Everyone using tamoxifen, does a prolonged qtc interval mean anything to you?

[criticalbench]

So many people here are so quick to hop on tamoxifen in pct. Understandable, it works. Does anyone here actually understand that tamoxifen is classified as a medication known to prolong the qtc interval? Prolonging the qtc interval can place your heart into a deadly rhythm, called torsades de pointes.

Now, many medications prolong the qt interval. The problem lies when you combine more than one medication that has the ability to prolong the qt interval. The risk is very very very low with just one medication, and unless you have cardiac issues, I wouldn't bat an eye to it. BUT, many medications that you may not be aware of, like benedryl, cialis, SSRIs, certain antibiotics, etc. have the ability to prolong the qt interval.

The point of this is, if running tamoxifen in pct, check any and all medications your take. Stupid little meds you may not think twice about can put you at great risk. Survival from Tdp is not very likely unless you are already in the hospital.

Many people take prescriptive medications. You need to check yourself for these sorts of interactions because your physician and pharmacist are not going to no you take tamoxifen. Also use a medication interaction checker when you are taking AIs, SERMs, Cialis, Pramipexole, dostinex, etc. They do not come without issues. Be responsible.

I take a high risk medication that prolongs the qt interval, in addition to a moderate risk medication (All medically prescribed) but I also take carvedilol, and alpha/beta blocker which shortens the QT interval.

*Also, take into account tamoxifen is hepatotoxic to a degree as well.

 

[Killcure666]

I'm digging the amount of science and medicine in this post.

What do the statistics say as far as how often deaths related to medication induced prolonged qt interval? Is this common?

 

[criticalbench]

I'm digging the amount of science and medicine in this post.

What do the statistics say as far as how often deaths related to medication induced prolonged qt interval? Is this common?

No, I wouldn't say it is very common. I see patients on 2, 3, 4 and so on, qt prolonging agents. Some people tolerate 4 medications, others convert into a deadly rhythm from 2. Hard to say, but it is a simple precaution to take. For instance, if you are on tamoxifen and you have an infection and your physician wants to prescribe you azithromycin (Z-pack) or erythromycin, it would be wise to ask for a different appropriate antibiotic like augmentin which does not possess qt properties, obviously after confirmation the bacteria you have is sensitive to augmentin but there are always other options, that is just an example. If your on tamoxifen and an SSRI, it would be wise to avoid benedryl, etc. and so on.

Everyone should understand their medications, especially when incorporating things that are not getting triple checked by physicians, pharmacists, and nurses for interactions.

 

[hairygrandpa]

Good info, thank you!

 

[jakz]

See. This is why I need TRT

 

[Vikingbro]

Invaluable info. Great work

 

[Vikingbro]

Anyone know if Exemestane and tramadol extend the qtc interval?

 

[criticalbench]

Anyone know if Exemestane and tramadol extend the qtc interval?

Aromasin, no. Tramadol, yes if blood levels build up and your body is not clearing the medication like it should, example would be someone in acute renal failure who can't clear metabolites thus, increasing the concentration the blood.

The point of this thread was that everyone needs to be responsible and educate themselves. It is not hard to look up drug interactions. People are playing around with agents used in combination as adjunct therapy to chemotherapeutic road maps. These are not tic tacs or skittles.

 

[criticalbench]

Something interesting I just read on a chemotherapy database in regards to tamoxifen, seems kind of the opposite but found this interesting.

"Loss of libido (particularly in men)"
"Your fertility, your ability to conceive or father a child, may be affected by tamoxifen"

Tamoxifen is also liver toxic as well as increases the possibility of developing DVTs or pulmonary emboli.

 

[saywutrly]

Thanks very much for posting this. I agree that this topic should be spoken on more often.

I switched to toremifene for my PCTs and I felt it worked very well. Someone on here actually recommended it, but yes most folks recommend nolva.

From my research, serious sides are less with the torem as opposed to clomid/ nolva.

 

[criticalbench]

Thanks very much for posting this. I agree that this topic should be spoken on more often.

I switched to toremifene for my PCTs and I felt it worked very well. Someone on here actually recommended it, but yes most folks recommend nolva.

From my research, serious sides are less with the torem as opposed to clomid/ nolva.

To be honest, Toremifene falls into the same bracket as tamoxifen and has quite extensive warnings placed on the drug facts for prolongation of the qt interval.

In reality, if this is all your taking, unless you have heart failure, conductive disorders, or electrolyte balancing issues, you SHOULD have nothing to worry about. This is more so an issue when people combine more than 1 if not 2, prolonging agents.

Any sort of liver impairment can increase blood concentration levels of any of these drugs making you more prone to issues as well. So if you completely trash your liver on cycle, then have two prolonging agents in your system in pct, you "MAY" be more prone to issues.

Everyone is different, everyone responds different. Again, point of the post is for people to take responsibility for there actions and not act like there pharmacological agents are candy, as if there is nothing to worry about. If you were taking 2 prolonging agents, your physician would be doing routine EKGs.

Always check drug interactions, take these medications into account the same as the pharmacist would for prescribed meds.

 

[NurseGray]

Great info. Just a friendly Murse tip to add in. There is a great free app to check interactions called Epocrates. I believe I have mentioned this app once on the forums before. Anyway, it's a pretty extensive medical app I use on a daily basis at work. You would be surprised the info you can find.

 

[criticalbench]

Great info. Just a friendly Murse tip to add in. There is a great free app to check interactions called Epocrates. I believe I have mentioned this app once on the forums before. Anyway, it's a pretty extensive medical app I use on a daily basis at work. You would be surprised the info you can find.

