Toremifene Citrate

A to Z Drug Facts

Toremifene Citrate

	Actions
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(TORE-EM-ih-feen)

Fareston

Oral tablets

60 mg

Class: Antiestrogen hormone

Actions A nonsteroidal antiestrogen that blocks the growth-stimulating effects of estrogen in the tumor. Absorption is not influenced by food. It binds extensively (> 99.5%) to serum proteins. It is extensively metabolized, principally by CYP3A4. Elimination half-life is » 5 days.

Indications Metastatic breast cancer in postmenopausal women.

Contraindications Standard considerations.

Route/Dosage

Breast Cancer

ADULTS: PO 60 mg once daily with or without food.

Interactions

Anticonvulsants

May increase toremifene clearance by 2-fold.

CYP3A4

Toremifene may be altered by drugs that inhibit (eg, ketoconazole, itraconazole, macrolides) or induce (eg, phenobarbital, phenytoin, carbamazepine) this enzyme.

Thiazide diuretics

May cause hypercalcemia with agents that reduce renal excretion of calcium.

Warfarin

May increase the hypoprothrombinemic effect of warfarin.

Lab Test Interferences None well documented.

Adverse Reactions

CARDIOVASCULAR: Edema; pulmonary embolism; thrombophlebitis; thrombosis; cerebrovascular accident; transient ischemic attack; cardiac failure; MI. CNS: Dizziness. ENDOCRINE: Hot flashes; sweating. GI: Nausea and vomiting; elevated LFTs. GU: Vaginal discharge; vaginal bleeding; endometrial thickening. METABOLIC: Hypercalcemia. MUSCULOSKELETAL: Bone and tumor pain at initiation of therapy; soft tissue lesions can temporarily increase in size. SPECIALSENSES: Cataracts; dry eyes; abnormal visual fields; corneal keratopathy; glaucoma; abnormal vision; diplopia.

Precautions

Pregnancy: Category D. Lactation: Undetermined. Children: Safety and efficacy not established. Hypercalcemia and tumor flare: Drugs that decrease renal calcium excretion (eg, thiazide diuretics) may increase the risk of hypercalcemia in patients receiving toremifene. Hepatic dysfunction: Metabolized in the liver; dose reduction may be necessary in patients with liver disease. Thromboembolic disease: Caution in patients with thromboembolic diseases. Preexisting endometrial hyperplasia: Avoid long-term use.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Store at room temperature. Protect from heat and light.
Administer PO without regards to food.

Assessment/Interventions

Tumor flare and hypercalcemia may occur during the first few weeks of treatment. Monitor serum calcium concentrations periodically.
Monitor CBC and LFTs periodically during therapy.
Monitor leukocyte and platelet counts.

OVERDOSAGE: SIGNS & SYMPTOMS
	Vertigo, headache, dizziness, nausea, vomiting, reversible hallucinations, ataxia

Patient/Family Education

Instruct patient to contact the health care provider if vaginal bleeding occurs.
Inform patient with bone metastases of typical signs/symptoms of hypercalcemia. Contact the health care provider if such signs or symptoms occur.