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Old 02-01-2013, 05:27 PM   #5
rhondalea
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Join Date: Jun 2011
Location: Somerset, NJ
Posts: 487
Re: Starting tomoxifan and wandering ?

Let me say first that I don't know a lot about Effexor or Lexapro (or any of the other antidepressants, for that matter), but I've spent a lot of time reading about Cytochrome P450 substrates, inhibitors and inducers.

Tamoxifen requires several different liver enzymes to be metabolized. There has been a disagreement (conflicting studies) over the need to test individuals taking tamoxifen for their ability to produce these enzymes. My own oncologist tried to patronize me out of my (well-founded) concern, even though I told her I am an intermediate metabolizer for CYP2D6 (the main enzyme for tamoxifen). A very recent study has now made her look like a...well, never mind. My gripes about my onc are legend.

So, it is an issue. Effexor apparently does not interfere. See here:

http://www.ncbi.nlm.nih.gov/pubmed/9597349

"In vitro, venlafaxine [Effexor] is a weaker CYP2D6 inhibitor than most of the selective serotonin reuptake inhibitors (SSRIs) by a factor of 1-3 orders of magnitude."

The above conclusion is echoed by nearly every article, study, opinion I've read.

Further poking reveals that Lexapro is *slightly* more risky, but "slightly" is the key word. This chart I found at breastcancer.about.com seems to concur with most of what I've read:

http://breastcancer.about.com/od/hor...-Tamoxifen.htm

I'm hesitant to ask, but I'll do it anyway: are you using antidepressants for a pre-existing condition or is this all cancer/cancer drug-related? If so, you might want to consider alternative treatments for the side effects you're experiencing. There are several that are safe. For example, pine bark (pycnogenol) is exceptional for hot flashes. (I have almost none, and those I do have are very, very mild--in fact, they're so mild that my genius of an oncologist feels that I'm not having hot flashes at all.) There are other supplements that will also help, depending on your specifc symptoms. If you're taking an antidepressant for a different reason, just ignore this bit of advice.

Another thing you can do is be genotyped to determine whether you are a poor metabolizer, intermediate metabolizer or extensive metabolizer. You can ask your doctor to order these tests or you can do it yourself at 23andMe.com for $99. (You'll also get a lot of additional genetic information.) If you are an extensive metabolizer, then your risk when using Lexapro will be significantly less than someone who is either a PM or IM.
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2/6/09 Core needle biopsy: negative; Mammos through 2010: no change
3/30/11 Pea-sized lump in left breast at site of prior biopsy; mammo negative, sonogram not so much
4/14/11 Core needle biopsy: negative for cancer
5/18/11 Excisional biopsy 1.2 cm tumor, LVI, positive margin; ER+60%,PR+20%,HER2/CEP17 5
6/15/11 BMX: Left DCIS & LH; Right ADH; SNB: 2/3 nodes: 1.4 cm and 1 mm; ALND L1&2: 0/10; Stage IIa, Grade 3
7/14/11 CT/Bone scans NED; MUGA 66%
7/19/11 Biweekly dd AC w/Neulasta; done 8/30/11
9/13/11 Transfusion (Hemoglobin 8.6); MUGA 64%
9/20/11 Start Taxol + Herceptin; Taxol done 12/6/2011; continue Herceptin until 9/4/2012
12/27/11 Radiation - 6 weeks; 2/27/2012 - DONE! Yayyyy!
2/29/12 Start Tamoxifen 20 mg/day; continue until 2/28/17
5/16/12 Start five-years Metformin trial
6/19/12 MUGA 61%
8/21/12 Brain MRI NED (head still hurts, brain still fogged)
9/4/12 Herceptin done!
9/6/12 Port out!
7/11/13 Aricept 5mg for cognitive impairment; increased to 10mg as of 8/23/13; back to 5mg 12/2013
5/2014 Add Namenda 7mg
9/2014 Stop Aricept and Namenda; Neuropsychological evaluation
10/24/14 Start cognitive rehabilitation therapy
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