Bottle o Tamoxifen
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Per Alicia's post, perhaps everyone knows this but I'll still comment that women get cysts (actually follicles, but they look like cysts) monthly on our ovaries as we ovulate, and those are picked up on ultrasounds, depending on what time of the month we get the test. Some of these follicles stick around for a couple of months and then disappear, so they're still harmless. Some people get freaked out when they hear "cyst, but it's normal!", so this is just an explanation of why that can be.
Have a great weekend everyone!
CS
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Hey "T" gals! Hope you all have a great weekend. One good thing about weekends, No Appts & No Treatments. Thinking of all of you & enjoying the Post! I appreciate all your great Info & Thanks for all the support!
I Saw my oncologist yesterday! Had a check up & they drew 8 vail of blood . Got a few results back. Still anemia, Low on Iron,( no wonder cause they took all my blood-LOL) Good news White count is back to normal yea, Infection gone. But My calcium is still low ,after taken extra 600 mg daily!! So on my day off today ( I work the weekend) I had a Dexascan done..(Bone Density Testing ). Sound so much fun for a day off!. I am suppose to be starting back on my tamoxifen as soon as possible, But I am planning on waiting til after Ky oaks Breast Cancer Survivor Parade April 30, so I can Parade around the track with no Leg pains & no headaches, I am finally feeling good. so I think I can wait a week, I so dread those Side effect! But I Know it necessary!
Thanks for all your prayers !
Happy weekend! {{hugs}} Gina
Please click' Pink glove Dance"< http://www.youtube.com/watch?v=OEdVfyt-mLw>
Regina Robinson0 -
I've been taking Tamox for three years now and have had all of the side effects! But, good news for you, Last year my joint pain was so severe that my onc sent me for bone density scans and x-rays and did a blood test searching for inflamation and that was all good for someone my age. (Minor Osteoarthritis) YEAH! It seems the pain is real but is not a sign of any damage being done, it's almost a phantom pain but as you can see by the number of us complaining of the same type of pain in the same joints it is real. My Onc prescribed Celebrex 200mg and that seems to keep it to a managable level. Ibuprofen just didn't work and at the levels needed causes gastrointestinal problems.
Hope that helps. Good luck!
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cs: Once again you keep us all informed, thanks!
heidium: It is so easy for all of us to forget that we are getting older and some of our "complaints" are natural parts of aging and not BC related. Thanks for the reminder!
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Hi All. This is my first post in almost 10 months. I'm approaching my 2 year mark on T. Biggest issue for me has been the hot flashes. Was on gabapentin to counter them yet still pretty sever so just started effexor. Not thrilled about taking an anti-depressant however it is making a huge difference for me - in just the first week. Have managed to actually drop some weight while on T - not as much as I need to but at least headed in the right direction. Enjoy the weekend.
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Jisman: Congrats on 2 years down! Also nice to know Effexor is working so quickly for you. I haven't decided yet if I want to ask for it at my next onco appt or not. He had suggested it when I started taking T and said many women take it and it helps and you can start and stop it easily. The idea of one more pill in my body though is more than I can take right now.
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Joan: what's the difference between gabapentin and effexor? Are they both antidepressants?
Wondering if the hot flashes are worse for women that have been pushed into menopause by chemo and Tamoxifen than those who have already started or finished menopause.
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bcincolorado: I am not personally on effexor but I have heard from another bc survivor that it is not easy to stop---my physical therapist after my BLM w/TE's had bc 10 years ago and took effexor for the hot flashes. She said it was very difficult and that she was still in the process of weaning off. Just another view...
TCK
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Morning girls! I think I'm missing something here, but I don't think you are supposed to take anti-depressants while on Tamoxifen. Did I get this wrong? That's why I love this board, because we can sort things out for each of us! And I quit eating my pink Grapefruit, because I heard it interferes with the absorption of Tamoxifen.
Heidim....I heard from my friend the same thing! She had taken Tamoxifen for 5 years after her mastectomy, and this was all 10 years ago.....ANYway, she just had her bone-scan, & everything looked great! Love the information from you gals! xoxoxoxo
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There are certain antidepressants that should be avoided while on T but not all. From an article in science digest Feb 2009: "Although many antidepressants have little or no impact on tamoxifen's metabolism, paroxetine, a member of the selective serotonin reuptake inhibitor (SSRI) class of drugs, is a potent inhibitor of the metabolic step that converts tamoxifen to endoxifen."
