Nomafen

Nomafen Uses, Dosage, Side Effects, Food Interaction and all others data.

Nomafen is a nonsteroidal agent that binds to estrogen receptors (ER), inducing a conformational change in the receptor. This results in a blockage or change in the expression of estrogen dependent genes. The prolonged binding of tamoxifen to the nuclear chromatin of these results in reduced DNA polymerase activity, impaired thymidine utilization, blockade of estradiol uptake, and decreased estrogen response. It is likely that tamoxifen interacts with other coactivators or corepressors in the tissue and binds with different estrogen receptors, ER-alpha or ER-beta, producing both estrogenic and antiestrogenic effects.

Nomafen is a selective estrogen receptor modulator that inhibits growth and promotes apoptosis in estrogen receptor positive tumors. It has a long duration of action as the active metabolite N-desmethyltamoxifen has a half life of approximately 2 weeks. It has a narrow therapeutic index as higher doses can lead to breathing difficulty or convulsions. Nomafen administration is also associated with an increased incidence of uterine malignancies.

Trade Name Nomafen
Availability Prescription only
Generic Tamoxifen
Tamoxifen Other Names Tamoxifen, Tamoxifène, Tamoxifene, Tamoxifeno, Tamoxifenum, trans-Tamoxifen
Related Drugs Supprelin LA, estradiol, anastrozole, letrozole, Premarin, testosterone, Lupron, Arimidex, megestrol, fluorouracil
Type
Formula C26H29NO
Weight Average: 371.5146
Monoisotopic: 371.224914555
Protein binding

The protein binding of tamoxifen in plasma is over 98% and mostly to serum albumin.

Groups Approved
Therapeutic Class Hormonal Chemotherapy
Manufacturer
Available Country Italy
Last Updated: September 19, 2023 at 7:00 am
Nomafen
Nomafen

Uses

Nomafen is used for the treatment of breast cancer.

Nomafen is a praparation of Nomafen which is a non-steroidal, triphenylene based drug and displays a complex spectrum of oestrogen antagonist and oestrogen agonist like pharmacological effects in different tissues. In breast cancer patients, at the tumour level, Nomafen acts primarily as an antioestrogen, preventing oestrogen binding to the oestrogen receptor. Additionally Nomafen has been reported to lead to maintenance of bone mineral density in post-menopausal women.

Nomafen is also used to associated treatment for these conditions: Breast Cancer, Desmoid Tumors, Endometrial Cancer, Gynecomastia, Invasive Breast Cancer, Invasive Breast Carcinoma, Metastatic Breast Cancer, Ovarian Cancer, Puberty, Precocious, Ovulation induction therapy

How Nomafen works

Nomafen competitively inhibits estrogen binding to its receptor, which is critical for it's activity in breast cancer cells. Nomafen leads to a decrease in tumor growth factor α and insulin-like growth factor 1, and an increase in sex hormone binding globulin. The increase in sex hormon binding globulin limits the amount of freely available estradiol. These changes reduce levels of factors that stimulate tumor growth.

Nomafen has also been shown to induce apoptosis in estrogen receptor positive cells. This action is thought to be the result of inhibition of protein kinase C, which prevents DNA synthesis. Alternate theories for the apoptotic effect of tamoxifen comes from the approximately 3 fold increase in intracellular and mitochondrial calcium ion levels after administration or the induction of tumor growth factor β.

Dosage

Nomafen dosage

Adults (including elderly): The dosage range is 20 to 40 mg daily, given either in divided doses twice daily or as a single dose once daily.

Side Effects

Side effects can be classified as either due to the pharmacological action of the drug, e.g., hot flushes, vaginal bleeding, vaginal discharge, pruritus vulvae and tumour flare or as more general side effects, e.g., gastrointestinal intolerance, headache, light-headedness and occasionally fluid retention and alopecia. When such side effects are severe, it may be possible to control them by a simple reduction of dosage (within the recommended dose range) without loss of control of the disease.

