Tamoxifen

What is tamoxifen?

Tamoxifen (Nolvadex® or Soltamox®) is a drug that treats hormone receptor-positive (hormone-positive) breast cancer. (Hormone-positive breast cancer is a type of cancer that needs estrogen and/or progesterone to grow.) Healthcare providers also use tamoxifen to help prevent breast cancer in people over 35 who have a high risk of the disease. Since the U.S. Food and Drug Administration (FDA) approved tamoxifen in 1998, it has become one of the most widely used breast cancer treatments.

Who should use tamoxifen?

Tamoxifen can help people with hormone receptor-positive breast cancer. The drug can lower the risk of breast cancer in:

• People who are high risk of breast cancer due to a family history of disease or mutated (changed) breast cancer (BRCA) genes.
• People who’ve already been diagnosed with breast cancer to prevent recurrence (return) of cancer. This includes development of breast cancer in the opposite, untreated breast and recurrence of breast cancer following surgery, chemotherapy or radiation therapy.

Your healthcare provider will talk with you about your medical history to determine if tamoxifen is right for you.

Why do breast cancer patients take tamoxifen?

Millions of people have used tamoxifen to prevent or treat breast cancer. The drug may lower the risk of:

• Breast cancer in the opposite breast by 50%.
• Breast cancer recurrence in premenopausal people by 30% to 50%.
• Breast cancer recurrence in postmenopausal people by 40% to 50%.
• Initial breast cancer diagnosis by up to 40%.
• Invasive breast cancer after the diagnosis of early-stage, noninvasive breast cancer (ductal carcinoma in situ or DCIS) by up to 50%.

What does tamoxifen do to the body?

Tamoxifen is an antiestrogen drug. It blocks estrogen activity in your breast. This may help stop the growth of breast tumors that need estrogen to multiply.

How do you take tamoxifen?

You must take tamoxifen daily by mouth, preferably at the same time each day. The drug comes in two forms:

• Nolvadex® pill.
• Soltamox® liquid.

How long should you take tamoxifen?

Most people take tamoxifen or other hormone therapy for at least five years and sometimes, up to 10 years. Treatment length depends on the specifics of your cancer diagnosis.

Your healthcare provider may recommend taking tamoxifen for five years and then switching to different hormone therapy for several more years.

What are the advantages of tamoxifen?

In addition to lowering the risk of breast cancer and cancer recurrence, tamoxifen:

• Prevents bone loss (osteoporosis) after menopause.
• Lowers cholesterol levels.

What is the most common side effect of taking tamoxifen?

Tamoxifen side effects may include:

• Menopause-like symptoms, including hot flashes, night sweats and vaginal dryness.
• Weight gain (more common) or fluid retention (edema).
• Irregular or loss of menstrual periods.
• Leg swelling.
• Nausea.
• Vaginal discharge.
• Skin rash.
• Erectile dysfunction.
• Fatigue.
• Headaches.

What are the risks of taking tamoxifen?

Rarely, tamoxifen may cause serious issues such as:

• Blood clots, deep vein thrombosis (DVT) and strokes.
• Cataracts or other eye problems.
• Endometrial (uterine) cancer.

What’s the chance of breast cancer recurrence (return) without tamoxifen?

Research indicates that you’re up to 61% more likely to experience breast cancer recurrence if you don’t take tamoxifen at all or take it incorrectly.

When should I see my healthcare provider?

You should call your healthcare provider if you’re taking tamoxifen and experience:

• Chest pain or shortness of breath.
• Fever.
• Signs of stroke, including slurred speech, blurred vision or sudden numbness in your legs, arms or face.
• Swelling in your legs, ankles or feet.
• Uncontrolled vomiting.

Is tamoxifen worth the risk?

Often, the benefits of taking tamoxifen outweigh the risks. But it depends on your specific situation. While the drug can successfully prevent breast cancer for many, it can also increase the risk of stroke, uterine cancer or blood clotting issues in others.

One research study tested the risks vs. benefits of tamoxifen in a group of 788 women (people assigned female at birth). All of the participants were on tamoxifen and none of them had a history of breast cancer. The study found that the benefits of tamoxifen outweighed the risks for 74% of their participants, but not for 20% of their participants.

During a consultation, a healthcare provider will discuss your medical history in detail. To determine if this type of therapy is right for you, your provider will take the following into consideration:

• Age.
• Race.
• Breast cancer risk.
• Risk for tamoxifen adverse effects (stroke, cataracts, uterine cancer, etc.).

Is it safe to take tamoxifen during pregnancy?

Tamoxifen may cause birth defects. You shouldn’t take the medication if you’re pregnant or planning to become pregnant. To prevent pregnancy, talk to your healthcare provider about nonhormonal birth control options. (Hormonal contraceptives can fuel the growth of hormone-positive breast cancer.) You’ll need to use contraception while taking tamoxifen and for two months after you stop the medication.

Is tamoxifen chemotherapy?

No, tamoxifen is a type of hormonal therapy. It belongs to a class of drugs called selective estrogen receptor modulators (SERMs).

Sometimes, healthcare providers refer to tamoxifen as “chemoprevention.” But usually, chemoprevention drugs aren’t the same as chemotherapy drugs.

Do tamoxifen side effects start immediately?

While it depends on the person, many individuals report side effects as soon as the first dose.

What things should I avoid while I’m taking tamoxifen?

Certain foods and beverages can make tamoxifen less effective, including:

• Grapefruit.
• Tangerines.
• Beverages containing alcohol.

If you’re taking tamoxifen, you should avoid the foods and beverages listed above.

How long does tamoxifen stay in your body after stopping?

Tamoxifen stays active for up to two weeks after your last dose. However, it can take about three months to flush out of your system completely.

A note from Cleveland Clinic

Tamoxifen is a highly effective breast cancer treatment. It may significantly lower your risk of breast cancer recurrence or invasive breast cancer. People who are at high risk for breast cancer may take tamoxifen to reduce their chances of getting the disease. Your healthcare provider can discuss whether tamoxifen or another form of hormone therapy is right for you.