管理他莫昔芬使用者的更年期症状和抑郁：药物和药物相互作用的影响。

Managing menopausal symptoms and depression in tamoxifen users: implications of drug and medicinal interactions.

机构信息

Allan Memorial Institute, McGill University Health Centre, Montreal, Quebec, Canada.

出版信息

Maturitas. 2010 Dec;67(4):296-308. doi: 10.1016/j.maturitas.2010.08.005. Epub 2010 Sep 28.

DOI:10.1016/j.maturitas.2010.08.005

PMID:20880642

Abstract

OBJECTIVE

Tamoxifen, a medication used in the treatment of breast cancer, often induces menopausal symptoms. Certain medications and natural supplements taken or prescribed to alleviate tamoxifen-induced hot flashes and depressive states in women with breast cancer interact with tamoxifen. This paper reviews potentially problematic interactions and offers treatment recommendations.

METHODS

Medline (1950-June 1, 2010), Embase Classic+Embase (1947-June 1, 2010) and PsycINFO (1967-June 1, 2010) were searched through Ovid. The word "tamoxifen" was searched with "depression" and then with "menopaus*" and "symptoms", with "treatment" as a limit. "Tamoxifen" was later searched with the MeSH terms "drug interaction" or "drug incompatibility".

RESULTS

Venlafaxine is efficacious for the treatment of hot flashes and depression and safe to use in combination with tamoxifen. Gabapentin is also efficacious in treating tamoxifen-induced hot flashes and, since it does not interact with cytochrome P450 system, is likely safe to use in patients using tamoxifen. Desvenlafaxine and pregabalin may be alternatives to venlafaxine and gabapentin, respectively, although desvenlafaxine has not yet been studied in this population. Paroxetine, fluoxetine and bupropion are strong CYP2D6 inhibitors which should be avoided in tamoxifen users. Fluvoxamine and nefazodone both inhibit CYP3A, which could potentially affect the metabolism of tamoxifen. Clonidine can be an alternative agent but may carry significant side effects. Evidence of medicinal products for the treatment of tamoxifen-induced hot flashes is equivocal at best.

CONCLUSIONS

Clinicians should remain cautious about using strong inhibitors and/or inducers of cytochrome 2D6 and 3A4 concomitantly with tamoxifen. Use of natural menopausal supplements and diets rich in isoflavones should not be encouraged in tamoxifen users until more data is available. There are however safe treatments for hot flashes and depression in tamoxifen users.

摘要

目的

他莫昔芬是一种用于治疗乳腺癌的药物，常引起绝经症状。某些药物和天然补充剂用于缓解乳腺癌女性因他莫昔芬引起的热潮红和抑郁状态，与他莫昔芬相互作用。本文综述了潜在的问题相互作用，并提出了治疗建议。

方法

通过 Ovid 检索 Medline（1950 年-2010 年 6 月 1 日）、Embase Classic+Embase（1947 年-2010 年 6 月 1 日）和 PsycINFO（1967 年-2010 年 6 月 1 日）。用“他莫昔芬”搜索“抑郁”，然后用“绝经”和“症状”，以“治疗”为限制。随后，用 MeSH 术语“药物相互作用”或“药物不相容性”搜索“他莫昔芬”。

结果

文拉法辛治疗热潮红和抑郁有效，与他莫昔芬联合使用安全。加巴喷丁也能有效治疗他莫昔芬引起的热潮红，由于它不与细胞色素 P450 系统相互作用，因此在使用他莫昔芬的患者中使用可能是安全的。去甲文拉法辛和普瑞巴林可能分别是文拉法辛和加巴喷丁的替代品，尽管去甲文拉法辛尚未在该人群中进行研究。帕罗西汀、氟西汀和安非他酮是强 CYP2D6 抑制剂，应避免在他莫昔芬使用者中使用。氟伏沙明和奈法唑酮均可抑制 CYP3A，这可能会影响他莫昔芬的代谢。可乐定可以作为替代药物，但可能会产生严重的副作用。治疗他莫昔芬引起的热潮红的药物证据充其量也只是模棱两可的。