Skin rashes including isolated reports of erythema multiforme, Stevens Johnson syndrome and bullous pemphigoid and rare hypersensitivity reactions, including angio-oedema have been reported. A small number of patients with bony metastases have developed hypercalcaemia on initiation of therapy.

Falls in platelet count, usually only to 80,000-90,000 per/mm3 but occasionally lower, have been reported in patients taking Nomafen for breast cancer.

A number of cases of visual disturbances including infrequent reports of corneal changes and retinopathy have been described in patients receiving Nomafen therapy. An increased incidence of cataracts has been reported in association with the administration of the drug. Uterine fibroids and endometrial changes including hyperplasia and polyps have been reported. Cystic ovarian swellings have occasionally been observed in premenopausal women receiving Nomafen.

Leucopenia has been observed following the administration of Nomafen, sometimes in association with anaemia and/or thrombocytopenia. Neutropenia has been reported on rare occasions; this can sometimes be severe. There is evidence of an increased incidence of thromboembolic events including deep vein thrombosis and pulmonary embolism during Nomafen therapy.

Nomafen has been associated with changes in liver enzyme levels and on rare occasions with a spectrum of more severe liver abnormalities, including fatty liver, cholestasis and hepatitis. Rarely, elevation of serum triglyceride levels, in some cases with pancreatitis, may be associated with the use of Nomafen.

Toxicity

High doses of tamoxifen in animals lead to respiratory difficulty and convulsions. High doses in advanced metastatic cancer patients resulted in acute neurotoxicity seen by tremor, hyperreflexia, unsteady gait, and dizziness. Patients experiencing and overdose should be given supportive treatment as no specific treatment for overdose is suggested.

Precaution

Menstruation is suppressed in a proportion of premenopausal women receiving Nomafen for the treatment of breast cancer. An increased incidence of endometrial cancer has seen reported in association with Nomafen treatment. The underlying mechanism is unknown, but may be related to the oestrogen-like effect of Nomafen. Any patients receiving or having previously received Nomafen, who report abnormal gynaecological symptoms, especially vaginal bleeding, should be promptly investigated.

A number of second primary tumors, occurring at sites other than the endometrium and the opposite breast, have been reported in clinical trials, following the treatment of breast cancer patients with Nomafen. No causal link has been established and the clinical significance of these observations remains unclear.

Interaction

When Nomafen is used in combination with coumarin type anticoagulants, a significant increase in anticoagulant effect may occur. Where such co administration is initiated, careful monitoring of the patient is recommended. When Nomafen is used in combination with cytotoxic agents, there is an increased risk of thromboembolic events.

Food Interaction

  • Exercise caution with St. John's Wort. This herb induces CYP3A4 metabolism, which may reduce the serum concentration of tamoxifen.
  • Take with a full glass of water.
  • Take with or without food.

[Moderate] GENERALLY AVOID: Due to their estrogenic effect, isoflavones present in soy such as genistein and daidzein may stimulate breast tumor growth and antagonize the antiproliferative action of tamoxifen.

Supportive data are derived primarily from in vitro and animal studies.

In vitro, low concentrations of these phytoestrogens have been found to promote DNA synthesis and reverse the inhibitory effect of tamoxifen on estrogen-dependent breast cancer cell proliferation.

In contrast, high concentrations of genistein greater than 10 microM

It is not known if these high concentrations are normally achieved in humans.

Plasma concentrations below 4 microM

These concentrations are comparable to the low plasma concentrations associated with tumor stimulation reported in animals.

In a study of 155 female breast cancer survivors with substantially bothersome hot flashes, a product containing 50 mg of soy isoflavones (40% to 45% genistein; 40% to 45% daidzein; 10% to 20% glycitein) taken three times a day was found to be no more effective than placebo in reducing hot flashes.

No toxicity or recurrence of breast cancer was reported during the 9-week study period.

Green tea does not appear to have significant effects on the pharmacokinetics of tamoxifen or its primary active metabolite, endoxifen.

