英文药名: Nolvadex(Tamoxifen Tablets)

中文药名: 诺瓦得士（他莫昔芬片）

品牌药生产厂家: AstraZeneca

药品名称

药品名称: 枸橼酸他莫昔芬; 他莫昔芬; 抑癌片, 三苯氧胺, 抑乳癌, 它莫西芬, 抗雌激素
英文名: Tamoxifen, Nolvadex, Zitazonium, ICI-46474, TAM
药理毒理

他莫昔芬为非固醇类抗雌激素药物。其结构与雌激素相似，存在Z型和E型两个异构体。两者物理化学性质各异，生理活性也不同，E型具有弱雌激素活性，Z型则具有抗雌激素作用。如果乳癌细胞内有雌激素受体（ER），则雌激素进入肿瘤细胞内，与其结合，促使肿瘤细胞的DNA和m-RNA的合成，刺激肿瘤细胞生长。而他莫昔芬Z型异构体进入细胞内，与ER竞争结合，形成受体复合物，阻止雌激素作用的发挥，从而抑制乳腺癌细胞的增殖。
药代动力学

本品为口服，吸收迅速。口服20mg后6～7.5小时，在血中达最高浓度，半衰期：7～14小时，4天或4天后出现血中第二高峰，可能是肝肠循环引起，半衰期大于7天。其排泄较慢，主要从粪便排泄，约占4/5，尿中排泄较少，约1/5。口服后13天时仍可从粪便中检测得到。
适应症

适用于治疗晚期乳腺癌和卵巢癌。
用法用量

口服：每次１０～２０ｍｇ，１日２次，可连续使用。 或遵医嘱！
不良反应

1.不良反应有恶心、呕吐、腹泻、月经失调、阴道出血、颜面潮红、脱发、皮疹、头痛、眩晕、体重增加，水肿、骨痛、肿瘤处疼痛。长期大量使用可出现视力障碍，偶有白细胞和血小板减少。
2.对胎儿有影响，妊娠妇女忌用。
3.血象和肝肾功能异常者应慎用。
4.偶有会阴部瘙痒、白带增多。
5.有时可引起高血钙症，１～２周内发生。
注意事项

有肝功能异常者应慎用。如有骨转移，在治疗初期需定期查血钙。
孕妇及哺乳期妇女用药

对胎儿有影响，妊娠，哺乳期妇女禁用。
药物相互作用

雌激素可影响本品治疗效果；抗酸药，西米替丁，雷尼替丁等在胃内改变pH值，使本品肠衣提前分解，对胃有刺激作用。
药品规格

片剂：10mg, 20mg。

How should you take Nolvadex?
Take Nolvadex exactly as prescribed. Do not stop taking Nolvadex without first consulting your doctor. It may be necessary to continue taking the drug for several years.

--If you miss a dose...

Do not try to make it up. Go back to your regular schedule with the next dose.

--Storage instructions...

Nolvadex may be stored at room temperature.

What side effects may occur?
Side effects from Nolvadex are usually mild and rarely require the drug to be stopped. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Nolvadex.

More common side effects may include:
Hot flashes, nausea, vomiting
Why should Nolvadex not be prescribed?
Do not take Nolvadex if you are sensitive to it or have ever had an allergic reaction to it.

If you are taking the blood-thinning drug Coumadin or have had problems with clots in your veins or your lungs, you should not take Nolvadex to reduce the risk of breast cancer, and when taking it to treat an actual case of the disease, you should use it with caution.

Special warnings about NolvadexIn addition to increasing the risk of uterine cancer, Nolvadex also raises the odds of developing endometriosis (the spread of endometrial tissue outside the uterus), uterine fibroids, uterine polyps, and ovarian cysts. W

omen who take Nolvadex also face a greater risk of stroke and blood clots lodging in their lungs. The risk increases further when Nolvadex is combined with toxic cancer drugs. Nolvadex can also cause liver damage, and should be used with caution if you already have liver problems.

If you experience visual problems while taking Nolvadex, notify your doctor immediately.

In a few women Nolvadex may raise the level of cholesterol and other fats in the blood. Your doctor may periodically do blood tests to check your cholesterol and triglyceride levels.

Nolvadex may produce an abnormally high level of calcium in the blood. Symptoms include muscle pain and weakness, loss of appetite, and, if severe, kidney failure. If you experience any of these symptoms, notify your doctor as soon as possible.

If tests show that your blood contains too few white blood cells or platelets while you are taking Nolvadex, your doctor should monitor you with special care. These problems have sometimes been found in women taking Nolvadex; whether the drug caused the blood-cell abnormalities is uncertain.

Possible food and drug interactions when taking NolvadexIf Nolvadex is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Nolvadex with the following:

Aminoglutethimide (Cytadren)
Blood-thinning drugs such as Coumadin
Bromocriptine (Parlodel)
Cancer drugs such as Cytoxan
Letrozole (Femara)

Phenobarbital
Rifampin (Rifadin)

Special information if you are pregnant or breastfeedingIt is important to avoid pregnancy while taking Nolvadex, because the drug could harm the unborn child. Since Nolvadex is an anti-estrogen drug, you will need to use a non-hormonal form of contraception, such as a condom and/or diaphragm, and not birth control pills. If you accidentally become pregnant while taking Nolvadex, or within 2 months after you have stopped taking it, discuss this with your doctor immediately.

Because Nolvadex might cause serious harm to a nursing infant, you should not breastfeed your baby while taking Nolvadex. If Nolvadex is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.

Recommended dosage
ADULTS

Breast Cancer Treatment

The daily dosage ranges from 20 to 40 milligrams. If you are taking more than 20 milligrams a day, your doctor will have you divide the total into 2 smaller doses taken in the morning and evening. Nolvadex comes in 10- and 20-milligram tablets.

Ductal Carcinoma in Situ

The recommended dose is 20 milligrams once daily for 5 years.

Breast Cancer Prevention

The recommended dose is 20 milligrams once a day for up to 5 years.

CHILDREN

Safety and efficacy in children have not been established.

Overdosage
Any medication taken in excess can have serious consequences. If you suspect an overdose of Nolvadex, seek medical attention immediately.