Gabapentin is an anti-epileptic medication, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. Using it for hot flashes appears to be an off-label use.
Effexor is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). Venlafaxine affects chemicals in the brain that may become unbalanced and cause depression.
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Well, THAT was good! Thanks Joan! I knew I had heard something like that somewhere....But our Oncologists should know what we are taking....And we have to tell them all the meds we are on! I also read about Tamoxifen with Melatonin.....Seems like the Melatonin is helpful, not only with our sleep, but also helping the Tamoxifen work? Did I get this right? I think this helps my sleep a little, but my little mind is just working all night, it seems.....even though I am "sleeping." But having only this side-effect, still makes taking the T pill worth it all!0
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I'm going to say "ditto" on Jisman's comment - she's got all that right.
I'll add that the SSRI's that have specifically been shown to inhibit tamoxifen include Zoloft (aka sertraline), Paxil (paroxetine), and Prozac (fluoxetine) (because they are strong inhibitors of the CYP2D6 enzyme that is needed to metabolize tamoxifen into its active compounds). Here's a news report summarizing one major study reported in 2009 on this: http://www.bloomberg.com/apps/news?pid=20601124&sid=acVRDiRcYWzQ The data show that women who took one of these drugs for a significant amt of time they were on tamoxifen had double the rate of recurrences of those who were only on tamox. In essence, it undid the ~halving of recurrences that tamox is typically credited with!
In comparison, Effexor (venlafaxine) is only a weak or non-inhibitor of CYP2D6, and is a preferred antidepressant/hot flash drug for tamoxifen takers. Celexa (citalopram) is also supposed to be ok.
Oh, now I just found this great pdf summarizing all that in great table and explanation...definitely worth a look: http://medicine.iupui.edu/clinpharm/COBRA/Tamoxifen and 2D6v7.pdf
I definitately 2nd the opinion above that we must keep all our docs informed of the drugs we're taking. Vitamins and supplements too.
For the technically interested, there's a table here of all the known drug substrates (those which are normally metabolized through the enzyme), inhibitors, and inducers of CYP2D6 here: http://medicine.iupui.edu/clinpharm/DDIs/table.asp. Look for the column labeled 2D6.
CS
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If they have tested Tamoxifen and then tested Tamoxifen with Melatonin and found people do better. Wouldn't it behoove them to test Melatonin alone? I read somewhere that women who develop BC often are lacking in Melatonin. I'm assuming that I am, since I have been waking up every hour for at least 7 years. I'm up to 29 mg of Melatonin a night and still waking up so I must NEED it very much since most people don't need more than 1 to 5 mg. I recommended it to the guy who works at the supplement store and he only needed 1 mg to sleep through the night.
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CS: Once again you have the real "scoop" and educate us all! Thanks!
Chevyboy: My bottle of Tamox has a label on it about grapefruit. We had to stop taking it a long time ago though in our house since DH is on anti-rejection meds that say no grapefruit. Too bad since we both love it!
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Hi Luna5... I just googled Tamoxifen with Melatonin & saw a lot of information there. And I didn't know, that men with prostrate cancer are sometimes given Tamoxifen! The T pill does have a great effect on tumor growth, AND the Melatonin works with the "membranes" of the tumor cells, making the Tamoxifen easier to inhibit.
Breast Cancer
Several studies suggest that melatonin levels may be associated with breast cancer risk. For example, women with breast cancer tend to have lower levels of melatonin than those without the disease. Laboratory experiments have found that low levels of melatonin stimulate the growth of certain types of breast cancer cells, while adding melatonin to these cells slows their growth. Preliminary evidence also suggests that melatonin may strengthen the effects of some chemotherapy drugs used to treat breast cancer. In a study that included a small number of women with breast cancer, melatonin (given 7 days before beginning chemotherapy) prevented the lowering of platelets in the blood. This is a common complication of chemotherapy that can lead to bleeding.
In another small study of women who were taking tamoxifen for breast cancer but seeing no improvement, adding melatonin caused tumors to modestly shrink in more 28% of the women. Women with breast cancer should ask their doctors before taking melatonin.
And I thought this was an interesting site ..
