| Drug |
Effect on CYP2D6 |
Advice |
| venlafaxine (Effexor) |
Minimal |
Safest choice if taken with tamoxifen. |
| desvenlafaxine (Pristiq), mirtazapine (Remeron) |
Direct studies with tamoxifen are lacking, but effect on endoxifen levels should be minimal. |
| citalopram (Celexa), escitalopram (Lexapro), nefazodone (Serzone) |
Mild |
Secondary choices if above are not options.
Only citalopram and sertraline have been studied directly with tamoxifen, so risk of reducing levels of endoxifen should be weighed against benefits of antidepressants. |
| duloxetine (Cymbalta), sertraline (Zoloft), fluvoxamine (Luvox) |
Moderate |
| paroxetine (Paxil), fluoxetine (Prozac), bupropion (Wellbutrin) |
Strong |
Best to avoid if taking tamoxifen. |
|