S.®, ESTRACE®, ESTRACOMB®,
ESTRADERM® or, ESTRING®) or birth control pills. However, ESTRING® may be
used in some cases to treat vaginal dryness as directed by your doctor.
• The drinking of alcohol (in small amounts) does not appear to affect the safety or
usefulness of tamoxifen.
• Tamoxifen may harm the baby if used during pregnancy. At higher doses, tamoxifen
is used as a fertility treatment. It is best to use a method of birth control while
BC Cancer Agency Cancer Drug Manual© Page 1 of 5 Tamoxifen
Developed: September 1994
Revised: 01 April 2009, 1 March 2011, 1 January 2012
Tamoxifen
being treated with tamoxifen if you are able to become pregnant. Do not use birth
control pills. Tell your doctor right away if you become pregnant. Do not breast
feed during treatment.
• Tamoxifen will not induce menopause unless you are approaching the age of your
natural menopause. It may cause your period to become irregular.
• Tell doctors or dentists that you are being treated with tamoxifen before you receive
any treatment from them. If you are planning to have major surgery (e.g., joint
replacement) you should stop taking tamoxifen 2-3 weeks prior to surgery and only
restart it once you are back to normal activity, about 3 weeks after surgery. This
helps to lower the risk of having a blood clot develop after surgery.
• Store tamoxifen tablets out of the reach of children, at room temperature, away from
heat, light, and moisture.
• Tamoxifen is usually well tolerated and serious side effects are rare.
Side effects are listed in the following table in the order in which they may occur. Tips to
help manage the side effects are included.
SIDE EFFECTS MANAGEMENT
Hot flashes (sudden sweating and If hot flashes are troublesome:
feelings of warmth) may commonly occur • Take your tamoxifen at bedtime.
when you first start taking tamoxifen. This • If night sweats interfere with sleep, try
usually improves as your body adjusts to taking tamoxifen in the morning.
tamoxifen.
• Some people find it helpful to avoid
alcohol, spicy food, caffeine intake
(coffee, tea, colas, chocolate).
• Follow a regular exercise program.
• Try staying in a cool environment.
• Wear layers so that if you do
experience a hot flash, the outer layers
may be removed.
• Talk to your doctor if your hot flashes
continue to bother you. There may be
medications available to lessen them.
Vaginal discharge or dryness may If vaginal dryness is bothersome:
rarely occur. • Try a water based lubricants, such as
REPLENS®.
• Ask your doctor for more advice if
vaginal dryness continues to bother
you.
If vaginal discharge is bothersome make
sure to mention it at your next visit.
BC Cancer Agency Cancer Drug Manual© Page 2 of 5 Tamoxifen
Developed: September 1994
Revised: 01 April 2009, 1 March 2011, 1 January 2012
Tamoxifen
SIDE EFFECTS MANAGEMENT
Nausea (upset stomach) may sometimes If nausea is a problem:
occur when you first start taking • Take your tamoxifen after eating.
tamoxifen. This should improve as your • Try the ideas in Food Choices to Help
body adjusts to the tamoxifen. Most Control Nausea.*
people have little or no nausea.
Headache may sometimes occur. Take acetaminophen (e.g., TYLENOL®)
every 4-6 hours if needed, to a maximum
of 4 g (4000 mg) per day.
Muscle or joint pain may sometimes You may take acetaminophen (e.g.,
occur. TYLENOL®) or ibuprofen (e.g., ADVIL®)
for mild to moderate pain. Tell your
doctor if the pain interferes with your
activity.
Skin rashes may rarely occur. If the rash is bothersome:
• Call your doctor during office hours.
• Otherwise make sure to mention it at
your next visit.
Tiredness and lack of energy may This is usually mild. If it persists:
sometimes occur. • Try the ideas in Your Bank of Energy
Savings: Helping People with Cancer
Handle Fatigue.*
Swelling of hands, feet, or lower legs This is usually mild. If swelling is a
may rarely occur if your body retains problem:
extra fluid. • Elevate your feet when sitting.
• Avoid tight clothing.
High blood pressure may rarely occur Check your blood pressure regularly.
with long-term use.
