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Beberapa Cara Memainkan Blackjack Online

Beberapa Cara Memainkan Blackjack Online – Blackjack yaitu suatu yang kerap dianggap dengan kasino. Mereka barangkali mengingat adegan classic seperti adegan kalkulasi kartu di Rain Man. Akan tetapi untuk mereka yang tak bisa pergi ke Atlantic City atau Las Vegas Anda bisa melaksanakan ini dalam kenyamanan rumah Anda sendiri main Situs bandarqq.

Di permukaan nampaknya game Situs IdnPoker bisa dipercaya yang relatif simple. Idenya ialah untuk memukul 21 memanfaatkan kartu sesedikit barangkali, dengan maksud permainan ialah untuk menundukkan rumah.

Dealer setelah itu bakal berusaha untuk menundukkan score Anda. Apabila ada yang berumur di atas 21 tahun, mereka kolaps serta kalah.

Mulainya Anda dikasihkan dua kartu, dengan kartu bergambar berharga 10 serta kartu As baik tinggi atau rendah. Ini bisa berganti terkait pada peraturan permainan, jadi yakinkan Anda periksa ini sebelum mendaftarkan. Idenya ialah untuk coba serta menundukkan rumah yang bakal coba serta mendapat nomor yang lebih bagus ketimbang Anda.

Ini yaitu permainan kiat. Baca bagaimana permainan berubah buat menyaksikan kapan bikin taruhan yang pas. Dalam sejumlah perkara ini bisa dibuktikan sukar.

Umpamanya, apabila Anda punya 17 karenanya terhasut buat cari kartu lain buat coba serta menghimpit 21. Akan tetapi barangkali lebih bagus untuk terus serta menyaksikan apa musuh Anda kolaps berusaha untuk membandingkan Anda.

Tips kiat bisa mendukung Anda namun pengalaman kerapkali sangat mungkin Anda buat bikin ketentuan yang lebih instingtif.

Singkat kata seperti pelayanan yang lain, Anda mesti menyaksikan permainan blackjack online apa yang tawarkan nilai terhebat buat taruhan Anda. Ada operan balik konsumen serta review situs website yang bisa tunjukkan terhadap Anda game terhebat. Anda pun penting periksa video demo online buat mengilustrasikan bagaimana permainan diputar buat menyaksikan apa itu pas buat Anda.

Bersenang-senang Berjudi Online Tanpa Batas

Bersenang-senang Berjudi Online Tanpa Batas – Taruhan, disaat diselesaikan dengan salah, barangkali begitu beresiko. Akan tetapi ada sejumlah kiat yang menarik buat berjudi serta tak kecanduan.

Anda menyaksikan selebriti idola Anda di tv main dengan poker. Kadangkala, yang terbaik dari itu yaitu kalau uang yang mereka menangi yaitu punya tubuh amal. Taruhan mungkin saja menghibur serta ketika yang sama berfaedah. Jadi, berikut ini sejumlah usul terkait trik terhebat buat membuahkan pengalaman main game yang membahagiakan.

Kasino kebanyakan yaitu pemberhentian Anda. Kasino punya pelbagai kesempatan babak buat hampir keseluruhan orang. Mesin slot sungguh-sungguh membahagiakan buat mengawali. Disinilah gulungan terkadang bergerak disaat tombol didesak atau kadangkala tuas dimanfaatkan. Kebanyakan kasino punya ini lantaran termasuk lebih dari 50% fasilitasnya. Yang sebaiknya Anda melakukan yaitu masukkan koin serta mengakibatkan tombol tuas. Apabila Anda punya ikon yang sama persis atau paduan ikon, Anda langsung jadi pemenang permainan. Ini begitu simple. Seusai semua, buat sungguh-sungguh nikmati pengembaraan game Anda, Anda mesti mengawali dari yang lebih kecil. Tak usah memakan kebanyakan.

Poker serta black jack akan juga berubah menjadi kompetisi yang dapat Anda mainkan waktu bertaruh di casinogame internet. Ini mungkin saja kalau-kalau akalmu turut main. Walaupun masih sebagai permainan Agen BandarQ kebetulan, Anda besar kemungkinan bakal memakai kepala Anda waktu nikmati besar kemungkinan bakal memahami awal mulanya apabila Anda kehilangan atau menang berat. Itu berubah menjadi pengalaman menakjubkan apabila Anda menang. Waktu Anda terasa tengah turunkan berat tubuh, berikut ini waktu yang pas buat menyambung.

Buat menaikkan pengalaman membahagiakan seusai berjudi, sertakan kawan Anda. Minuman berbasiskan alkohol ketika yang sama. Ini bebaskan kondisi hati Anda buat bertaruh. Waspadalah tidak untuk minum kebanyakan lantaran Anda akan tidak punya kapabilitas buat stop main game apabila minuman keras bikin Anda dongkol.

