Bottle o Tamoxifen
Comments
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Thank you Lala I will definitely look I to trying it. How do you take it in food or just with water?
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I talked to my MO and said I was seriously consideringquitting tamoxifen. I can live like I'm 80 for the next 10 years!! We agreed to give me a two week break and look at alternative drugs. I've been off Tamoxifen for 3 days and I feel so much better!!!
One of the drugs she mentioned is Feraston. Apparently quite costly and often denied by insurance.
Whatever drug I end up with..ill probably just swap one side effect for another.
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hsant.....no worries, you weren't harsh, you gave me good advice! I guess I'm just trying to gather as much info and opinions on Tamoxifen before I start it.
You're SO right...cancer is scary and so are the meds/treatments. Since this is something my MO told me he would like to see me take for 10 years, I want to feel as prepared as possible. For some reason, Tamoxifen's side effects scare me.....I guess because I've heard so many horror stories. (But....I need to learn to ignore the horror stories. I was told them about various tests and treatments that I had, but nothing horrible happened to me.)
Anyway, thanks for taking the time to apologize, but really, it's okay!
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Occovegirl--I just take my capsules in the morning with breakfast along with almost all my other supplements. I also take magnesium (400mg) that I split am and pm so I take my multivitamin at night with the magnesium. Everything else is morning. I'm more likely to remember morning (although I set the alarm on my fitbit for 8pm every night to help me remember that dose) so the important things like turmeric, ginger and Tamoxifen are morning.
etnasgrl--I have a recently diagnosed friend who is supposed to take tamoxifen but is refusing because she heard so many stories from me about it. I explained to her that you really only hear the bad things. She could be someone who has no SEs or very mild ones. You just need to start and see what happens. The great thing is there are thousands of women here just waiting to offer advice on how to get through it. I had strong SEs that started around month 3. I asked for advice here and then went to a holistic doctor and now I have a pretty normal life. There isn't anything I can't do because of Tamoxifen SEs. I struggle more with the effects of the mastectomy because my strength on that side is still somewhat limited. But Tamoxifen is manageable for most.
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I started tamoxifen about a month ago. So far, no SE. When did people start noticing SE if they have any? Thanks!!
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I had chills and hot flashes before I started Tamoxifen. I was in chemopause.
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My SEs started around the 3rd month. For me, it was just muscle and joint pain. At a year, I had some nausea and dizziness. And I kept catching colds that first winter on it. Now I use saline rinse and probiotics along with my turmeric and ginger and I feel really good.
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etnasgirl...I started Tamoxifen 9 1/2 weeks after chemo (5 weeks after BMX). Side effects are manageable...I do feel 80 when I get up out of bed in the morning, but after a little bit I'm okay. I've been taking it for 7 months now and the hot flashes/chills are much better than they were last summer!
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Please pay attention to the possibilty that curcumin can inhibit tamoxifen. That is why the SE's disappear. Curcumin and tamox use the same breakdown-path in the liver,
Many 'holistic' stuff can counterplay regular medicine, so take care!
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2012 Feb;67(2):124-30.
Effects of curcumin on the pharmacokinetics of tamoxifen and its active metabolite, 4-hydroxytamoxifen, in rats: possible role of CYP3A4 and P-glycoprotein inhibition by curcumin.
