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Tamoxifen - managing adverse effects - Management
Basis for recommendation

  • Many products have been suggested for vasomotor symptoms in women with breast cancer, but CKS cannot recommend them because of limited evidence of efficacy and a lack of safety data [Harris et al, 2002; Duffy and Cyr, 2003; Boekhout et al, 2006; RCOG, 2006; Bordeleau et al, 2007; Hickey et al, 2008]. These include:
    • Black cohosh — published data are conflicting and the benefit of using black cohosh for treatment of hot flushes is not supported by evidence from methodologically sound clinical trials. There are also safety issues to consider. The Commission on Human Medicines and the Herbal Medicines Advisory Committee have reviewed the available data on liver reactions with black cohosh and, subsequently, advised that these data support a causal association between black cohosh and the risk of liver disorders [MHRA, 2006].
    • Red clover — studies indicate it may be effective in reducing hot flushes compared with placebo, but there is a lack of statistically significant data. There were no safety concerns in the short-term studies, but longer-term data are needed.
    • Evening primrose oil — there is no evidence of efficacy for menopausal symptoms, and two trials have found it to be ineffective for treating hot flushes.
    • Phyto-oestrogens — data from trials are contradictory and long-term safety is unclear. It is difficult to compare studies because of the differences in products and doses.
    • Homeopathy — well-conducted studies assessing safety and efficacy are needed. Homeopathy appears to be not effective for alleviating hot flushes.
    • Vitamin E — evidence is limited. Vitamin E is not registered for this indication so it should be used with caution. Supplemental vitamin E at doses of more than 400 IU/day have been linked with an increase in all-cause mortality.
    • Acupuncture — there is evidence from some studies suggesting electro-acupuncture and acupuncture may decrease the number of hot flushes. However, rare but potentially serious adverse effects (bacterial endocarditis, hepatitis) may occur. Care is needed if the woman has had axillary surgery for lymph node dissection because of the risk of lymphoedema.

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