Patient/caregiver was educated on contraindications for using Tamoxifen as follows:
- Tamoxifen use carries the risk for clot formation, resulting in deep venous thrombosis and pulmonary embolism. Individuals can present with symptoms such as, pain and swelling of extremities – especially swelling of the lower extremities with pain in the calf muscle, episode of sudden cough and shortness of breath, episode of chest pain, and any sudden vision changes. So, tamoxifen could be avoided or used with extreme caution in individuals with history of thrombus formation.
- Tamoxifen intake carries the risk of increasing the blood lipid levels, contribute to forming atherogenic blocks in the blood vessels, and result in compromised blood supply to the heart muscle, episodes of chest pain or discomfort, exacerbation of shortness of breath, and even heart attack, leading to debility and sudden cardiac death. Tamoxifen could be avoided or used with close monitoring of cardiac function, in individuals with history of chest pain and myocardial infarction.
- Tamoxifen is mainly metabolized in the liver. If liver function is deficient, the metabolism of tamoxifen can be compromised. This can lead to increased blood levels of the medication and metabolites for longer periods of time, resulting in increased risk for side-effects and consequent toxicity. Also, tamoxifen intake can result in hepatitis, fatty changes in the liver, and compromised liver function. Individuals can present with enlarged liver, pain in the right upper quadrant of abdomen, diminished appetite & intake, compromised metabolism, weight loss, fatigue, ascites (fluid accumulation in abdomen), and jaundice with yellowing of white in the eyes. So, tamoxifen could be avoided in individuals with history of hepatitis and compromised liver function and an alternative medication considered or used with caution, with periodical monitoring for liver functions and development of any toxic symptoms.