Abstract
The effects of curcumin, a natural anti-cancer compound, on the bioavailability and pharmacokinetics of tamoxifen and its metabolite, 4-hydroxytamoxifen, were investigated in rats. Tamoxifen and curcumin interact with cytochrom P450 (CYP) enzymes and P-glycoprotein, and the increase in the use of health supplements may result in curcumin being taken concomitantly with tamoxifen as a combination therapy to treat or prevent cancer. A single dose of tamoxifen was administered orally (9 mg x kg(-1)) with or without curcumin (0.5, 2.5 and 10 mg x kg(-1)) and intravenously (2mg x kg(-1)) with or without curcumin (2.5 and 10 mg x kg(-1)) to rats. The effects of curcumin on P-glycoprotein (P-gp) and CYP3A4 activity were also evaluated. Curcumin inhibited CYP3A4 activity with 50% inhibition concentration (IC50) values of 2.7 microM. In addition, curcumin significantly (P < 0.01 at 10 microM) enhanced the cellular accumulation of rhodamine-123 in MCF-7/ADR cells overexpressing P-gp in a concentration-dependent manner. This result suggested that curcumin significantly inhibited P-gp activity. Compared to the oral control group (given tamoxifen alone), the area under the plasma concentration-time curve (AUC(0-infinity)) and the peak plasma concentration (C(max)) of tamoxifen were significantly (P < 0.05 for 2.5 mg x kg(-1); P < 0.01 for 10 mg x kg(-1)) increased by 33.1-64.0% and 38.9-70.6%, respectively, by curcumin. Consequently, the absolute bioavailability of tamoxifen in the presence of curcumin (2.5 and 10 mg x kg(-1)) was 27.2-33.5%, which was significantly enhanced (P < 0.05 for 2.5 mg x kg(-1); P < 0.01 for 10 mg x kg(-1)) compared to that in the oral control group (20.4%). Moreover, the relative bioavailability of tamoxifen was 1.12- to 1.64-fold greater than that in the control group. Furthermore, concurrent use of curcumin significantly decreased (P < 0.05 for 10 mg x kg(-1)) the metabolite-parent AUC ratio (MR), implying that curcumin may inhibit the CYP-mediated metabolism of tamoxifen to its active metabolite, 4-hydroxytamoxifen. The enhanced bioavailability of tamoxifen by curcumin may be mainly due to inhibition of the CYP3A4-mediated metabolism of tamoxifen in the small intestine and/or in the liver and to inhibition of the P-gp efflux transporter in the small intestine rather than to reduction of renal elimination of tamoxifen, suggesting that curcumin may reduce the first-pass metabolism of tamoxifen in the small intestine and/or in the liver by inhibition of P-gp or CYP3A4 subfamily.
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What you just posted says curcumin enhances the bioavailability of tamoxifen. That would be a good thing!
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That's very odd as I spoke at length to the dietician that is excellent at our cancer center as I question EVERYTHING with its relationship to Tamoxifen. She was very clear that Turmeric has no effect on Tamoxifen..I even repeated my question to her. She did say that she prefer I not take the pill form (supplement) of Turmeric but rather use the spice itself so I am doing that. She felt that the pill is not absorbed as well. She did say to always take the Turmeric with black pepper and a fat of some sort for best absorption. She has me take my other supplements at least two hours before or two hours after Tamoxifen as they can interfere so I take Tamoxifen at night (5pm) and Calcium/D in the morning (about 7am). I also asked about Magnesium - at first, a couple months ago, she suggested I avoid it and try to get it from food but i asked again as I am/was having SE and she said to give it a try but no more than 300mg/day and see how I do with it. Think she is worried about diarrhea as a SE there.
As I've found on this journey, ask 10 health care people a question and perhaps get 10 different answers. I have tried to sort through it all and take what I feel to be the best information. Its certainly not an exact science and I've read so many studies on various topics that completely contradict one another. It can be hard to sort through - guess we all just have to continue to do our best. As I told my MO when I was first diagnosed, I didn't have a single risk factor and led a very healthy and active lifestyle. His answer was "most people dont have any risk factors" - go figure
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Another article from PubMed-this one is a bit easier to wade through.
Curcumin induces cell death and restores tamoxifen sensitivity in the antiestrogen-resistant breast cancer cell lines MCF-7/LCC2 and MCF-7/LCC9.
Jiang M1, Huang O, Zhang X, Xie Z, Shen A, Liu H, Geng M, Shen K.