In a study consisting of 14 patients who have been receiving tamoxifen treatment at a stable dose of 20 mg (n=13) or 40 mg (n=1) once daily for at least 3 months, coadministration with green tea supplements twice daily for 14 days resulted in no significant differences in the pharmacokinetics of either tamoxifen or endoxifen with respect to peak plasma concentration (Cmax), systemic exposure (AUC), and trough plasma concentration (Cmin) compared to administration of tamoxifen alone.

The combination was well tolerated, with all reported adverse events categorized as mild (grade 1) and none categorized as serious or severe (grade 3 or higher) during the entire study.

Although some adverse events such as headache, polyuria, gastrointestinal side effects (e.g., constipation, dyspepsia), and minor liver biochemical disturbances were reported more often during concomitant treatment with green tea, most can be attributed to the high dose of green tea used or to the caffeine in green tea.

The green tea supplements used were 1000 mg in strength and contained 150 mg of epigallocatechin-3-gallate (EGCG), the most abundant and biologically active catechin in green tea.

According to the investigators, the total daily dose of EGCG taken by study participants is equivalent to the amount contained in approximately 5 to 6 cups of regular green tea.

However, it is not known to what extent the data from this study may be applicable to other preparations of green tea such as infusions, since the bioavailability of EGCG and other catechins may vary between preparations.

MANAGEMENT: Until more information is available, patients treated with tamoxifen may consider avoiding or limiting the consumption of soy-containing products.

Consumption of green tea and green tea extracts during tamoxifen therapy appears to be safe.

Volume of Distribution

The volume of distribution of tamoxifen is approximately 50-60L/kg.

Elimination Route

An oral dose of 20mg reaches a Cmax of 40ng/mL with a Tmax of 5 hours. The metabolite N-desmethyltamoxifen reaches a Cmax of 15ng/mL. 10mg of tamoxifen orally twice daily for 3 months results in a Css of 120ng/mL and a Css of 336ng/mL.

Half Life

The terminal elimination half-life of tamoxifen is 5 to 7 days, while the half-life of N-desmethyltamoxifen, the primary circulating metabolite, is approximately 14 days.

Clearance

The clearance of tamoxifen was 189mL/min in a study of six postmenopausal women.

Elimination Route

Nomafen is mainly eliminated in the feces. Animal studies have shown 75% of radiolabelled tamoxifen recovered in the feces, with negligible collection from urine. However, 1 human study showed 26.7% recovery in the urine and 24.7% in the feces.

Pregnancy & Breastfeeding use

Pregnancy: Nomafen must not be administered during pregnancy. There have been a small number of reports of spontaneous abortions, birth defects and foetal deaths after women have taken Nomafen, although no causal relationship has been established. Reproductive toxicology studies in rats, rabbits and monkeys have shown no teratogenic potential.

Women should be advised not to become pregnant whilst taking Nomafen and should use barrier or other nonhormonal contraceptive methods if sexually active. Premenopausal patients must be carefully examined before treatment to exclude pregnancy. Women should be informed of the potential risks to the foetus, if they want to become pregnant whilst taking Nomafen or within two months of cessation of therapy.

Lactation: It is not known if Nomafen is excreted in human milk and therefore the drug is not recommended during lactation. The decision to discontinue Nomafen should take into account in case of the importance of the drug to the lactating mother.

Contraindication

Nomafen must not be administered during pregnancy. Nomafen should not be given to patients who have experienced hypersensitivity to the product or any of its ingredients.

Storage Condition

Store between 20-25° C. Protect from light.

Innovators Monograph

You find simplified version here Nomafen

Nomafen contains Tamoxifen see full prescribing information from innovator Nomafen Monograph, Nomafen MSDS, Nomafen FDA label

FAQ

What is Nomafen used for?

Nomafen used to treat hormone receptor-positive breast cancer. It can greatly reduce the risk of cancer recurrence and invasive cancer.

How does Nomafen do to the body?

Nomafen attaches to the hormone receptors in the cancer cell, blocking estrogen from attaching to the receptors. This slows or stops the growth of the tumor by preventing the cancer cells from getting the hormones they need to grow.

