- Question from Fredda: I am taking tamoxifen and unable to take Effexor for hot flashes, and vitamin E didn't work. Is there something else?
Sandra F. Schnall, M.D.
There are some herbal therapies one can try. However, many—such as evening primrose oil or black cohosh—carry natural estrogen in them, which makes them a less than optimal therapy.
Other agents, such as some antihypertensive agents, can help to some degree, but they have other side effects. The hypertensive agent may be the clonidine (brand name: Catapres) patch. Although this is often well tolerated, there can be lowering of blood pressure, which can be uncomfortable or symptomatic.
Marisa C. Weiss, M.D.
Some women may have a good response to another low-dose antidepressant even if they couldn't tolerate the first one. Other medications you might try besides Effexor can include the antidepressants Paxil (chemical name: paroxetine) and Prozac (chemical name: fluoxetine), and the mood-stabilizer medication Neurontin (chemical name: gabapentin).
Before going to medications, of course, it's helpful to look at your lifestyle. Stress reduction can be quite helpful, as can exercise, meditation, weight loss, and dressing in layers of natural fiber clothing. Get a thermal cup with ice water in it and bring it with you wherever you go. Put nearly full water bottles into the freezer and take those with you and drink them as they melt during the day.
Portable fans and avoiding caffeine and spicy foods can make a difference. Try to get to meetings on time when possible and do your best to prepare before the meeting to avoid avoidable stresses. Check out other ideas at Breastcancer.org You have to be resourceful and patient because it does take a lot of trial-and-error to find the 1-2-3 combination of things that might help you.
Editor's Note: If you are taking tamoxifen, talk to your doctor about which antidepressants are safe for you to take to manage hot flashes. Some antidepressants -- including Paxil, Wellbutrin (chemical name: bupropion), Prozac, Cymbalta (chemical name: duloxetine), and Zoloft (chemical name: sertraline) -- interfere with the body's ability to convert tamoxifen into its active form, preventing you from getting the full benefit of tamoxifen. For more information, please visit the Tamoxifen page.
- Sandra F. Schnall, M.D. Oftentimes, the hot flashes do dissipate without medical intervention, or the patient may become more tolerant of them so they seem less bothersome.
On Wednesday, April 21, 2004, our Ask-the-Expert Online Conference was called Hormonal Therapy Updates. Sandra Schnall, M.D. and Marisa Weiss, M.D. answered your questions about hormonal therapies and answered questions about which ones work best in different situations, how they might fit into your treatment sequence, how to deal with side effects, and more.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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