Author information
Abstract
Curcumin, a principal component of turmeric (Curcuma longa), has potential therapeutic activities against breast cancer through multiple signaling pathways. Increasing evidence indicates that curcumin reverses chemo-resistance and sensitizes cancer cells to chemotherapy and targeted therapy in breast cancer. To date, few studies have explored its potential antiproliferation effects and resistance reversal in antiestrogen-resistant breast cancer. In this study, we therefore investigated the efficacy of curcumin alone and in combination with tamoxifen in the established antiestrogen-resistant breast cancer cell lines MCF-7/LCC2 and MCF-7/LCC9. We discovered that curcumin treatment displayed anti-proliferative and pro-apoptotic activities and induced cell cycle arrest at G2/M phase. Of note, the combination of curcumin and tamoxifen resulted in a synergistic survival inhibition in MCF-7/LCC2 and MCF-7/LCC9 cells. Moreover, we found that curcumin targeted multiple signals involved in growth maintenance and resistance acquisition in endocrine resistant cells. In our cell models, curcumin could suppress expression of pro-growth and anti-apoptosis molecules, induce inactivation of NF-κB, Src and Akt/mTOR pathways and downregulate the key epigenetic modifier EZH2. The above findings suggested that curcumin alone and combinations of curcumin with endocrine therapy may be of therapeutic benefit for endocrine-resistant breast cancer.
- PMID:
- 23299550
- [PubMed - indexed for MEDLINE]
Free full text
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Ladies,
I work for a world renowned drug information company, Micromedex (when you Google a drug, thats our information box that pops up on the right). We provide all the evidenced based information to hospital and pharmacies around the globe and I have full access to any of that information. If you ever have a question, just IM me...I am glad to look up any question on drugs, side effects or interactions. The trouble with looking up studies on your own is you have no idea if its a valid or adequate study or written with a self-serving bias.(was the study funded by the drug company?)
I've researched in our data and there is no concerns or drug interactions with either calcium or turmeric.
cheers!
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Thanks much, jbokland. that's very helpful!
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My MO loves to research this stuff! These are the articles he found and used in his decision to allow turmeric. I don't know how scientifc they are but I trust him and his research.
CURCUMIN Modulates Tamoxifen Response in Resistant Breast Cancer Cells.
Can TURMERIC Slow Down the Spread of Breast Cancer? | Dr. Nalini Chilkov
The Effect of CURCUMIN on Breast Cancer Cells
CURCUMIN induces cell death and restores tamoxifen sensitivity in the antiestr
Harvest the Power of CURCUMIN To Kill Breast Cancer Cells | MarnieClark.com
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Thanks for the info lala1. Etnasgrl many women don't have all the side effect of tamoxifen. I have been on it for 3 months and the side effects come and go. Just started really crazy hot flashes but not everyday and aches and joint pain in mornings mostly.. but I still just keep it moving . some days are great some not but that's life! Good luck hoping you have no problems or side effects!
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I went through the literature about tamoxifen and curcumin which is found in turmeric. I got concerned that if the availability of functionality of tamoxifen is increased by anything, doesn't that mean that the negative effects - like increased risk of uterine cancer - could also be possibly increasing? If any of you have any insight into this I'd like to hear it.
I find the foodforbreastcancer website below typically gives information that is based on literature - though I think that in reality there are no population studies on any food interactions with tamoxifen so in reality it is a grey area.
http://foodforbreastcancer.com/articles/breast-cancer-diet-during-tamoxifen-treatment
http://foodforbreastcancer.com/foods/turmeric
For those who like scientific articles I found this one to be interesting:
http://www.sciencedirect.com/science/article/pii/S0022286012010642
Tamoxifen and curcumin binding to serum albumin. A Spectroscopic study. Maciążek-Jurczyk et al, 2012.
In the presence of curcumin, tamoxifen is less bound to albumin, which would make the tamoxifen more available. But then I ask the same question - doesn't the increased risk of endometrial cancer also increase further?
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Why do some of you mix ginger with the turmeric? Flavor? or is it of value? I started the whole thing yesterday and certainly hope it helps with my joint and muscle pain (using it always mixed with black pepper as I read that is a must for absorption)
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I use both because both are considered anti inflammatories which are helpful for arthritis. That's the same type of pain we feel from the Tamoxifen. I will say that I also take magnesium which I've been told can be helpful as well with arthritis. Don't know if that is also contributing to the reduced pain for me.
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i take magnesium and although I have only been on Tamoxifen for 2 months, I have had no joint paint or stiffness at all.
