Toremifene

What is Toremifene

Toremifene is an oral nonsteroidal antiestrogen for the treatment of metastatic breast cancer in postmenopausal women.

It is a derivative of tamoxifen, which is also an antiestrogen. Toremifene is as effective as tamoxifen in treating metastatic breast cancer;

cross-resistance has been suggested.

Toremifene may also have a more favorable effect on lipid levels than tamoxifen. In one study, toremifene increased high-density lipoprotein (HDL) cholesterol serum concentrations whereas tamoxifen decreased HDL cholesterol serum concentrations.

Toremifene has been associated with QT prolongation, and is contraindicated in patients with congenital/acquired QT prolongation (long QT syndrome), uncorrected hypokalemia, or uncorrected hypomagnesemia.

The most common adverse reactions are hot flashes, sweating, nausea and vaginal discharge.

Brand Name

Fareston

Indications

  • breast cancer

For the treatment of metastatic breast cancer in postmenopausal women with estrogen-receptor positive tumors or with tumors of unknown estrogen-receptor status

Side Effects

  1. alopecia
  2. angina
  3. anorexia
  4. arrhythmia exacerbation
  5. asthenia
  6. ataxia
  7. blurred vision
  8. cataracts
  9. constipation
  10. corneal opacification
  11. depression
  12. diaphoresis
  13. diplopia
  14. dizziness
  15. dyspnea
  16. edema
  17. elevated hepatic enzymes
  18. endometrial hyperplasia
  19. erythema
  20. fatigue
  21. heart failure
  22. hepatitis
  23. hot flashes
  24. hyperbilirubinemia
  25. hypercalcemia
  26. jaundice
  27. keratopathy
  28. lethargy
  29. leukopenia
  30. musculoskeletal pain
  31. myocardial infarction
  32. nausea
  33. paresis
  34. phlebitis
  35. pruritus
  36. pulmonary embolism
  37. QT prolongation
  38. skin discoloration
  39. stroke
  40. thrombocytopenia
  41. thrombosis
  42. tremor
  43. vaginal bleeding
  44. vaginal discharge
  45. vertigo
  46. visual impairment
  47. vomiting
  48. xerophthalmia

Monitoring Parameters

  • CBC
  • ECG
  • LFTs
  • serum calcium
  • serum magnesium
  • serum potassium

Contraindications

  • alcoholism
  • bradycardia
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • contraception requirements
  • coronary artery disease
  • diabetes mellitus
  • electrolyte imbalance
  • endometrial cancer
  • endometrial hyperplasia
  • females
  • geriatric
  • heart failure
  • hepatic disease
  • hepatitis
  • hepatotoxicity
  • hypercalcemia
  • hypertension
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • infertility
  • leukopenia
  • long QT syndrome
  • malnutrition
  • myocardial infarction
  • pregnancy
  • QT prolongation
  • reproductive risk
  • thrombocytopenia
  • thromboembolic disease
  • thyroid disease