What cancer does Nomafen treat?

Nomafen can be used to treat women with breast cancer who have or have not gone through menopause. It can be used in several ways: In women at high risk of breast cancer,Nomafen can be used to help lower the risk of developing breast cancer.

What are the side effects of Nomafen?

Common side effects of Nomafen include:

  • Menopause-like symptoms, including hot flashes, night sweats and vaginal dryness.
  • Weight gain (more common) or fluid retention (edema).
  • Irregular or loss of menstrual periods.
  • Leg swelling.
  • Nausea.
  • Vaginal discharge.
  • Skin rash.
  • Erectile dysfunction .
  • Fatigue.
  • Headaches.



How long should I take Nomafen?

Most people take Nomafen or other hormone therapy for at least five years and sometimes up to 10 years. Treatment length depends on the features of your cancer diagnosis.

How do take I Nomafen?

You must take Nomafen daily by mouth, preferably at the same time each day.

Is it safe to take Nomafen during pregnancy?

Nomafen may cause birth defects. You shouldn’t take the medication if you’re pregnant or planning to become pregnant. To prevent pregnancy, talk to your healthcare provider about nonhormonal birth control options.

Is Nomafen safe during breasfeeding?

Nomafen and its active metabolites are detectable in milk and accumulate in milk over time. It can also suppress lactation. If a mother requires treatment with Nomafen, breastfeeding should be avoided.

Can I drink alcohol while taking Nomafen?

Alcohol can raise the risk of side effects with Nomafen, some of which can be serious. Alcohol makes it harder for Nomafen to work properly and should be limited or avoided while you're taking this medication. Alcohol can raise your risk of developing breast cancer.

How does Nomafen make me feel?

Some people go through mood swings or feel low or depressed while they are taking Nomafen. Or it may be harder to think clearly or concentrate.

Is Nomafen really necessary?

Nomafen is a highly effective breast cancer treatment. It may significantly lower your risk of breast cancer recurrence or invasive breast cancer. People who are at high risk for breast cancer may take Nomafen to reduce their chances of getting the disease.

Does Nomafen lower my immune system?

Taking hormone therapy does not affect your immune system.

Does Nomafen cause I to gain weight?

Nomafen has been loosely associated with weight gain. Studies have tracked weight gain and other side effects of the drug for years. Some resources even list weight gain as a possible side effect.

Can Nomafen raise blood pressure?

There was no effect of Nomafen on clinic BP.

Does Nomafen cause hair loss?

No one goes bald from Nomafen but some people do experience thinning hair. Like hair thinning, a lowered libido is common postmenopause and in the setting of reduce estrogen.

Is Nomafen an anti inflammatory?

Results suggest that the mechanism of action of Nomafen administration is to modulate anti-oxidant, anti-inflammatory and anti-gliotic responses.

Is Nomafen an anti inflammatory?

Results suggest that the mechanism of action of Nomafen administration is to modulate anti-oxidant, anti-inflammatory and anti-gliotic responses.

Does Nomafen make me tired?

When you start to take Nomafen, you may feel tired, drowsy, or feel like you have no energy.

Can Nomafen cause memory loss?

memory loss and concentration issues brought on by use of Nomafen or aromatase inhibitors.

Does Nomafen affect mood?

Nomafen does not affect mood or sexual functioning.

Can Nomafen cause anxiety?

Clinical evidence suggests the drug increases rates of anxiety and the incidence of hot flashes, both of which may result from reduced action of estrogen.

Can Nomafen cause hip pain?

The terrible groin and hip pain is pretty clearly a side effect of the Nomafen.

Is Nomafen good for my bones?

Taking Nomafen slows down bone loss and can reduce the risk of osteoporosis.

Does Nomafen make me itchy?

Dry, itchy skin is a common side effect of Nomafen.

Is it better to take Nomafen at night or morning?

Nomafen may be taken at any time of the day but should be taken at the same time each day. it is within 12 hours of the missed dose.

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