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What type and how much Magnesium? I was at two stores today looking for it, before even seeing your post, and couldn't find it - will go to another after lunch - The Cancer Center here is not big on Magnesium and sort of discouraged it but I want to give it a try - she told me to be careful about the dose
Lala1 - do you just sprinkle ginger on your food? I mixed it with the Turmeric and black pepper and added to my dinner.
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I'm still on 40 mg per day of Tam with no side effects. I questioned my doc about whether ANY study supports 40 mg/day for Stage 1, but he still hasn't sent me any articles. I am going in for a 2nd opinion on Monday. My concern, though is that my CEA levels are elevated at 5.2. I know a few of you said not to worry about that, but I do.... This doc wants to do scans if the level stays above 5. Others say their docs do no scans (except mammos) and no markers unless there is a problem. I feel like I'm being frightened into staying with this doc and doing all the scans "just in case", you know? But the rational side of me knows I'm probably being overtreated. Errr!
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I have declined Tamoxifen for over 4 years. I just didn't see the value for the small percentage it was suppose to help me. So now I am back with my second round and awaiting surgery and rads and my dr says to go on it. I picked up the prescription yesterday and was really going to start last night. Then I read the warning:
"This drug my raise the chance of very bad and sometimes deadly side effects like stroke, blood clots, or endometrial or uterine cancer"
It goes on the next page over the full page with " It can cause very bad health problems that my not go away, and sometimes death". This is from the pharmacy.
I didn't take it last night. Woke up very sick this morning throwing up. Glad I didn't take it because I would have definitely thought I was dying.
How do you jump off the cliff and take it?
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You look at the Material Safety Data Sheet (MSDS) or side effects sheet for anything and see the horrific-sounding side effects. This puts it in perspective. Water, for example. Drinking too much can cause psychosis, electrolyte washout, and death. So every morning I look at the Tamoxifen and say, "Thank you, Tamoxifen," and take it with the other medications that I don't worry about so much.
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Thats how I feel - Tamoxifen is my defense right now and I,too, say, "please work" every time I swallow it - I think of it like this...I trust my Dr and had a 2nd opinion at Dana Farber. Both gave me my stats WITH taking Tamoxifen and radiation so, I have to trust that they know what they are saying and that this little white pill will help me. I do not feel like there is another choice if I want to do what I need to do - KSusan is right int hat every drug has a long list of possible side effects...when I hear the commercials on tv and they spend most of the time warning you what can happen - my goodness, if that were true for most, no one would take anything.
I found Magnesium 250Mg so will try it. Thansk all
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So here is the Drugs.com info for Tylenol, for example. Many/most of us were told to take Tylenol rather than aspirin or ibubrofen because Tylenol causes fewer potential problems after surgery:
As well as its needed effects, acetaminophen (the active ingredient contained in Tylenol) may cause unwanted side effects that require medical attention.
If any of the following side effects occur while taking acetaminophen, check with your doctor immediately:
Rare- Bloody or black, tarry stools
- bloody or cloudy urine
- fever with or without chills (not present before treatment and not caused by the condition being treated)
- pain in the lower back and/or side (severe and/or sharp)
- pinpoint red spots on the skin
- skin rash, hives, or itching
- sore throat (not present before treatment and not caused by the condition being treated)
- sores, ulcers, or white spots on the lips or in the mouth
- sudden decrease in the amount of urine
- unusual bleeding or bruising
- unusual tiredness or weakness
- yellow eyes or skin
If any of the following symptoms of overdose occur while taking acetaminophen, get emergency help immediately:
Symptoms of overdose- Diarrhea
- increased sweating
- loss of appetite
- nausea or vomiting
- stomach cramps or pain
- swelling, pain, or tenderness in the upper abdomen or stomach area
For Healthcare Professionals
Applies to acetaminophen: compounding powder, intravenous solution, oral capsule, oral granule effervescent, oral liquid, oral powder for reconstitution, oral suspension, oral tablet, oral tablet chewable, oral tablet disintegrating, oral tablet extended release, rectal suppository
General
In general, acetaminophen (the active ingredient contained in Tylenol) is well-tolerated when administered in therapeutic doses.[Ref]
Hepatic
Alcoholic patients may develop hepatotoxicity after even modest doses of acetaminophen (the active ingredient contained in Tylenol) In healthy patients, approximately 15 grams of acetaminophen is necessary to deplete liver glutathione stores by 70% in a 70 kg person. However, hepatotoxicity has been reported following smaller doses. Glutathione concentrations may be repleted by the antidote N-acetylcysteine. One case report has suggested that hypothermia may also be beneficial in decreasing liver damage during overdose.
