Nolvadex for women
Among the indications for taking Nolvadex are breast cancer in women, ovarian and prostate cancer, soft tissue cancer (melanoma, sarcoma), kidney cancer. In some cases, the drug is also prescribed for female infertility.
In premenopausal women with metastatic breast cancer, Nolvadex is an alternative to ovariectomy or radiation therapy to the ovary. The available evidence indicates that patients whose tumors are estrogen receptor positive are more likely to benefit from treatment with Nolvadex.
Nolvadex is indicated for the treatment of women with lymph node infection following total or segmental mastectomy, axillary dissection and breast irradiation. Also indicated for the treatment of breast cancer without axillary nodules in women after total or segmental mastectomy, axillary dissection and breast irradiation.
Nolvadex is used:
- in breast / breast cancer (for adjuvant treatment in women with affected lymph nodes, including metastatic breast cancer in women, breast cancer in men);
- with endometrial cancer;
- with anovulatory infertility.
In women with DCIS, Nolvadex (tamoxifen citrate) after breast surgery and radiation therapy is indicated to reduce the risk of invasive breast cancer. The decision to treat with Nolvadex to reduce the incidence of breast cancer should be based on an individual assessment of the benefits and risks of treatment with Nolvadex.
Pregnancy and breastfeeding with Nolvadex
It should not be used during pregnancy. In pregnant women treated with Nolvadex, there have been isolated cases of miscarriage, congenital malformations, fetal death, but the relationship between these phenomena and tamoxifen has not been definitively established. Reproductive toxicity studies in animals have not shown teratogenic effects.
Fetal development studies in animals have shown that drug treatment is associated with changes similar to the effects of estradiol, ethinyl estradiol, clomiphene and diethylstilbestrol. Only a small number of pregnant women have been exposed to Nolvadex. In these cases, there is no report that such exposure is the cause of subsequent development of vaginal adenosis or clear cell carcinoma of the vagina or cervix in young women exposed to tamoxifen.
Before starting treatment, it is necessary to make sure that the patient is not pregnant. During the entire course of treatment and at least 3 months after its completion, it is necessary to use contraceptives.
Oral contraceptives should not be used. If sexual activity occurs while using Nolvadex, women should be advised to avoid pregnancy and use barrier or other non-hormonal contraceptives.
It is not known whether the drug is excreted in human milk, therefore breast-feeding is discontinued during the treatment period.
Dosage and administration of Nolvadex
Nolvadex is taken orally with water.
The standard dose for adults is 20 mg. In the case of a common form of the disease, the dose may be increased to 30-40 mg / day.
The maximum daily dose is 40 mg. An objective response is usually observed after 4-10 weeks of treatment, but in the case of detection of bone metastases, the therapeutic effect can only be observed after several months of taking the drug.
The duration of treatment is determined by the severity and course of the disease. As a rule, the treatment is long, lasts until remission is achieved.
No dose adjustment is required in elderly patients, patients with renal or hepatic impairment.
Cases of acute overdose are not described. High doses can cause estrogenic effects. Treatment: supportive symptomatic therapy.
In case of serious side effects, they can be controlled by simply reducing the dose, while having control over the course of the disease.
Despite a long history of studying the carcinogenic properties of Nolvadex, especially with regard to the development of pathologies in the organs of the female reproductive system, no way has been found to prevent them. It is clear that patients taking Nolvadex should be made aware of the risk of endometrial hyperplasia, endometrial cancer and uterine sarcoma, as well as any abnormal vaginal bleeding, spotting from the vagina. Postmenopausal women taking Nolvadex should be closely monitored by oncologists and gynecologists.
There is a need to develop a strategy to assess the risk of developing endometrial pathology in breast cancer patients receiving Nolvadex treatment. One such tactic is to study the initial state of hormone status in patients, their individual genetic, structural, and molecular properties, and the properties of drug metabolism.