Is Tamoxifen Citrate compatible with breastfeeding? Do we have alternatives for Tamoxifen Citrate?

Tamoxifen Citrate

June 10, 2018 (Very High Risk)

Non-steroidal anti-estrogen with an estrogen antagonist action by binding to the estrogen receptor. Similar action to clomiphene.
Indicated in breast cancer after remission in order to prevent recurrence.
Oral administration once or twice a day for 5 years.
It has also been used in combination with clomiphene to induce ovulation (Suginami 1993).

Since the last update date we have not found published data on its excretion in breastmilk.

Its high binding to plasma proteins would hinder transfer to breastmilk, but high pKa and its long half-life make its transfer to breastmilk likely.

It inhibits breastfeeding in the immediate postpartum (Masala 1978, Shaaban 1975), possibly due to decreased prolactin levels (Jordan 1991).

Until there is more data about this product in relation to breastfeeding, scientific associations and expert authors strongly advise against breastfeeding while taking tamoxifen because of the risk of interfering with the infant's estrogen balance (Hale 2017 p.906, Pistilli 2013, WHO 2002, Helewa 2002).


See below the information of this related product:

Alternatives

We do not have alternatives for Tamoxifen Citrate.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Writings

  • Ταμοξιφαίνη κιτρική (Greek)
  • Тамоксифена Цитрат (Cyrillic)
  • タモキシフェンクエン酸塩 (Japanese)
  • Tamoxifène Citrate (French)
  • C26 H29 NO,C6 H8 O7 (Molecular formula)
  • (Z)-2-[4-(1,2-Diphenylbut-1-enyl)phenoxy]ethyldimethylamine citrate (Chemical name)
  • L02BA01 (ATC Code/s)

Drug trade names

References

  1. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  2. AEMPS. Tamoxifeno. Ficha técnica. 2013 Full text (in our servers)
  3. Pistilli B, Bellettini G, Giovannetti E, Codacci-Pisanelli G, Azim HA Jr, Benedetti G, Sarno MA, Peccatori FA. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013Abstract
  4. Astra Zeneka. Tamoxifen. Drug Summary. 2004 Full text (in our servers)
  5. Helewa M, Lévesque P, Provencher D, Lea RH, Rosolowich V, Shapiro HM; Breast Disease Committee and Executive Committeee and Council, Society of Obstetricians and Gynaecologists of Canada.. Breast cancer, pregnancy, and breastfeeding. J Obstet Gynaecol Can. 2002Abstract
  6. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  7. Suginami H, Kitagawa H, Nakahashi N, Yano K, Matsubara K. A clomiphene citrate and tamoxifen citrate combination therapy: a novel therapy for ovulation induction. Fertil Steril. 1993Abstract
  8. Jordan VC, Fritz NF, Langan-Fahey S, Thompson M, Tormey DC. Alteration of endocrine parameters in premenopausal women with breast cancer during long-term adjuvant therapy with tamoxifen as the single agent. J Natl Cancer Inst. 1991Abstract
  9. Masala A, Delitala G, Lo Dico G, Stoppelli I, Alagna S, Devilla L. Inhibition of lactation and inhibition of prolactin release after mechanical breast stimulation in puerperal women given tamoxifen or placebo. Br J Obstet Gynaecol. 1978Abstract
  10. Shaaban MM. Suppression of lactation by an antiestrogen, tamoxifen. Eur J Obstet Gynecol Reprod Biol. 1975Abstract