Apabila Anda lebih sukai melaksanakannya dengan aman serta sehat, karenanya main game di internet begitu sesuai. Semestinya ada sebagian kecil kesempatan judi online yang dapat Anda memakai. Pastinya ada perjudian dengan uang tunai. Namun Anda barangkali mau akan memutuskan buat coba suatu yang tak libatkan uang tunai betul-betul. Anda bahkan juga bakal menemukannya permainan yang dapat Anda mainkan seperti korek api poker dimana Anda bisa main dengan laptop dikurangi perjudiannya. Dengan langkah berikut, Anda mempertaruhkan uang pc jadi substitusi kartu credit. Itu bertambah membahagiakan diakhir Anda sendiri lantaran Anda miliki waktu tiada akhir buat main serta tak ada yang dapat di hilangkan. Anda cuma bisa menyambung serta mulai lagi serta terus bertaruh atau main dengan. Ini yaitu keadaan win win.

Suka ria atas hasilnya yaitu apa yang wajib Anda lakoni. Itu pemicunya banyak pria serta wanita pergi ke kasino buat bertaruh. Itu yaitu dashboard yang mempertahankannya menyenangkan. Walau begitu, Anda mesti meyakinkan tidak untuk terlalu berlebih melaksanakannya. Sisi dari hiburan ini yaitu mendalami kapan mesti stop.

Jadi, ingat kalau bertaruh barangkali kesenangan. Anda cuma mesti sadar serta mendalami batasan Anda sendiri. Anda mesti cari tahu kapan mesti menyambung serta menyambung ke rumah. Kehilangan dana yaitu sisi dari permainan namun perlu diingat buat bertaruh cuma sebagian kecil modal. Anda tak usah membahayakan seluruhnya dengan privat demikian Anda minum sedikit setiap waktu Anda sukses. Jangan dibiarkan judi ambil alih akal sehat Anda. Jadi pilihan, diamkan itu berubah menjadi pengalaman yang begitu menarik.

Tips Dari Para Ahli Dalam Sebuah Buku Yang Layak Dibaca

heheSaat Anda betul-betul harus jadi pro dalam poker online atau serta poker riil di dalam rumah, hal paling baik yang bisa menolong Anda ialah membaca info penting yang hadir dari buku-buku poker. Mereka kemungkinan pada akhirnya jadi cukup mahal, tapi yang perlu ialah mereka ialah sumber bukti serta tehnik yang paling efisien yang akan Anda peroleh kapan juga di dalam bermain poker online dengan cara aktif.

Buku-buku poker ini sangat mungkin bandar poker Anda untuk bukan hanya menghormati permainan online lebih bagus dan juga sangat mungkin Anda untuk tahu aplikasi yang dipakai dalam permainan, sudut pandang beberapa pemain setiap saat mereka bermain poker serta apa yang perlu Anda lihat setiap waktu pada beberapa pemain poker itu. Pelajari pemikiran musuh Anda akan menolong Anda jadi sukses dengan bertambah banyak game.

Tidaklah heran jika sebab pernyataan permainan ini, banyak buku poker dicatat serta banyak yang dicatat tiap hari. Meski begitu, itu ialah pilihan Anda untuk memperoleh yang disenangi dengan mencari kesaksian buku yang dicatat oleh guru serta spesialis benar-benaran. Mereka kemungkinan mahal, tapi mereka memberi Anda perincian valid, dibanding beberapa yang tambah murah.

Dengan service buku-buku ini, gampang untuk bermain poker Holdem online lebih baik. Itu bermakna Anda bisa membuahkan uang dari kenyamanan rumah Anda. Anda tak perlu mengecek kasino online untuk bertaruh hingga Anda mempunyai banyak keuntungan privacy pribadi serta kenyamanan di ujung jari Anda.

Rekam jejak poker dapat dihubungkan dengan buku-buku poker ini sebab mereka sudah menolong beberapa orang untuk tahu mengenai nuansa yang lebih bagus dari permainan ini, serta mereka saat ini berperan serta dalam permainan dengan keyakinan diri yang semakin lebih baik dibanding di waktu dulu. Internet mempunyai situs situs online yang tidak terhitung banyaknya yang memberi banyak bukti bermanfaat mengenai permainan pada pengunjung situs.

Walau ada perbincangan terus-terusan mengenai buku mana yang bisa dipandang seperti buku paling baik, serta banyak nama disebut, tidak disangsikan jika banyak yang mengaku peranan yang dilaksanakan oleh buku-buku ini dalam jadikan mereka pemain poker online yang lebih bagus dalam permainan.