Interactions

  • Aclidinium; Formoterol
  • Albuterol
  • Albuterol; Ipratropium
  • Alfuzosin
  • Amiodarone
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Anagrelide
  • Apalutamide
  • Apomorphine
  • Arformoterol
  • Aripiprazole
  • Arsenic Trioxide
  • Artemether; Lumefantrine
  • Asenapine
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atomoxetine
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azithromycin
  • Bedaquiline
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Budesonide; Formoterol
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Carbamazepine
  • Ceritinib
  • Chloramphenicol
  • Chloroquine
  • Chlorpromazine
  • Ciprofloxacin
  • Cisapride
  • Citalopram
  • Clarithromycin
  • Clofazimine
  • Clomipramine
  • Clozapine
  • Cobicistat
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Conivaptan
  • Conjugated Estrogens
  • Conjugated Estrogens; Bazedoxifene
  • Conjugated Estrogens; Medroxyprogesterone
  • Crizotinib
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Dasatinib
  • Degarelix
  • Delavirdine
  • Desipramine
  • Deutetrabenazine
  • Dexamethasone
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Diclofenac
  • Diclofenac; Misoprostol
  • Dienogest; Estradiol valerate
  • Diethylstilbestrol, DES
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Dolutegravir; Rilpivirine
  • Donepezil
  • Donepezil; Memantine
  • Doxepin
  • Dronabinol
  • Dronedarone
  • Droperidol
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elagolix; Estradiol; Norethindrone acetate
  • Eliglustat
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Encorafenib
  • Entrectinib
  • Enzalutamide
  • Eribulin
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Escitalopram
  • Esterified Estrogens
  • Esterified Estrogens; Methyltestosterone
  • Estradiol
  • Estradiol Cypionate; Medroxyprogesterone
  • Estradiol; Levonorgestrel
  • Estradiol; Norethindrone
  • Estradiol; Norgestimate
  • Estradiol; Progesterone
  • Estrogens
  • Estropipate
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Etravirine
  • Ezogabine
  • Fingolimod
  • Flecainide
  • Fluconazole
  • Fluoroestradiol F 18
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Fluvoxamine
  • Formoterol
  • Formoterol; Mometasone
  • Fosamprenavir
  • Foscarnet
  • Fosphenytoin
  • Gemifloxacin
  • Gemtuzumab Ozogamicin
  • Gilteritinib
  • Glasdegib
  • Glyburide
  • Glyburide; Metformin
  • Glycopyrrolate; Formoterol
  • Goserelin
  • Granisetron
  • grapefruit juice
  • Halogenated Anesthetics
  • Haloperidol
  • Histrelin
  • Hydroxychloroquine
  • Hydroxyzine
  • Ibutilide
  • Idelalisib
  • Iloperidone
  • Imipramine
  • Indacaterol
  • Indacaterol; Glycopyrrolate
  • Indinavir
  • Inotuzumab Ozogamicin
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Itraconazole
  • Ivosidenib
  • Ketoconazole
  • Lapatinib
  • Lefamulin
  • Lenvatinib
  • Letermovir
  • Leuprolide
  • Leuprolide; Norethindrone
  • Levalbuterol
  • Levofloxacin
  • Lithium
  • Lofexidine
  • Long-acting beta-agonists
  • Loperamide
  • Loperamide; Simethicone
  • Lopinavir; Ritonavir
  • Lumacaftor; Ivacaftor
  • Lumacaftor; Ivacaftor
  • Macimorelin
  • Maprotiline
  • Mefloquine
  • Meloxicam
  • Meperidine; Promethazine
  • Mephobarbital
  • Mestranol; Norethindrone
  • Metaproterenol
  • Methadone
  • Metronidazole
  • Midostaurin
  • Mifepristone
  • Mirtazapine
  • Mitotane
  • Moxifloxacin
  • Nateglinide
  • Nefazodone
  • Nelfinavir
  • Nilotinib
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Olodaterol
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole; Amoxicillin; Rifabutin
  • Ondansetron
  • Osilodrostat
  • Osimertinib
  • Ospemifene
  • Oxaliplatin
  • Ozanimod
  • Paliperidone
  • Panobinostat
  • Pasireotide
  • Pazopanib
  • Pentamidine
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenobarbital
  • Phenylephrine; Promethazine
  • Phenytoin
  • Pimavanserin
  • Pimozide
  • Pirbuterol
  • Pitolisant
  • Posaconazole
  • Primaquine
  • Primidone
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rilpivirine
  • Risperidone
  • Ritonavir
  • Romidepsin
  • Salmeterol
  • Saquinavir
  • Segesterone Acetate; Ethinyl Estradiol
  • Selpercatinib
  • Sertraline
  • Short-acting beta-agonists
  • Siponimod
  • Solifenacin
  • Sorafenib
  • Sotalol
  • St. John’s Wort, Hypericum perforatum
  • Sugammadex
  • Sunitinib
  • Tacrolimus
  • Tamoxifen
  • Telavancin
  • Telithromycin
  • Terbutaline
  • Tetrabenazine
  • Thiazide diuretics
  • Thioridazine
  • Tiotropium; Olodaterol
  • Tipranavir
  • Tolterodine
  • Torsemide
  • Trazodone
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimipramine
  • Triptorelin
  • Tucatinib
  • Umeclidinium; Vilanterol
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Voriconazole
  • Vorinostat
  • Warfarin
  • Ziprasidone
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