Tamoxifen |
| Lifestyle changes in dressing and bedding For severe symptoms try SSRIs or SNRIs (venlafaxine, citalopram, escitalopram, sertraline) Avoid paroxetine and fluoxetine
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| Use caution in patients with factor V Leiden heterozygosity or homozygosity, recent fracture, recent surgery, immobilization, or prior history of VTE Treat VTE per guidelines
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| No routine surveillance for standard-risk patients Premenopausal patients: any irregular vaginal bleeding to be investigated with endometrial biopsy Postmenopausal patients: all vaginal bleeding to be investigated with endometrial biopsy; otherwise, only normal routine gynecologic examination per standard guidelines
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| No routine screening recommended If fatty liver documented, obtain liver enzyme levels every 3-6 mo Stop tamoxifen if liver enzyme levels exceed twice the upper limit of normal
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Aromatase inhibitors |
| Bone mineral density measurement at baseline and every 2 y Vitamin D: 800 IU/d Total calcium (diet and supplement): 1200 mg/d Manage as per osteoporosis guidelines
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| Switch the aromatase inhibitor Consider exercise, massage, acupuncture, or NSAIDs
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