Certain anti-depressants taken with tamoxifen pose risk

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In CURE's upcoming Fall issue we write about the importance of talking with your doctor if you are taking tamoxifen along with an anti-depressant such as Prozac, Paxil, or Zoloft--three widely prescribed serotonin reuptake inhibitors (SSRIs for short). Many women are prescribed anti-depressants to combat hot flashes--a well documented side effect of tamoxifen. New studies indicate that certain SSRIs may in fact put women at a much higher risk for recurrent breast cancer. It appears that not all SSRIs are alike, and while some demonstrated cause for alarm, others didn't pose a problem at all. Before you flush your anti-depressants down the toilet, however, let me give you a warning... Don't discontinue taking any anti-depressant without first consulting your doctor.I was talking with a close friend recently who began taking Lexapro a couple of years ago to combat hot flashes. She lives in Brazil now and has discovered that it's very difficult to get her prescriptions filled in South America. She was spending a few hundred dollars each month to refill her prescription and decided to stop taking the Lexapro rather than battle the bureaucracy. In her mind, the benefit didn't outweigh the cost. Fast forward a couple of weeks... She began to feel like she was getting the flu. She was achy, having chills, was feverish, and disoriented. She was incredibly depressed too. She slept all day and told me that she didn't even have enough energy to go outside. As her mystery illness progressed, she and her husband became very concerned. After a bit of investigative work (and an overdue trip to the doctor), they realized that she was experiencing withdrawal symptoms from her abrupt discontinuation of Lexapro. She was put back on the medication and after a few days, she felt normal again. Her doctor informed her that she should never stop taking her Lexapro without talking to him first and that she needed to gradually wean herself from the drug in order to minimize the risk of withdrawal symptoms.All drugs are given with specific product information. It's a good idea to keep the package insert for future reference–-since some people experience the infrequent side effects, which can be major. And always discuss stopping a medication with your doctor-- don't just do it.

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For patients with cancer, the ongoing chemotherapy shortage may cause some anxiety as they wonder how they will receive their drugs. However, measuring drugs “down to the minutiae of the milligrams” helped patients receive the drugs they needed, said Alison Tray. Tray is an advanced oncology certified nurse practitioner and current vice president of ambulatory operations at Rutgers Cancer Institute in New Jersey.  If patients are concerned about getting their cancer drugs, Tray noted that having “an open conversation” between patients and providers is key.  “As a provider and a nurse myself, having that conversation, that reassurance and sharing the information is a two-way conversation,” she said. “So just knowing that we're taking care of you, we're going to make sure that you receive the care that you need is the key takeaway.” In June 2023, many patients were unable to receive certain chemotherapy drugs, such as carboplatin and cisplatin because of an ongoing shortage. By October 2023, experts saw an improvement, although the “ongoing crisis” remained.  READ MORE: Patients With Lung Cancer Face Unmet Needs During Drug Shortages “We’re really proud of the work that we could do and achieve that through a critical drug shortage,” Tray said. “None of our patients missed a dose of chemotherapy and we were able to provide that for them.” Tray sat down with CURE® during the 49th Annual Oncology Nursing Society Annual Congress to discuss the ongoing chemo shortage and how patients and care teams approached these challenges. Transcript: Particularly at Hartford HealthCare, when we established this infrastructure, our goal was to make sure that every patient would get the treatment that they need and require, utilizing the data that we have from ASCO guidelines to ensure that we're getting the optimal high-quality standard of care in a timely fashion that we didn't have to delay therapies. So, we were able to do that by going down to the minutiae of the milligrams on hand, particularly when we had a lot of critical drug shortages. So it was really creating that process to really ensure that every patient would get the treatment that they needed. For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.
Yuliya P.L Linhares, MD, an expert on CLL
Yuliya P.L Linhares, MD, and Josie Montegaard, MSN, AGPCNP-BC, experts on CLL
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