(I have also read, that we continually lose our natural Melatonin by aging, & by 80, we don't have any left. So hopefully, by taking that extra pill every night, my chances are getting better!)
bdincolorado....Isn't it funny that you & I are both in a "non-citrus" State, & maybe that's why we can't get enough of that Ruby Red Grapefruit? Ha! We must crave it now, because we shouldn't have it! Does the same analagy hold true for those huge oranges this time of year? Okay gals...my brain hurts from all this thinking......xoxoxoxo
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YouTube - Bomshel-Fight Like A Girl Lyrics Click for awesome song & words to live by!
Have a great week girls, Good luck with appt & treatments .prayers & Hugs
I worked all weekend, so I am off today & waiting for my Oncocgist office to call me back with Lab results & results from the dexan-scan I had friday!
Hope you enjoy the song, it inspired me today, Iam in a boo-hoo modd, but it raining here, so that doesn't help!
Love Gina
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Hey Gina! Great to see you again! Good luck with your test/scan results.
Hubby was out of town last weekend and I had lots of time to work on all my craft/art projects. It was so much fun. I want to make that my new career.
I'm still doing really well on Tamox. The side effects seem to be gone. I hope they stay gone!
Happy Monday, Tamoxibabes!
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Gina....I LOVED that song! I had tears in my eyes! Thank you for sharing! Jeannette0
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Great song Gina. Thanks for sharing. I posted it on my facebook page.
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Love to read all the post. I started my Tamoxifen March 1st, and at that time they switched my Anti-depressant from Wellbutrin to Lexapro: about 10 days in, I started have general sadness: my doctor upped the dose and I was on that for 3 weeks with not much improvement. I called today to see if we could try something else. For me, dealing with depression is worse than going through all the cancer treatment. The doctor put me on Effexor XR, so hopefully in a couple weeks it will kick in.
How does everyone deal with depression?
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Gina: Thanks for the link to that song--it brought tears to my eyes. Hope you get a good report from you doctor and have a restful week!
TCK
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Gina: Thanks for the link. Made me sure start crying too! Hope your appointment goes well.
Brenda: As far as post-surgical depression goes, I know it is normal. There is a section of the boards here devoted to it even. So far I just cry at the drop of hat, but am blaming it on adjusting to tamoxifen right now. I'm not ready to try meds quite yet. Effexor is supposed to help with Tamox side effects though like hot flashes too, so hopefully it will work well for you.
Chevyboy: I am still eating big oranges! Not quite the same though. Tired of all this snow here.
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Ok now I'm worried. I knew about the grapefruit thing, but it seems from putting Tamoxifen and citrus in Google that there is another more generalized citrus worry. I have been on T since the end of January. I have also been eating clementines/mandarins and naval oranges in fairly large quantities. I wonder if I have been cancelling out all the effects. The onc doesn't even say anything about contraindicated foods/substances.
Tamoxifen for breast cancer: You should avoid citrus fruits and juices and the citrus bioflavonoid tangeretin.
This was from: http://www.doctorsofusc.com/condition/document/21574
Oh what to believe.
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Brenda, hang in there!
Before my DX I was on Lexapro. It worked great for a while. I took it all through surgery & rads. Then after rads was over my depression got much worse. They doubled my dose of Lexapro which only made me sleepy. My psych switched me to Effexor XR. We increased the dose every week. It took about a month before we hit on my magic #, 225mg. I felt OK on some of the lower doses but I listened to my psych and went along with increasing them. When it finally kicked in it was amazing! I feel happy and healthy. Side effects from Tamox don't bother me as much and they seem to be almost gone now. I'm not sure if it's because of the Effexor or because I've been on Tamox long enough for the SEs to calm down. I've been taking Tamox for 3 months.Sometimes it takes a bit of trial and error to find the right AD and the right dose. Everyone is different. I would encourage you to stick with it- it really is the difference between night and day for me.
XOXO- Tamara 0 -
Sparrow - Thanks for sharing your experience in response to Brenda's question. I was hoping someone in the same boat would give a first person accounting. Good luck to you Brenda on working it all out!
Speaking of interactions, cary1, thanks for bringing up the stuff about tangeretin. I hadn't run into this before. I read the article you linked to, plus the original research articles they referenced, and I don't find anything there that says as a blanket "Tamoxifen for breast cancer: You should avoid citrus fruits and juices." They did indeed caution tamox-takers to avoid excessive amounts of tangeretin, a flavenoid in citrus. The good news though, is that tangeretin is mostly found in citrus peels, and only in low amounts in the flesh you eat or the juice.
