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tamoxifen citrate
Nolvadex, Nolvadex-D†‡, Novo-Tamoxifen†, Tamofen†, Tamone†

Pregnancy Risk Category D

How supplied
Tablets:
10 mg, 20 mg
Tablets (enteric-coated)†:
10 mg, 20 mg

Action
Exact neoplastic action unknown. Acts as an estrogen antagonist.

Indications & dosage
Advanced breast cancer in women and men--

Adults:
10 to 20 mg P.O. b.i.d.
Adjunct treatment of breast cancer in women--

Adults:
10 mg P.O. b.i.d. for 5 years.
Reduction of breast cancer incidence in high-risk women--

Adults:
20 mg P.O. daily for 5 years.

Adverse reactions
CNS:
confusion, weakness, sleepiness, headache.
CV:
fluid retention.
EENT:
corneal changes, cataracts, retinopathy.
GI:
nausea, vomiting, diarrhea.
GU:
vaginal discharge, vaginal bleeding, irregular menses, increased BUN level, amenorrhea.
Hematologic:
leukopenia, thrombocytopenia.
Hepatic:
changes in liver enzyme levels, fatty liver, cholestasis, hepatic necrosis.
Metabolic:
hypercalcemia, weight gain or loss.
Musculoskeletal:
brief exacerbation of pain from osseous metastases.
Skin:
skin changes, rash.
Other:
temporary bone or tumor pain, hot flashes.

Interactions
Drug-drug.
Antacids: may affect absorption of enteric-coated tablet. Don't use within 2 hours.
Bromocriptine:
may elevate tamoxifen levels. Monitor closely.
Coumadin-type anticoagulants:
may cause significant increase in anticoagulant effect. Monitor patient, PT, and INR closely.

Effects on diagnostic tests
Variations on karyopyknotic index in vaginal smears and various degrees of estrogen effect on Papanicolaou smears have been infrequently seen in postmenopausal patients.

Contraindications
Contraindicated in patients with hypersensitivity to drug. Therapy to reduce risk of breast cancer in high-risk women who need concomitant coumarin-type anticoagulant therapy or in women with history of deep vein thrombosis or pulmonary embolism is also contraindicated.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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