In a recent retrospective study of 306 patients admitted for acetaminophen overdose, 6.9% had severe liver injury but all recovered. None of the 306 patients died.
A 19-year-old female developed hepatotoxicity, reactive plasmacytosis and agranulocytosis followed by a leukemoid reaction after acute acetaminophen toxicity.[Ref]Hepatic side effects including severe and sometimes fatal dose dependent hepatitis have been reported in alcoholic patients. Hepatotoxicity has been increased during fasting. Several cases of hepatotoxicity from chronic acetaminophen therapy at therapeutic doses have also been reported despite a lack of risk factors for toxicity.[Ref]
Gastrointestinal
One study has suggested that acetaminophen (the active ingredient contained in Tylenol) may precipitate acute biliary pain and cholestasis. The mechanism of this effect may be related to inhibition of prostaglandin and alterations in the regulation of the sphincter of Oddi.[Ref]
Gastrointestinal side effects have included nausea (34%) and vomiting (15%). Cases of acute pancreatitis have been reported rarely.[Ref]
Renal
Renal side effects are rare and have included acute renal failure, acute tubular necrosis, and interstitial nephritis. Adverse renal effects are most often observed after overdose, after chronic abuse (often with multiple analgesics), or in association with acetaminophen-related hepatotoxicity.[Ref]
Acute tubular necrosis usually occurs in conjunction with liver failure, but has been observed as an isolated finding in rare cases. A possible increase in the risk of renal cell carcinoma has been associated with chronic acetaminophen use as well.
One case-control study of patients with end-stage renal disease suggested that long term consumption of acetaminophen may significantly increase the risk of end-stage renal disease particularly in patients taking more than two pills per day.
However, a recent cohort study of analgesia use of initially healthy men concluded that moderate use of analgesics including acetaminophen was not associated with increased risk of renal disease.[Ref]Hypersensitivity
Hypersensitivity side effects including anaphylaxis and fixed drug eruptions have been reported rarely in association with acetaminophen (the active ingredient contained in Tylenol) use.[Ref]
Hematologic
Hematologic side effects including rare cases of thrombocytopenia associated with acetaminophen (the active ingredient contained in Tylenol) have been reported. Acute thrombocytopenia has also been reported as having been caused by sensitivity to acetaminophen glucuronide, the major metabolite of acetaminophen. Methemoglobinemia with resulting cyanosis has been observed in the setting of acute overdose.[Ref]
Dermatologic
Dermatologic side effects including erythematous skin rashes associated with acetaminophen (the active ingredient contained in Tylenol) have been reported, but are rare. Acetaminophen associated bullous erythema and purpura fulminans have been reported. One case of toxic epidermal necrolysis associated with acetaminophen administered to a pediatric patient has been reported. Dermatologic side effects associated with IV acetaminophen have included infusion site pain and peripheral edema.