Agreed, epocrates is legit, I use it from time to time. Pepid is solid, Lexicomp I find the most overall information but I doubt most here will be able to access that.

I made this post because as you no, TDp is not joke. When you playing with meds that can prolong it, exercising and depleting potassium and magnesium, etc. anything can happen especially when you have stimulants in your system.

 

[InItForGainz]

Clomid for the win then

 

[Toren]

I like threads like these becasue they get people thinking. There are plenty of us on here that far too often are stacking multiple prescription medications without the supervision of a doctor. I often take a lot of health supplements and therefor regularly check for contraindications for what I take.

I remember reading about this topic in the past but didn't pay it much attention. A quick search....

http://www.medsafe.govt.nz/profs/PUArticles/DrugInducedQTProlongation.htm

http://drugs.emedtv.com/medicine/qt-prolonging-medications.html

http://www.sads.org.uk/drugs-to-avoid/

I was shocked to see Ketoconazole (Nizoral shampoo contains this active) on the list in the third link. This should only be a concern with oral ingestion of the medication though as topical application has shown very limited systemic absorption even with very heavy usage. Males shouldn't be taking this medication orally without plenty of supervision anyway.

Nice topic!

 

[criticalbench]

I like threads like these becasue they get people thinking. There are plenty of us on here that far too often are stacking multiple prescription medications without the supervision of a doctor. I often take a lot of health supplements and therefor regularly check for contraindications for what I take.

I remember reading about this topic in the past but didn't pay it much attention. A quick search....

http://www.medsafe.govt.nz/profs/PUArticles/DrugInducedQTProlongation.htm

http://drugs.emedtv.com/medicine/qt-prolonging-medications.html

http://www.sads.org.uk/drugs-to-avoid/

I was shocked to see Ketoconazole (Nizoral shampoo contains this active) on the list in the third link. This should only be a concern with oral ingestion of the medication though as topical application has shown very limited systemic absorption even with very heavy usage. Males shouldn't be taking this medication orally without plenty of supervision anyway.

Nice topic!

Very very true bro. Some meds are ones we would never think. If using prescription medication self prescribed, you need to spend a few minutes to learn and understand the medications and contraindications.

 

[criticalbench]

Clomid for the win then

Clomid does not pose any threat to qt prolongation.

 

[georgetown]

Clomid does not pose any threat to qt prolongation.

Clomid gives me bad sides and I can only use tamoxifen, does the ssri citalopram have too much of a negative interaction with tamoxifen? (Epocrates didnt mention anything about qtc with the pair)

 

[InItForGainz]

Clomid gives me bad sides and I can only use tamoxifen, does the ssri citalopram have too much of a negative interaction with tamoxifen? (Epocrates didnt mention anything about qtc with the pair)

Blurry vision, overly emotional or acne?

 

[georgetown]

Blurry vision, overly emotional or acne?

Flu like symptoms, and feeling horrible, quite a unique experience. First and only pct with pharma clomid, luckily had some rc nolva that helped me recover (had bloods done)

Wouldnt knock clomid for others just my experience

 

[criticalbench]

Clomid gives me bad sides and I can only use tamoxifen, does the ssri citalopram have too much of a negative interaction with tamoxifen? (Epocrates didnt mention anything about qtc with the pair)

Celexa is actually the worst of all SSRIs for cardiac complications, I am not kidding. It is rarely used now a days as its sister, Lexapro which is relatively similar but much safer has taken over.

INTERACTION LEVEL: MAJOR
"Using citalopram together with tamoxifen can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening"

Prozac has a lot of interactions as well. Zoloft, tends to be the SSRI with the least interactions and although prolonged qt syndrome will be listed with any SSRI, zoloft in studies has not demonstrated any such effects.

 

[georgetown]

Celexa is actually the worst of all SSRIs for cardiac complications, I am not kidding. It is rarely used now a days as its sister, Lexapro which is relatively similar but much safer has taken over.

INTERACTION LEVEL: MAJOR
"Using citalopram together with tamoxifen can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening"

Prozac has a lot of interactions as well. Zoloft, tends to be the SSRI with the least interactions and although prolonged qt syndrome will be listed with any SSRI, zoloft in studies has not demonstrated any such effects.

Wow, even in low doses?

 

[Vikingbro]

Clomid gives me bad sides and I can only use tamoxifen, does the ssri citalopram have too much of a negative interaction with tamoxifen? (Epocrates didnt mention anything about qtc with the pair)

Citalopram is on the list

 

[criticalbench]

Wow, even in low doses?

It's obviously Dose dependent but I can't pull data showing that at certain doses there is no risk. Celexa has really been weaned out of the ssri market because of all the negative cardiac attention it has gotten and lexapro has replaced it as its big brother, although the same warnings have been carried over to lexapro but have not actually shown the issue in clinical setting.

I am on an ssri and I picked to start on Zoloft specifically because of qt prolonging concerns as I respond extremely well to azithromycin for most infections which prolongs the qt interval and I also use a GI med that is high risk. But then again I take carvedilol to shorten the qt.

Zoloft and Luvox as far as SSRIs appear to be the safest for this issue, celexa being the worst. Prozac sucks because it literally has drug interactions with everything.

 

[Bigman2323]

Wanted to bump this. On 50 mg of Zoloft and have Torem for my PCT. Is it better to use clomid instead?

 

[BlockBuilder]

Wanted to bump this. On 50 mg of Zoloft and have Torem for my PCT. Is it better to use clomid instead?

I take lexapro and would just go with clomid. Better safe than sorry. No interactions with clomid