Paxil, Tamoxifen May Be a Risky Combo
Study Shows Increased Risk of Death for Breast Cancer Patients Taking Antidepressant Paxil and Tamoxifen
Why Tamoxifen's Power May Be Weakened continued...
In the newly published study, Juurlink and colleagues analyzed the medical records of 2,430 women with breast cancer who took tamoxifen for an average of about four years between 1993 and 2005.
About 30% of the women also took an SSRI at some point while taking tamoxifen. Paxil was the most widely prescribed antidepressant, followed by Zoloft and Celexa.
Of the drugs examined, only the Paxil-tamoxifen combination was associated with an increased risk of death from breast cancer.
Treatment with Paxil for 41% of the time on tamoxifen, which was the average length of overlap, was found to result in one extra breast cancer death for every 20 women treated over five years of follow-up.
The study appears in the journal BMJ.
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.