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Feb 23, 2011 11:39PM CvilleJanine wrote:
I have been lucky enough to find a nutritionist that has been supporting me through chemo and now possibly tamoxifen. (I am actually trying to decide if I should take it since it may help 1-2% max). The nutritionist gave me several pages of info. (BTW- it mentions grapefruit, not citrus in general.) They talk about the two enzymes that are involved in activating tamoxifen CYP2D6 amd CYP3A4. The list below shows things that may inhibit or interfer with these enzymes.
Hope this helps,
Things that inhibit tamoxifen absorbtion
CYP2D6 Inhibitors: Strong inhibitors- prozac, paxil, cardioquin, wellbutrin. Moderate inhibitors-cymbalta, zoloft, benadryl, mellaril, cordarone, trazodone, tagamet.
Herbs that may inhibit: Goldenseal (use for only short periods), Kava. Ashwaganda did inhibit cyp2d6 in mice.
Black cohosh apears to weakly inhibit CP2D6 but the authors concluded that the amount was not clinically relevant. In addition, a German study of over 1,000 bc survivors taking black cohosh showed a significant prolonged survival over those not taking it.
Rhodiola inhibits cyp3a in vitro- use cautiously.
Green tea may make a small reduction in cyp3a, but the investigators concluded that repeated green tea catechin administration is not likely to reult in clinically significant effects on teh disposition of drugs metabolized by cyp enzymes.
Diltiazem- a calcium channel blocker is a weak to moderate cyp3a inhibitor.
CYP3A Inducers- Things that may help activate tamoxifen: (Note: these have not been studied completely. Saint John's wort, garlic, quercetin, grapeseed, ginseng, kava
Supplements to take with Tamoxifen:
Coenzyme Q10 with riboflavin and niacin0 a few human studies suggest that coQ10 (100mg) with 10mg riboflavin and 50 mg niacin- has a number of favorable effects in women already taking tamozifen. It lowered cancer markers in women, improved dna repair, lowered biochemical markers of angiogenesis, and improved lipid profiles.. NOTE: It is important to take a B-complex or multivitamin that has natural (Folinic acid and methylfolate), not synthetic folic acide. Brands include ProThera, Designs for Health, and Pure Encapsulations brands
Gamma linolenic acid (GLA) from evening primrose oil, black currant oil, or borage oil.
Fish oil- may reduce side effects, may suport tissue sensitivity and may help prevent development of ER-tumors
Supplements that are NOT contraindicated with tamoxifen
Melatonin, American & Korean ginsengs, Indole-3-carbinol, selenium
Supplements that ARE contraindicated with Tamoxifen:
Licorice root. Licorice root has estrogenic activites that may potentiate estrogens and could stimulate estrogen receptors on cancer cells. Note: This does NOT include dgl for heartburn and gastritis, in which the component that is active in cortisol and horrmonal issues removed
Long term use of phyoestrogenic herbs such as alfalfa, red clover, and rehmannia should be avoided until we understand their interactions with tamoxifen. However, since we know that the phytoestrogens in soy are not problematic, it may be that the phytoestrogens in these herbs are helpful as well.
Dietery Considerations- Things that may synergize with tamoxifen
Flaxseeds, green tea, soy