In women who are menstruating regularly, but with anovular cycles, the initial course of treatment consists of 20 mg given daily on the second, third, fourth and fifth days of the menstrual cycle. Elderly people: Similar dosing regimens of tamoxifen have been used in older people with breast cancer and in some of these patients it has been used as sole therapy. Anovulatory infertility: Before commencing any course of treatment, whether initial or subsequent, the possibility of pregnancy must be excluded. Substantive evidence supporting the use of treatment with 30-40mg per day is not available, although these doses have been used in some patients with advanced disease. No additional benefit, in terms of delayed recurrence or improved survival in patients, has been demonstrated with higher doses. The primary prevention of breast cancer in women at moderate or high risk (see section 5.1) Women aged less than 30 years old were excluded from primary prevention trials so the efficacy and safety of tamoxifen treatment in these younger women is unknown. Breast cancer: Adults: The recommended daily dose of tamoxifen is normally 20mg. If unsatisfactory basal temperature records or poor pre-ovulatory cervical mucus indicate that this initial course of treatment has been unsuccessful, further courses may be given during subsequent menstrual periods, increasing the dosage to 40mg and then 80mg daily. In women who are not menstruating regularly, the initial course may begin on any day. In 2006, the large STAR clinical study concluded that raloxifene is equally effective in reducing the incidence of breast cancer, but after an average 4-year follow-up, although the difference was not statistically significant, there were 36% fewer uterine cancers and 29% fewer blood clots in women taking raloxifene than in women taking tamoxifen. Tamoxifen improves fertility in males with infertility by disinhibiting the hypothalamic–pituitary–gonadal axis (HPG axis) via ER antagonism and thereby increasing the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and increasing testicular testosterone production. It is taken as a preventative measure in small doses, or used at the onset of any symptoms such as nipple soreness or sensitivity. Other drugs are taken for similar purposes such as clomifene and the anti-aromatase drugs which are used in order to try to avoid the hormone-related adverse effects. Occasionally tamoxifen is used in treatment of the rare conditions of retroperitoneal fibrosis A report in September 2009 from Health and Human Services' Agency for Healthcare Research and Quality suggests that tamoxifen, raloxifene, and tibolone used to treat breast cancer significantly reduce invasive breast cancer in midlife and older women, but also increase the risk of adverse side effects. Some cases of lower-limb lymphedema have been associated with the use of tamoxifen, due to the blood clots and deep vein thrombosis (DVT) that can be caused by this medication. Resolution of the blood clots or DVT is needed before lymphedema treatment can be initiated.
Do not respond to tamoxifen, who cannot tolerate tamoxifen due to side-effects, or who have contraindications to tamoxifen, we use azathioprine or pentoxifylline Given the side-effect profile of cyclophosphamide › When considered for primary reduction of breast cancer risk, tamoxifen is contraindicated in women who require concomitant coumarin-type anticoagulant.