Tamoxifen is indicated for the following conditions-

• Metastatic Breast Cancer
• Adjuvant Treatment of Breast Cancer
• Adjuvant Treatment of Breast Cancer
• Reduction in Breast Cancer Incidence in High-Risk Women

Breast Cancer

• Breast Cancer: A daily dose of 20-40 mg is advised. Doses of more than 20 mg per day should be divided into two doses (morning and evening)
• Ductal Carcinoma in Situ (DCIS): The recommended dose of TAMOXIFEN 20 mg daily for five years.
• Reduction in Breast Cancer Incidence in High-Risk Women: The recommended dose is TAMOXIFEN 20 mg daily for five years.
• Treatment of infertility: Before starting Tamoxifen medication, the potential of pregnancy must be ruled out. The dose for infertility treatment is determined by the menstrual cycle.
  
  • The patient is advised to take 20mg of Tamoxifen on the second, third, fourth, and fifth days of her menstrual cycle if she has regular periods. If the patient’s initial course of treatment is ineffective, she may be given more treatments later increasing the dose to 40mg and eventually 80mg daily.
  • Women with irregular periods may initiate the course with 20mg on any day. If no signs of period bleeding (ovulation) appear after 45 days, a new round of treatment can be started, with the dosage increased to 40mg and subsequently 80mg daily. If menstruation (period bleeding) occurs, the next round of treatment should begin on the second day of the patient’s cycle.

Adverse reactions to TAMOXIFEN are relatively mild and rarely severe enough to require discontinuation of treatment in breast cancer patients. In patients with metastatic breast cancer, the most frequent adverse reaction to TAMOXIFEN is hot flashes. Other adverse effects include-

• Tiredness
• fatigue 
• nausea
• Fluid retention
• Skin rashes

Hot flash

Fatigue

Nausea

Edema

• For Women with Ductal Carcinoma in Situ (DCIS) and Women at High Risk for Breast Cancer: Serious and life-threatening events associated with TAMOXIFEN in the risk reduction setting (women at high risk for cancer and women with DCIS) include uterine malignancies, stroke and pulmonary embolism). Some of the strokes, pulmonary emboli, and uterine malignancies were fatal.
• PREGNANCY CATEGORY-D; Considered to be teratogenic.
• The benefits of TAMOXIFEN outweigh its risks in women already diagnosed with breast cancer.
• Decreases in platelet counts, usually to 50,000-100,000/mm3, infrequently lower, have been occasionally reported in patients taking TAMOXIFEN for breast cancer. In patients with significant thrombocytopenia, rare hemorrhagic episodes have occurred, but it is uncertain if these episodes are due to TAMOXIFEN therapy. Leukopenia has been observed, sometimes in association with anemia and/or thrombocytopenia. There have been rare reports of neutropenia and pancytopenia in patients receiving TAMOXIFEN; this can sometimes be severe.