The People's Perspective on Medicine



Nolvadex is a nonsteroidal agent with potent antiestrogenic properties.

The antiestrogenic effects allow it to compete with estrogen for binding sites in target tissues, particularly the breast.

Nolvadex is prescribed to delay the recurrence of breast cancer following appropriate treatment and to combat metastatic breast cancer as an alternative to radiation or removal of the ovaries.

Side Effects and Interactions

Without question, the most common side effects of Nolvadex are hot flashes and nausea and/or vomiting.

Up to one fourth of the women on this medication may experience them; they are not usually severe enough for women to stop their medicine, however.

Other side effects to be alert for include vaginal bleeding, vaginal discharge, menstrual irregularities and skin rash.

Less commonly Nolvadex may produce a temporary flare of bone pain associated with metastatic disease, high calcium levels, swelling of the hands and feet, distaste for food, genital itching, depression, dizziness, headache and hair thinning or partial hair loss.

Some women have experienced visual changes while taking Nolvadex, and periodic eye exams are prudent.

There are some cases of serious blood clots in patients on Nolvadex.

Notify your doctor immediately if you suddenly notice confusion, blurred vision, shortness of breath, weakness, sleepiness, or pain and swelling in the leg or groin, as these might be signs of a clot.

This medication can interact with the blood thinners Coumadin and increase bleeding time. If they must be used together, prothrombin time should be monitored carefully.

There are hints that phenobarbital and Parlodel may alter Nolvadex blood levels.

This medication can affect thyroid tests, raising T4 levels without changing thyroid function. This should be taken into account in interpreting the results of a thyroid test.

Check with your pharmacist and physician to make sure Nolvadex is safe in combination with any other drugs you take.

Special Precautions

Nolvadex should not be taken during pregnancy, and any woman taking this medicine should use effective contraception.

Not all breast cancers are sensitive to estrogen, so the doctor will order hormone receptor studies on the tumor tissue to see if it is susceptible to Nolvadex.

Changes of the endometrium (lining of the uterus) have been reported in women taking Nolvadex. These include growths (polyps), overgrowth (hyperplasia) and even cancer.

Experts believe that the underlying mechanism is related to the estrogenic properties of Nolvadex.

Any woman on Nolvadex who experiences abnormal vaginal bleeding should report it to her doctor immediately.

Nolvadex should be used cautiously in women with abnormal blood counts. Regular blood tests to check both white and red cells and also liver enzymes may be appropriate.

Taking the Medicine

Nolvadex is taken twice a day, preferably on an empty stomach. The pills may be taken with food if they cause stomach upset.

Nolvadex tablets should be protected from heat and light.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Was on Arimidex for 1 year but lost bone density and had Dequervains syndrome. Switched to Tamoxifen (Nolvadex 20 mg daily) 1 year ago, now need to go for D&C due to cystic spaces in my endometrium and thickening and non homogenous endometrium. I had no symptoms, was just for routine pelvic ultrasound because on Tamoxifen – Apparently this is very common with Tamoxifen.
Makes me wonder if I should have a prophylactic hysterectomy… I feel like I’m being punished for having my uterus intact. I’m 56. Otherwise, I feel fine, the hot flashes and insomnia are a pain, but I keep telling myself, that means its working well, and that makes it easier to get over them. Hubby is supportive. Got at least 3 more years to go. Much easier on me than Arimidex which was causing a lot of pain in my muscles and making me have terrible time walking, and especially climbing stairs. Didn’t realize how bad I was getting until I was put on Tamoxifen/Nolvadex …so much better.

How about Arimidex (anastrozole)? Is improved chance for being cancer free worth the side effects of bone weakness-fractures?I have osteoporosis already( at -2.5)

I am taking 20 mg of Tamoxifen dly. Had a lumpectomy, clear margins, estrogen positive, and finished radiation.
Prefer Tamoxifen as the AI’s can cause bone loss.
However, think that 20 mg is too much. 10 mg dly or 20mg every other day would be better. Have seen some research to that effect–Dr.Andrea Decensi, Milan, Italy.
The lesser dosage might well decrease the chances of liver, heart and vein problems.
Have there been other studies on the reduced dosage?

Between Zoladex and Tamoxifen, I find that the “loss” of estrogen has made me think more clearly. I am not kidding about this. And I’m calmer also.

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