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Tamoxifen - managing adverse effects - Management
Should I prescribe drug treatment?
- Do not prescribe hormone replacement treatment for women with menopausal symptoms who are taking tamoxifen.
- If hot flushes are not relieved by lifestyle measures, consider prescribing one of the following:
- A trial of 2–4 weeks of clonidine (licensed use).
- Start with 50 micrograms twice daily.
- If after 2 weeks there has been no improvement in symptoms, increase to 75 micrograms twice daily.
- Stop if no benefit is noted after 4 weeks of treatment, or if the woman experiences unacceptable adverse effects.
- A trial of 2 weeks of venlafaxine 37.5 mg twice a day (unlicensed use).
- A trial of gabapentin 900 mg daily (unlicensed use).
- Titration up to this dose is advised.
- If these are ineffective or unsuitable, seek specialist advice.
- Check regularly (for example every 3–6 months) that the drug is still needed by reducing the dose then discontinuing if symptoms do not return. However, if symptoms persist and adverse effects are not a problem, the drug can be continued as long as the woman is taking tamoxifen.
- For information on contraindications, cautions, drug interactions, and adverse effects, see Prescribing information, and the electronic Medicines Compendium (eMC) (http://emc.medicines.org.uk) or the British National Formulary (BNF) (www.bnf.org).
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