Tamoxifen + bupropion/fluoxetine/paroxetine — ↓ activation
- Tamoxifen needs CYP2D6 → endoxifen
- Strong 2D6 inhibitors reduce activation
- paroxetine/fluoxetine/bupropion
- Endoxifen concentrations can fall markedly
- Avoid strong 2D6 inhibitors when feasible
- Prefer weak/non-2D6 alternatives
Interaction at a glance
- Strong 2D6 inhibitors reduce activation
- paroxetine/fluoxetine/bupropion
- Avoid strong 2D6 inhibitors when feasible
Mechanism
- Tamoxifen needs CYP2D6 → endoxifen
Management
- Strong 2D6 inhibitors reduce activation
- paroxetine/fluoxetine/bupropion
- Endoxifen concentrations can fall markedly
Management / timing
- Avoid strong 2D6 inhibitors when feasible
- Prefer weak/non-2D6 alternatives
Self-check
- What is preferred when managing Tamoxifen + bupropion/fluoxetine/paroxetine?
weak/non-2D6 alternatives.
- What is the preferred management of Tamoxifen + bupropion/fluoxetine/paroxetine?
Avoid strong 2D6 inhibitors when feasible.
- Should Tamoxifen + bupropion/fluoxetine/paroxetine generally be combined?
No—avoid the combination when feasible.
Drugs in this interaction (4)
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