Blood clots may rarely occur, usually in Tell your doctor if you have ever had
the leg. This is more likely to happen if treatment for a blood clot.
you have had blood clots before. Signs to To help prevent blood clots:
watch for include tenderness or hardness • Keep active.
over a vein, calf tenderness, sudden
• Drink plenty of fluids.
onset of cough, chest pain, or shortness
of breath. • Avoid tight clothing.
• Do not sit with your legs crossed at the
knees for long periods of time.
Weight changes may sometimes occur. To maintain your weight:
A small amount of weight gain or loss • Keep active.
may occur. • Modify your diet as necessary.
BC Cancer Agency Cancer Drug Manual© Page 3 of 5 Tamoxifen
Developed: September 1994
Revised: 01 April 2009, 1 March 2011, 1 January 2012
Tamoxifen
SIDE EFFECTS MANAGEMENT
Hair thinning may rarely occur. Your hairTo minimize thinning:
will grow back once you stop treatment • Use a gentle shampoo and soft brush.
with tamoxifen. Colour and texture may • Care should be taken with use of hair
change. spray, bleaches, dyes, and perms.
Changes in cholesterol or triglycerides Discuss this with your doctor if you have:
may rarely occur. • A history of heart disease. High blood
pressure.
• Elevated triglycerides.
• You may need to have your cholesterol
and triglycerides levels checked a few
months after starting tamoxifen.
Endometrial cancer: cancer of the lining Tell your doctor if you have:
of the uterus (womb) may rarely occur • any unexpected bleeding from the
with prolonged use of tamoxifen. vagina, persistent abdominal pain
and/or pressure or discomfort in the
pelvis.
There is no risk of this cancer to women
who have had a hysterectomy (uterus
removed).
Cataracts may rarely occur. See an eye doctor if your vision becomes
cloudy or blurred.
Depression may rarely occur. If you become unusually sad, or tearful,
and lose interest in the usual things that
give you pleasure, speak to your doctor.
*Please ask your chemotherapy nurse or pharmacist for a copy.
STOP TAKING TAMOXIFEN AND SEE YOUR DOCTOR OR GET EMERGENCY
HELP IMMEDIATELY IF YOU HAVE:
• Signs of a stroke such as sudden onset of severe headache, eyesight changes,
slurred speech, loss of coordination, weakness or numbness in arm or leg.
• Signs of a blood clot such as tenderness or hardness over a vein, calf swelling and
tenderness, sudden onset of cough, chest pain, or shortness of breath.
• Signs of an allergic reaction including dizziness, fast heart beat, face and tongue
swelling, and breathing problems with or without a rash.
SEE YOUR DOCTOR AS SOON AS POSSIBLE (DURING OFFICE HOURS) IF YOU
HAVE:
• Signs of anemia such as unusual tiredness or weakness.
• If you have bone metastases, report unusual thirst if it occurs in the first 4 weeks of
treatment.
• Unexpected bleeding from the vagina, persistent abdominal pain and/or pressure
or discomfort in the pelvis.
• Signs of liver problems such as yellow eyes or skin, white or clay-coloured stools.
BC Cancer Agency Cancer Drug Manual© Page 4 of 5 Tamoxifen
Developed: September 1994
Revised: 01 April 2009, 1 March 2011, 1 January 2012
Tamoxifen
• Changes in eyesight.
CHECK WITH YOUR DOCTOR IF ANY OF THE FOLLOWING CONTINUE OR
BOTHER YOU:
• Uncontrolled nausea, vomiting, diarrhea, or constipation.
• Hot flashes that are troublesome.
• Significant persistant aches and pains.
• Headache or pain not controlled with acetaminophen.
• Excessive swelling of hands, feet or lower legs.
• Trouble sleeping.
• Vaginal discomfort, dryness, or discharge.
• Significant weight gain or loss.
• Excessive breast swelling or soreness.
• Persistent cough or sore throat.
• Skin rash or itching.
• Depression, anxiety (nervousness or worry) or dizziness that is not usual for you.
• If you have bone metastases, bone pain may initially worsen; if pain persists or is not
controlled, check with your doctor
REPORT ADDITIONAL PROBLEMS TO YOUR DOCTOR
BC Cancer Agency Cancer Drug Manual© Page 5 of 5 Tamoxifen
Developed: September 1994
Revised: 01 April 2009, 1 March 2011, 1 January 2012