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.