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Paxil, Tamoxifen May Be a Risky Combo

Study Shows Increased Risk of Death for Breast Cancer Patients Taking Antidepressant Paxil and Tamoxifen

Antidepressant Options for Tamoxifen Patients

In an editorial accompanying the study, Frank Andersohn, MD, of Berlin's Charite University Medical Center, writes that antidepressants with a low potential to inhibit CYP2D6, such as the SSRIs Effexor and Celexa, are clearly the drug of choice for patients on tamoxifen.

"The risk is probably not that great with any SSRI taken for a few weeks or months," he tells WebMD. "But it is clear that for long-term use with tamoxifen, Paxil and Prozac should be avoided."

When breast cancer survivor Courtney Bugler went on tamoxifen four years ago following treatment at age 29, she knew pretty quickly she needed something to deal with the hot flashes and other side effects that made her miserable and kept her up at night.

"I was on fire all the time. I couldn't sleep and was getting really cranky," she tells WebMD. "My doctor was emphatic that Effexor was the only SSRI I should be on. And I can honestly say that it changed my universe. I was on a baby dose, but it was enough to take the edge off the hot flashes and help me sleep at night."

Bugler, who is now executive director of the Atlanta affiliate for the breast cancer support group Young Survival Coalition, says the topic of which antidepressants are OK with tamoxifen and which are not gets a lot of attention on breast cancer message boards.

"This is not a really big problem for patients like me who take antidepressants for tamoxifen-related side effects," she says. "But it is a big deal for patients taking Paxil or Prozac for depression, especially if these are the drugs that work best for them."

A spokeswoman for the pharmaceutical company GlaxoSmithKline, which markets Paxil, tells WebMD that in 2008 the company updated the drug's label to warn that taking Paxil with tamoxifen may reduce tamoxifen's effectiveness.

"GlaxoSmithKline will review the additional data published this week and will work with regulatory agencies to determine the next steps," Sarah Alspach, GlaxoSmithKline's director of U.S. corporate media, notes in a statement.

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