Breast cancer and antidepressant use

Abstract

■Tamoxifen, an antiestrogen drug, is used for many indications related to breast cancer. Antidepressants are also often used in breast cancer patients, for states such as depression, anxiety, and hot flashes associated with chemical menopause. ■Tamoxifen is a prodrug. Some antidepressants (eg, paroxetine, fluoxetine, bupropion, duloxetine) inhibit CYP2D6, the enzyme that converts tamoxifen into endoxifen, its most important active metabolite. This could compromise tamoxifen's efficacy. ■Clinicians should avoid CYP2D6 inhibitors in patients receiving tamoxifen in favor of drugs with low or no CYP2D6 inhibitor activity (eg, mirtazapine, escitalopram, fluvoxamine, reboxetine, citalopram, sertraline, venlafaxine, desvenlafaxine). © Copyright 2012 Physicians Postgraduate Press, Inc.