Bruce E. Hillner, MD
Do some selective serotonin reuptake inhibitors (SSRIs) reduce the effectiveness of tamoxifen in women with breast cancer?
Population-based cohort study with database linkage. Mean follow-up was 2.38 years.
2430 women ≥ 66 years of age (median age 74 y) who were newly treated with tamoxifen for breast cancer and also prescribed a single SSRI during tamoxifen therapy. SSRIs prescribed were paroxetine (26%), sertraline (22%), citalopram (19%), venlafaxine (15%), fluoxetine (10%), and fluvoxamine (7%).
Proportion of time receiving tamoxifen with concomitant SSRI.
Breast-cancer mortality and all-cause mortality after cessation of tamoxifen.
1074 women (44%) died, including 374 (15%) with breast cancer as the cause of death. Women who received paroxetine had increased risks for breast-cancer mortality and all-cause mortality; increases in the proportion of time receiving concomitant tamoxifen and paroxetine were associated with increases in breast-cancer mortality and all-cause mortality (Table). Concomitant use of other single SSRIs (sertraline, citalopram, venlafaxine, fluoxetine, or fluvoxamine) during tamoxifen therapy was not associated with increased risk for breast-cancer or all-cause mortality.
Concomitant use of paroxetine during tamoxifen therapy for breast cancer was associated with increased risk for breast-cancer mortality and all-cause mortality. Concomitant use of other single SSRIs during tamoxifen therapy was not associated with increased breast-cancer mortality or all-cause mortality.
Mortality in women with breast cancer who were receiving tamoxifen and concomitant paroxetine*
*CI defined in Glossary.
†Adjusted for age and comorbid conditions in the year before stopping tamoxifen, year tamoxifen started, duration of tamoxifen therapy, time between diagnosis and start of tamoxifen, socioeconomic status, and receipt of other CYP2D6 inhibitors during tamoxifen therapy.
Hillner BE. Use of paroxetine during tamoxifen therapy for breast cancer was associated with increased breast-cancer and all-cause mortality. Ann Intern Med. ;152:JC6–13. doi: 10.7326/0003-4819-152-12-201006150-02013
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Published: Ann Intern Med. 2010;152(12):JC6-13.
Breast Cancer, Hematology/Oncology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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