ABSTRACT
Tamoxifen (Tmf), is a standard of care for women with estrogen receptor positive (ER+) breast cancer. Endoxifen is a Tmf metabolite generated by cytochrome P450 2D6 (CYP2D6). Antidepressive agents (AD) are often prescribed to women with breast cancer not only for depression, but also for anxiety and hot flashes. Some AD are substrates or inhibitors of the Tmf metabolic pathway. Therefore there may be interactions when Tmf and AD are prescribed simultaneously. Oncologic protection afforded by Tmf may become less effective or null when AD are indicated, especially in poor metabolizing patients. We performed an update of the literature about the criteria for choosing AD in women receiving Tmf. Tricyclic AD, paroxetine and fluoxetine should be avoided in patients receiving Tmf, because they are strong inhibitors of CYP2D6. Bupropion, duloxetine and sertraline are only moderate inhibitors of the cytochrome and are not contraindicated. Citalopram, desvenlafaxine, escitalopram, milnacipran and venlafaxine are recommended, because they do not influence the metabolism and clinical efficacy of Tmf and have fewer drug interactions. However, other additional pharmacological and clinical issues should be considered when choosing an antidepressant in women with breast cancer.
Subject(s)
Humans , Female , Tamoxifen/pharmacology , Breast Neoplasms/drug therapy , Antineoplastic Agents, Hormonal/pharmacology , Antidepressive Agents/pharmacology , Tamoxifen/metabolism , Breast Neoplasms/metabolism , Risk Factors , Antineoplastic Agents, Hormonal/metabolism , Cytochrome P-450 CYP2D6/drug effects , Drug Interactions , Genotype , Antidepressive Agents/metabolismABSTRACT
Tamoxifen is used as an adjuvant therapy to reduce breast cáncer recurrence among women with estrogenreceptor positive tumors. Antidepressants are also com-monly used in such women, to treat depression or to manage hotflush.es, afrequent tamoxifen secondary effect. Some antidepressants couldpotentially inhibit cytochrome P450 2D6, required to actívate tamoxifen, interfering with its action. Although there is not a clear cut directive on the subject, it is nowadays recommended to treat women with antidepressants with the lower cytochrome P450 2D6 inhibition potential to avoid apossible antagonism that may reduce tamoxifen s prevention of breast cáncer recurrence at least in some patients with CYP2D6 genetic variation. The recommended antidepressants are desvenlafaxine, milnacipran, venlafaxin, escitalopram and citalopram.
Subject(s)
Female , Humans , Antidepressive Agents/adverse effects , Breast Neoplasms/drug therapy , /antagonists & inhibitors , Estrogen Antagonists/metabolism , Tamoxifen/metabolism , Antidepressive Agents/pharmacology , /genetics , Drug InteractionsABSTRACT
Los Trastornos del Espectro Autista (TEA) agrupan diversos cuadros clínicos que se caracterizan por presentar alteraciones del desarrollo con deficiencias en las áreas de comunicación, conducta e interacción social. Su prevalencia ha presentado un importante aumento desde 4 a 5 por 10.000 hasta 10 por 10.000 niños. Las manifestaciones clínicas son características según cada etapa evolutiva y, tanto la adaptabilidad al medio, como el pronóstico final van a depender del desarrollo intelectual alcanzado y de la rehabilitación psicosocial temprana. El pronóstico de vida es igual al de la población general y los autistas adultos presentan generalmente cuadros de agitación psicomotora y de adaptación, tanto depresivos como ansiosos. El origen de las TEA es neurobiológico, se remonta a etapas tempranas del desarrollo fetal o infantil y está relacionado con factores genéticos complejos. El abordaje psicofarmacológico es inespecífico y va dirigido a corregir las alteraciones conductuales que priman en cada caso.
Autism Spectrum Disorders (ASD) are severe developmental diseases marked by significant impairment in social, behavioral, and communicative functioning. Their prevalence has increased from earlier estimates of 4 to 5 per 10.000 to about 10 per 10.000. Symptoms are age specific. Intellectual development and early psychosocial rehabilitation are the most important prognostic factors. Life expectancy is similar to that of the general population. In adult life, comorbidity with anxiety disorders or depression and aggression toward self and others may appear. The assumption is that ASDs are of neurobiological origin beginning before birth or in very early child development and involve complex genetic factors. The psychopharmacotherapy of autistic disorders involves treating behavioral symptoms.