Saat ini, Bila Anda betul-betul ingin jadi pro di bagian bermain poker, pilihan paling baik yang akan Anda peroleh umumnya dengan pelajari serta memperoleh akses ke info yang hadir dari buku-buku poker ini. Mereka kemungkinan entahlah bagaimana mahal tapi yang perlu ialah jika mereka ialah pilihan baik panduan yang dapat Anda peroleh saat hadir untuk nikmati poker.

Startegi Poker Untuk Melihat Bluff

heheTidakkah kita berada di sana? Kami duduk di belakang pemain yang terus menyapu pot kiri serta kanan. Sesudah pasangan pertama-tama Anda berpikir, “WOW, orang ini tentu benar-benar baik! ” Sesudah beberapa pot menang, Anda berpikir, “Ya ampun, orang ini tentu tangkap beberapa kartu pembunuh malam hari ini. ” Sesudah ini bersambung untuk sesaat waktu Anda berpikir, “Oke, ini jadi konyol ! ! Orang ini tetap mengusung kerai saya. Ada yang perlu dibenahi. Apa saya digertak di sini? ” Yah, Anda kemungkinan benar! Berikut lima panduan untuk mengendus gertakan pada malam poker Anda selanjutnya.

Strategi # 1 – Bahasa Badan

Berkonsentrasilah SahabatQQ pada bahasa badan musuh Anda. Apa yang mereka kerjakan sesudah mereka bertaruh atau tingkatkan. Kita pernah dengar pepatah, “Orang yang melakukan tindakan lemah serta benar-benar kuat serta orang yang melakukan tindakan kuat betul-betul lemah. ” Coba lihat beberapa hal halus yang dilaksanakan orang itu. Apa mereka bertaruh dan memandang Anda. Lemah. Apa mereka bertaruh dan duduk kembali lagi di bangku mereka. Kuat.

Strategi # 2 – Kisah taruhan

Ingat sebanyak-banyaknya mengenai kisah taruhan musuh. Info ini bisa jadi komponen kunci dalam tangkap bluffer. Apa musuh tetap mengusung saat orang khusus buta besar, pada intinya coba menggertak orang ini? Apa musuh Anda tingkatkan setiap saat mereka mempunyai kartu as, tidak perduli apa kartu ke-2? Bagaimana orang ini bertaruh dengan pasangan saku mereka? Apa mereka coba memaksakan orang untuk melipat saat mereka seimbang?

Strategi # 3 – Penyidikan untuk Info

Panduan ini memerlukan waktu untuk prima. Anda kemungkinan seringkali menyaksikannya di TV. Satu pemain mengusung lainnya dan investigasi diawali. “Jadi, apa yang kamu punya disana, sahabat? Kamu punyai raja? Kamu tidak mengusung pra tidak berhasil jadi saya sangsi. Apa yang kamu peroleh dari ratu raja, suatu hal semacam itu? ” Seorang veteran tahu tidak untuk menjelaskan sepatah kata juga sebab serta dalam usaha untuk lemparkan musuh, suatu hal yang tidak menyengaja bisa memberikan panduan musuh jika kemungkinan ada banyak gertakan yang berlangsung. Jadi tanyakanlah sebanyak-banyaknya pertanyaan. Coba untuk memperoleh info mengenai permainan musuh Anda lewat bahasa badan atau serta suara dalam suaranya. Anda kemungkinan kaget jika musuh Anda bisa memberi info penting serta bila mereka tidak menjelaskan sepatah kata juga.

Strategi # 4 – Bayar untuk Lihat Tangan

Di dunia info poker ialah kuncinya. Sesekali bila Anda berasa seperti dihamburkan uang Anda, bayarlah untuk lihat tangan bluffers. Ini kemungkinan susah dilaksanakan bila Anda betul-betul ingin menaklukkan, tapi selanjutnya itu tentu sebanding. Sesudah kartu dibalik, Anda harus ingat bagaimana semua tangan dimainkan. “Oke, saya kembali lagi naik pra tidak berhasil, kembali lagi naik di sungai, tikungan dicheck serta sungai dicheck. Tetapi kau punyai Q9 offsuit! ” Info ini kemungkinan menolong Anda di step akhir permainan.

Panduan # 5 – Catch’em on Tilt

Seorang pemain “saat dimiringkan” bermakna mereka memperoleh ketukan yang benar-benar jelek di tangan awalnya serta mereka kelihatan terguncang serta benar-benar geram. Umumnya pemain ini akan mainkan apapun yang dimainkan selanjutnya, tentunya dengan fakta, serta umumnya mainkan tangan ini di luar kendali. Bila Anda tangkap pemain waktu mereka miring umumnya Anda bisa tangkap mereka menggertak.

