Nolvadex (Tamoxifen)

Take NOLVADEX exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Take this medication with a full glass (8 ounces) of water. NOLVADEX can be taken with or without food.

If you are taking NOLVADEX to reduce your risk of breast cancer, you may need to take your first dose while you are having a menstrual period. You may also need to have a pregnancy test before you start taking NOLVADEX, to make sure you are not pregnant. Follow your doctor's instructions.

Use NOLVADEX regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. You may need to keep using this medication for up to 5 years.

To make sure this medication is not causing harmful effects, your doctor may want you to have mammograms and to perform routine breast self-exams on a regular basis. Your liver function may also need to be tested. Visit your doctor regularly.

Store at room temperature away from moisture, heat, or cold. Do not freeze.

NOLVADEX Overdose

Seek emergency medical attention or call the Poison Help line.

Missed Dose of NOLVADEX

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double up to catch up.

NOLVADEX may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• Increased bone or tumor pain
• Pain or reddening around the tumor site
• Hot flashes
• Nausea
• Excessive tiredness
• Dizziness
• Depression or anxiety
• Headache
• Thinning of hair
• Weight loss or weight gain
• Irregular menses
• Vaginal dryness
• Edema
• Stomach cramps
• Constipation
• Loss of sexual desire or ability (in men)

Some side effects can be serious. If you experience any of the following symptoms, contact your doctor immediately, or call 911:

• Vision problems
• Loss of appetite
• Swelling and pain in calf
• Chest pain
• Coughing up blood
• Yellowing of the skin or eyes
• Unusual bruising or bleeding
• Fever
• Blisters
• Rash
• Swelling of the eyes, face, lips, tongue, throat, hands, arms, feet, ankles, or lower legs
• Wheezing or shortness of breath
• New breast masses
• Muscle weakness
• Restlessness

NOLVADEX may increase the risk that you will develop other cancers, including liver cancer and uterine cancer. It may also increase the risk that you will develop cataracts (clouding of the lens in the eye) that may need to be treated with surgery.

Talk to your doctor about these risks, and notify him if you have any unusual problems while taking this medication.

If you are taking NOLVADEX to reduce your risk of breast cancer, you may need to take your first dose during your menstrual period. You may also need to have a pregnancy test before you start taking NOLVADEX, to make sure you are not pregnant. Follow your doctor's instructions.

Taking NOLVADEX may increase your risk of uterine cancer, stroke, or a blood clot in the lung, which can be fatal. Talk with your doctor about your specific risks in taking this medication.

To make sure this medication is not causing harmful effects, your doctor may order a mammogram and perform breast exams on a regular basis. Your liver function may also need to be tested regularly.

Before taking NOLVADEX, you should:

• Tell your doctor and pharmacist about all medications you are taking (including over-the-counter drugs, prescription drugs, recreational drugs, and vitamins and herbal supplements).
• Talk to your doctor about the pros and cons of NOLVADEX and decide whether the possible benefits are worth the risks of taking the medication.

You should not use NOLVADEX if you are allergic to it, or if you have:

• A history of blood clots in your veins or your lungs
• If you are also taking a blood thinner such as warfarin (Coumadin)

To make sure you can safely take NOLVADEX, tell your doctor if you have any of these conditions:

• Liver disease
• High cholesterol or triglycerides (a type of fat in the blood)
• A history of stroke or blood clot
• A history of cataract
• If you are receiving chemotherapy or radiation

Pregnancy and NOLVADEX

Do not use NOLVADEX if you are pregnant. It could harm the unborn baby. Use a barrier form of birth control (such as a condom or diaphragm with spermicide) while you are using this medication and for at least two months after your treatment ends.

Hormonal contraception (such as birth control pills, injections, implants, skin patches, and vaginal rings) may not be effective enough to prevent pregnancy during your treatment.

It is not known whether NOLVADEX passes into breast milk or if it could harm a nursing baby. However, this medication may slow breast milk production. You should not breastfeed while taking NOLVADEX.

Many drugs can interact with NOLVADEX. Tell your doctor if you are using any of these medications:

• Bromocriptine (Parlodel)
• Cimetidine (Tagamet)
• Clozaril (Clozapine)
• Cyclophosphamide (Cytoxan)
• Isoniazid (Nydrazid) for treating tuberculosis
• Letrozole (Femara)
• Methimazole (Tapazole)
• Nicardipine (Cardene)
• Pioglitazone (Actos)
• Rifampin (Rifadin)
• Ropinirole (Requip)
• Ticlopidine (Ticlid)
• Tranylcypromine (Parnate)
• Anti-malaria medication such as chloroquine (Aralen), pyrimethamine (Daraprm), or quinine (Qualaquine)
• An antifungals such as terbinafine (Lamisil)
• An antidepressant such as bupropion (Wellbutrin), clomipramine (Anafranil), desipramine (Treyzafagit, Norpramin and Pertofrane), duloxetine (Cymbalta), fluoxetine (Prozac, Sarafem), imipramine (Tofranil), paroxetine (Paxil, Paxil CR, Pexeva), sertraline (Zoloft), or tranylcypromine (Parnate)
• A heart rhythm medication such as amiodarone (Cordarone) or quinidine (Quinidine)
• HIV or AIDS medicine such as delavirdine (Rescriptor) or ritonavir (Norvir)
• Medicine to treat psychiatric disorders (aripiprazole (Abilify), chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), perphenazine (Trilafon), or thioridazine (Mellaril)

This list is not complete and other drugs may interact with NOLVADEX. Tell your doctor about all medications you use. This includes prescription and over-the-counter (OTC) drugs, vitamin and herbal products, and recreational drugs. Do not start a new medication without telling your doctor.