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[乳腺癌女性中他莫昔芬与抗抑郁药的拮抗作用]

[Antagonism of tamoxifen and antidepressants among women with breast cancer].

作者信息

Irarrázaval O María Elisa

机构信息

Unidad Salud Mental y Enlace, Clínica Oncológica Fundación Arturo López Pérez, Santiago, Chile.

出版信息

Rev Med Chil. 2011 Jan;139(1):89-99. Epub 2011 Apr 11.

Abstract

Tamoxifen is used as an adjuvant therapy to reduce breast cancer recurrence among women with estrogen receptor positive tumors. Antidepressants are also commonly used in such women, to treat depression or to manage hot flushes, a frequent tamoxifen secondary effect. Some antidepressants could potentially inhibit cytochrome P450 2D6, required to activate tamoxifen, interfering with its action. Although there is not a clear cut directive on the subject, it is nowadays recommended to treat women with antidepressants with the lower cytochrome P450 2D6 inhibition potential to avoid a possible antagonism that may reduce tamoxifen s prevention of breast cancer recurrence at least in some patients with CYP2D6 genetic variation. The recommended antidepressants are desvenlafaxine, milnacipran, venlafaxin, escitalopram and citalopram.

摘要

他莫昔芬用作辅助疗法,以降低雌激素受体阳性肿瘤女性的乳腺癌复发率。抗抑郁药也常用于这类女性,用于治疗抑郁症或处理潮热(他莫昔芬常见的副作用)。一些抗抑郁药可能会抑制激活他莫昔芬所需的细胞色素P450 2D6,从而干扰其作用。尽管关于这个问题没有明确的指导意见,但现在建议用细胞色素P450 2D6抑制潜力较低的抗抑郁药来治疗女性,以避免可能的拮抗作用,这种拮抗作用可能至少在一些具有CYP2D6基因变异的患者中降低他莫昔芬预防乳腺癌复发的效果。推荐的抗抑郁药有去甲文拉法辛、米那普明、文拉法辛、艾司西酞普兰和西酞普兰。

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