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Paroxetine Approval

Mahon, Suzanne M. DNSc, RN, AOCN, APNG; Kaplan, Marcelle MS, RN, AOCN, CBCN

AJN The American Journal of Nursing: January 2014 - Volume 114 - Issue 1 - p 10
doi: 10.1097/01.NAJ.0000441774.81603.dd

Suzanne M. Mahon, DNSc, RN, AOCN, APNG

St. Louis

Marcelle Kaplan, MS, RN, AOCN, CBCN

Merrick, NY

We would like to thank Diane S. Aschenbrenner for her detailed discussion of the unexpected FDA approval of paroxetine as the first nonhormonal drug treatment for postmenopausal hot flashes (Drug Watch, October 2013). This is good news, as there's an overwhelming need for safe and effective nonhormonal therapies. Yet, a large subgroup of women likely to experience hot flashes—those taking tamoxifen for the prevention or treatment of breast cancer—won't be able to take advantage of this new treatment option.

Paroxetine is not recommended in individuals taking tamoxifen because it interferes with the activation of tamoxifen's active agent. When used concomitantly with tamoxifen, paroxetine has been associated with an increase in breast cancer–related deaths.1 Paroxetine's label contains a warning that its use may reduce the effectiveness of tamoxifen, and current oncology guidelines advise caution when coadministering these drugs.2

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1. Kelly CM, et al. Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study BMJ. 2010;340:c693
2. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: breast cancer version 3.2013. Fort Washington, PA; 2013.
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