Very rare potentially fatal skin reactions: Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP).[Ref]Respiratory
Respiratory side effects have included dyspnea and a case of acetaminophen-induced eosinophilic pneumonia.[Ref]
Cardiovascular
Two cases hypotension have been reported following the administration of acetaminophen (the active ingredient contained in Tylenol) Both patients experienced significant decreases in blood pressure. One of the two patients required pressor agents to maintain adequate mean arterial pressures. Neither episode was associated with symptoms of anaphylaxis. Neither patient was rechallenged after resolution of the initial episode.[Ref]
Cardiovascular side effects including hypertension and hypotension have been reported following the administration of acetaminophen.[Ref]
Metabolic
Metabolic side effects have included hypokalemia. Metabolic side effects including metabolic acidosis have been reported following a massive overdose of acetaminophen (the active ingredient contained in Tylenol) [Ref]
In the case of metabolic acidosis, causality is uncertain as more than one drug was ingested. The case of metabolic acidosis followed the ingestion of 75 grams of acetaminophen, 1.95 grams of aspirin, and a small amount of a liquid household cleaner. The patient also had a history of seizures which the authors reported may have contributed to an increased lactate level indicative of metabolic acidosis.[Ref]
Nervous system
Nervous system side effects associated with IV acetaminophen (the active ingredient contained in Tylenol) have included headache (10%), insomnia (7%), and fatigue.
Musculoskeletal
Musculoskeletal side effects associated with acetaminophen (the active ingredient contained in Tylenol) IV have included muscle spasms and trismus.
Psychiatric
Psychiatric side effects associated with acetaminophen (the active ingredient contained in Tylenol) IV have included anxiety.
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New-girl: Not everyone would get every side effect. Has your MO explain to you which side effects might more common, for you?
My MO listed all the signs one should watch out generally. But since I had Chemo, I saw her every 3 weeks & did blood test before each round, from that she can kinda predicted how my body reacts to the medicine. So from that list, she said most likely Hot Flashes & vaginal discharge. Watch out for abnormal bleeding or heavy period. She actually think my period would come back after couple month after Chemo (hasn't happened). Well... except the period part, she's pretty right on target.
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MomofTwins--I take ginger in capsule form as well. My turmeric is Gaia brand which is made in NC and includes the black pepper as well. I buy my magnesium at Vitamin Shoppe. I take magnesium glycinate 400....200 mg in am and 200 in pm. My doc said to take as much as I can take without causing diarrhea but no more than 450-500mg a day. This dose keeps me regular, minimizes my hot flashes and seems to help with joint pain as well.
Newgirl--- "How do you jump off the cliff and take it?" I'm more of the "How do you not?" I was nervous to take Tamoxifen but knowing it reduced my BC risk by 50% made me pretty quick to jump on the bandwagon! I knew that if I didn't take it and BC came back, I'd never be able to live with myself. And knowing that I could quit it if I wanted made it easier. Maybe you could give it a go knowing there are other options if it's just too much. And you may be one of the many many people who do just fine on it. I think you might find you are one of those. You said "How do you jump off the cliff and take it?" I'm more of the "How do you not?"We all have different ways of seeing things and justifying things in our minds. One woman may find the idea of researching BC to be scary while another may find it comforting. Same thing with whether you want to hear exactly what a doctor is going to do to you in surgery. Perfect example for me....my sister, stupidly, still won't go get a mammogram because she says it didn't catch my BC or any of her friends. We found them through self exam so she figures she'll get by with that. She says "Well, you had a mammogram 6 months before you found the lump and it didn't catch the lump so why bother?!" My way of looking at that is that once I found the lump and was diagnosed I was comforted by the idea that maybe my lump was less than 6 months old. I figured if a mammogram didn't see it, then it must not have been there so since it's younger that 6 months, maybe it won't be a "bad" type. Mine did turn out to be small and I didn't need chemo or rads so that was good. Nipples and nip tats are another example. I love my recon nip and tattooed areola. When I pass a mirror and give a quick glance, I look and feel whole. Others may not care about that or want another surgery or whatever. As to Tamoxifen, do what makes you most comfortable. My newly diagnosed friend is declining it. She doesn't want the side effects and says she's ok with the risk of it coming back. I was the opposite way. My doc told me the risks percentages and benefit percentages and I knew I had to give it a try. And I was even one of the ones who got a thickened endometrial lining from it and had a total hysterectomy a year ago. And today I feel awesome!
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lala1, tell your sister that there are kinds of cancer that are not lumps. I had microscopic calcifications found on my mammogram. It was grade 3. When I was told I had cancer, radiologist said to hurry in for treatment with the kind of cells that were found. If I had skipped my mammo for just one year, I don't think I would be alive.
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