Is There a Deadline to Start Anti-Estrogen Therapy?
I saw my MO on Monday, and we VERY briefly discussed the options for my anti-estrogen therapy, and I decided to try Tamoxifen since I have osteoporosis and don't want to be on a bisphosphonate too.
I tried to go over the serious side effects with him, but like with the other MOs he kind of skimmed over things and minimized their likelihood. Seems common with MOs, the last one I saw did the same thing - actually wouldn't even discuss them with me, just wanted to prescribe one. Dr. Susan Love said this is common with oncologists, even though anti-estrogen therapy can be as toxic as chemo, the side effects are often glossed over, probably because no one would take them if they knew.
In any case I looked at the drug contraindications today for Tamoxifen and other than the handful of drugs where the contraindication was additive for liver damage or kidney damage, the majority of the drugs noted the possibility of Long QT syndrome. In reading the Professional version of the rationale, it seems there are many, many drugs (over 300) which include some very common OTC drugs - Pepcid, Immodium, colonoscopy prep, propofol (which was used during my lumpectomy and is also used during colonoscopy) and some very common antibiotics, etc. that have this potential to exacerbate the Long QT Prolongation cause by Tamoxifen.
Long QT Syndrome can cause Ventricular Arrhythmia, which is quickly fatal in the great majority of cases. Non-pharacologic additive risk factors are age (older), being female, and having bradycardia or slow heart rate, which I have (it's most often right at 50).
Given this, I don't feel comfortable taking this until I can talk to my cardiologist about this. Unfortunately he doesn't do virtual visits, and he's very hard to get in to see. I also can talk to the pharmacist, but she of course doesn't know my cardiac history. So I either just take it and risk something serious and potentially fatal, wait until I can get an appt with my cardiologist, or call my MO and ask to be put on an AI instead. I know AIs also have their share of potential heart issues, but I am not versed in what they are. It would be nice if an MO sat down and went over complete medical history, and prescribed based on the option with the least amount of toxicity.
I didn't know if there was a "deadline" by which I need to start these meds. I finished my radiation the day after Thanksgiving so I am already a month out (my MO is very hard to get into and this past Monday was the first available appt. I could get.
Not sure what to do...