In the research studies that your link referred to, they did indeed find in mouse studies that the inhibitory effects of tamoxifen were negated by adding tangeritin to the mice's drinking water. However, they note in their discussion that the tangeretin concentrations used were HUGE relative to what a normal human would normally ingest from food. Supplements, however, might put you into this range. Here's their discussion on that:
"The human equivalent of the amount of tangeretin used in our experiments would be 280 mg per day. Since tangeretin is poorly water soluble, this dose cannot be ingested by drinking reasonable amounts of citrus juices; nor do we underestimate the numerous health benefits that accrue from eating or drinking citrus products, even for cancer patients. (Our data certainly do not indicate that citrus flavonoids would be carcinogenic!). Methoxylated flavones, however, are components of citrus peel oil, and the equivalent human dose of tangeretin (280 mg) corresponds to about 20 mL of tangerine oil. The addition of citrus peel oils to beverages and foods, baked goods, candy, and confections-both in the United States (28) and in Europe-may lead to a higher tangeretin intake than with juices. We are even more concerned about the promotion and sale of dietary supplements containing citrus flavonoids (i.e., tablets that are currently marketed with a recommended daily dose of about 1 g of citrus flavonoids). Furthermore, we recently found that another methoxylated flavonoid, named nobiletin, is 10 times more potent than tangeretin in inhibiting NK cell activity in vitro. In addition, nobiletin is the major methoxylated flavone in orange oil (0.2%- 0.4%). Taken together, our results plead against excessive consumption of tangeretin-added products or dietary supplements by breast cancer patients during tamoxifen treatment." (Liu et al 1999 see article here: http://jnci.oxfordjournals.org/cgi/reprint/91/4/354)
One last point is that the only mechanism they could find was an effect of tangeretin on the immune system, not the interaction of tamoxifen with tumor cells, or tangeretin's own anti-cancer effects on BC tumor cells. This is important because the immune systems of mice are massively different than humans, so the translation of that effect to humans is highly ambiguous.
Anyway, I hope this will let you relax a bit. I for one intend to continue eating my citrus in reasonable amounts. I don't, however, intend to take concentrated flavenoid supplements (but then, I wasn't before I knew this either).
CS
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Tamara: I appreciate your response. It give me hope. I guess I will just try to get through each day and hopefully soon I will feel better.
Brenda
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CS: I am taking 1000mg Vitamin C daily (chewable because I hate pills!)....do you think that is ok with Tamox? Your knowledge amazes me!
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Hi Tamoxibeauties! I am doing my usual "driveby". lol
Hoping that all is well with everyone and that you are enjoying this beautiful weather! I have been so busy..with everything! lol Good stuff!
Well, have a great day tomorrow and pray that you all are doing well!
♥ Susie
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Hi All,
My friend has Stage IV breast cancer and has been switched to Tamoxifen because Arimosin no longer works for her. She has been experienced all over malaise and a low grade fever. Has anyone you know had that side effect. Her onc said it was definately a side effect of the drug.
Roseann
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bcincolorado: I haven't looked into vitamin C and tamoxifen interactions. I don't have time to do research today, but I'll put it on my list to look up soon. I'd be surprised if a "reasonable" amount of vit C, or any other vitamin, would be a problem, but you never know (and who's to say what's reasonable?). Since we're not explicitly warned off of vitamin C like we are off of some of the antidepressants, grapefruit, etc., I suspect there's little specific study of it. But, I'll take a look soon.
I don't want to start a scare here, so note that this is just an inquiry...I read a woman's post in another forum (not on BCO) that her pharmacist said not to take tamox with calcium supplements because the Ca could bind up the tamox and make it less absorbed. I searched the web and pubmed and could find absolutely no mention of this elsewhere or evidence of any kind, so I'm inclined to dismiss it as a rogue one-off statement based on a single pharmacist's speculation. Has anyone else heard anything about issues with Ca supplements? Hopefully not, but I'm willing to listen.
Roseanne, Sorry to hear of your friend's stage 4 bc. If her onc actually admits these are SEs of tamox then they probably are. The long lists of SEs from the various tamox studies do include things like "flu syndrome" and "fatigue", which could include your friend's symptoms. I do hope the tamox works for her.
CS
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