Drug interactions -summary

Thiazide diuretics-
drugs that decrease renal calcium excretion ( thiazide diuretics ) may increase risk of
 hypercalcemia in patients receiving toremifene citrate

Anticoagulants-
increased coagulation time. When concomittant use of anticoagulant with toremifene
is necessary carfully monitor prothrombin time.

CYP450 isoenzymes-
cytochrome P450 enzyme inducers eg phenobarbital, carbamazepine increase
rate of toremifene metabolism.

Breast cancer

Adverse reactions reported-

Dizziness 8%

Edema 4%

Hot flushes 30%

Nausea 12%

Sweating 15%

Vaginal bleeding 1%

Vaginal discharge  10%

Vomiting  3%

Hypersensitivity to the drug

Special Precautions/Warnings-

Hypercalcemia and tumor flares-
Tumor flares have been reported in some breat cancer patients with  bone metastates during first weeks of treatment. Tumor flares is often accompanied by hypercalcemia

If hypercalcemia is severe , discontinue toremifene citrate treatment

Thromboembolic disease/pre-existing endometrial hyperplasia -
Patients with a history of thromboembolic diseases should generally not be treated with toremifine citrate.

Pregnancy- appraise patient of the potenial hazard to the fetus or potential risk for loss of the pregnancy

Lactation- not known if the drug is excreted in human . Excercise caution

Children- no indication for use children.

Monitoring- periodic complete blood counts , calcium levels, and liver function tests should
be obtained. 

Indication-

Breast cancer

Dosage-
Recommended dose is 60mg once daily. Treatment is generally continued until progression
is observed

Store - 25C ( 77F ). Protect from heat and light.

 Vaginal bleeding has been reported in patients using toremifine citrate.

 Inform patients about this and instruct them to contact their physcian if such  bleeding occurs.

Pregnancy-
Appraise patient of the potenial hazard to the fetus or potential risk for loss of the
pregnancy

Lactation-
Not known if the drug is excreted in human . Excercise caution

Children-
No indication for use children.