Preparation usually well tolerated by patients. For part of the digestive system: often – heartburn, nausea, abdominal pain, constipation or diarrhea, flatulence, dyspepsia; very rarely – dry mouth, taste perversion, biliary cholestasis, hepatitis, gastralgia, cholestatic jaundice, hepatic dysfunction, hepatitis, acute pancreatitis. On the part of the central tamoxifen citrate and peripheral nervous system: often – headache, dizziness; very rarely – peripheral neuropathy, sleep disorders, fatigue, insomnia, paresthesia, mental disorders (including anxiety). From the side of the musculoskeletal system: often – myalgia, muscle cramps; rare – myopathy, myositis, dermatomyositis; very rarely – in patients taking cyclosporine, gemfibrozil or nicotinic acid increased risk of rhabdomyolysis.
From the side of hematopoiesis: rarely – as a manifestation of a hypersensitivity syndrome (hemolytic anemia, leukopenia, thrombocytopenia). From a sight organ: very rarely – “fog” before your eyes, cataract, cataracts, optic atrophy. Laboratory tests: a moderate increase in activity of “liver” transaminases: alanine aminotransferase and asparaginaminotransferazy (including a three-fold increase in relation to the upper limit of normal – 1.5% cases); rarely – increasing the activity of creatine phosphokinase ; very rare – increase in alkaline phosphatase and bilirubin. Allergic tamoxifen citrate reactions: very rarely – hypersensitivity syndrome (anaphylaxis, lupus-like syndrome, arthralgia, angioedema, urticaria, erythema multiforme, including Stevens – Johnson), toxic epidermal necrolysis (Lyell’s syndrome), skin rash , itchy skin. Other: very rarely – reduced potency, acute renal failure (due to rhabdomyolysis), chest pain, palpitations, alopecia.
described several cases of accidental admission of unnecessarily large doses of the drug, but the specific symptoms in patients with no observed. Treatment: removal of preparation, general activities: monitoring and maintenance of vital functions, preventing further absorption of the drug (gastric lavage, administration of activated charcoal or laxatives) , monitor liver function. With the development of myopathy and rhabdomyolysis with acute renal failure must be intravenous sodium bicarbonate solution and a diuretic, with hyperkalemia – intravenous calcium chloride or calcium gluconate solution, glucose infusion with insulin; in severe cases – hemodialysis.
The interaction with other drugs
simultaneously tamoxifen citrate the drug and nicotinic acid (more than 1 g / day), cyclosporine, macrolide antibiotics (erythromycin, clarithromycin) “azole” antifungal drugs (ketoconazole, itraconazole), protease inhibitors (ritonavir), nefazodone may increase the lovastatin concentration in the blood plasma, which can occur due to rhabdomyolysis and myopathy, renal insufficiency. Grapefruit juice in large amounts (above 1 l / d) increases the maximum plasma concentration of lovastatin, and the risk of myopathy. Simultaneous administration of the drug with fibric acid derivatives . Can also lead to the development of myopathy, although the mechanism in this case is unclear.
Co-administration of warfarin and tamoxifen citrate drug can increase the influence of the latter on the parameters of coagulation and therefore , may increase the risk of bleeding.