Bila Anda ikuti lima panduan simpel ini serta Anda akan ada di jalan yang pas untuk temukan bluffer di laga kandang selanjutnya.

Side effects

report in September 2009 from Health and Human Services’ Agency for Healthcare Research and Quality suggests that tamoxifen, raloxifene, and tibolone used to treat breast cancer significantly reduce invasive breast cancer in midlife and older women, but also increase the risk of adverse side effects.[35]

Some cases of lower-limb lymphedema have been associated with the use of tamoxifen, due to the blood clots and deep vein thrombosis (DVT) that can be caused by this medication. Resolution of the blood clots or DVT is needed before lymphedema treatment can be initiated.

Bone[edit]

A beneficial side effect of tamoxifen is that it prevents bone loss by acting as an ER agonist (i.e., mimicking the effects of estrogen) in this cell type. Therefore, by inhibiting osteoclasts, it prevents osteoporosis.[36][37] When tamoxifen was launched as a drug, it was thought that tamoxifen would act as an ER antagonist in all tissue, including bone, and therefore it was feared that it would contribute to osteoporosis. It was therefore very surprising that the opposite effect was observed clinically. Hence tamoxifen’s tissue selective action directly led to the formulation of the concept of SERMs.[38] In contrast tamoxifen appears to be associated with bone loss in premenopausal women who continue to menstruate after adjuvant chemotherapy.[39]

Endometrial cancer[edit]

Tamoxifen is a SERM.[40] Even though it is an antagonist in breast tissue it acts as partial agonist on the endometrium and has been linked to endometrial cancer in some women. Therefore, endometrial changes, including cancer, are among tamoxifen’s side effects.[41] With time, risk of endometrial cancer may be doubled to quadrupled, which is a reason tamoxifen is typically only used for five years.[42]

The American Cancer Society lists tamoxifen as a known carcinogen, stating that it increases the risk of some types of uterine cancer while lowering the risk of breast cancer recurrence.[43] The ACS states that its use should not be avoided in cases where the risk of breast cancer recurrence without the drug is higher than the risk of developing uterine cancer with the drug.

Cardiovascular and metabolic[edit]

Tamoxifen treatment of postmenopausal women is associated with beneficial effects on serum lipid profiles. However, long-term data from clinical trials have failed to demonstrate a cardioprotective effect.[44] For some women, tamoxifen can cause a rapid increase in triglyceride concentration in the blood. In addition, there is an increased risk of thromboembolism especially during and immediately after major surgery or periods of immobility.[45] Use of tamoxifen has been shown to slightly increase risk of deep vein thrombosispulmonary embolism, and stroke.[46] Tamoxifen is also a cause of fatty liver, otherwise known as steatorrhoeic hepatosis or steatosis hepatis.[47]

Central nervous system[edit]

Tamoxifen-treated breast cancer patients show evidence of reduced cognition,[48] and semantic memory scores.[49] However, memory impairment in patients treated with tamoxifen was less severe compared with those treated with anastrozole (an aromatase inhibitor).[50]

A significant number of tamoxifen-treated breast cancer patients experience a reduction of libido.[51][52]

Liver toxicity[edit]

Tamoxifen has been associated with a number of cases of hepatotoxicity.[53] Several different varieties of hepatotoxicity have been reported.[53]

Weight gain[edit]

Weight gain is a commonly reported side effect,[54] but studies have not been able to find significant evidence of a correlation.[55]

Overdose[edit]

Acute overdose of tamoxifen has not been reported in humans.[4] In dose-ranging studies, tamoxifen was administered at very high doses in women (e.g., 300 mg/m2) and was found to produce acute neurotoxicity including tremorhyperreflexiaunsteady gait, and dizziness.[4] These symptoms occurred within three to five days of therapy and disappeared within two to five days of discontinuation of therapy.[4] No indications of permanent neurotoxicity were observed.[4] QT prolongation was also observed with very high doses of tamoxifen.[4] There is no specific antidote for overdose of tamoxifen.[4] Instead, treatment should be based on symptoms.[4]

Interactions[edit]

Patients with variant forms of the gene CYP2D6 (also called simply 2D6) may not receive full benefit from tamoxifen because of too slow metabolism of the tamoxifen prodrug into its active metabolites.[56][57] On 18 October 2006, the Subcommittee for Clinical Pharmacology recommended relabeling tamoxifen to include information about this gene in the package insert.[58]

Certain CYP2D6 variations in breast cancer patients lead to a worse clinical outcome for tamoxifen treatment.[59] Genotyping therefore has the potential for identification of women who have these CYP2D6 phenotypes and for whom the use of tamoxifen is associated with poor outcomes.

Recent studies suggest that taking the selective serotonin reuptake inhibitors (SSRIs) antidepressants paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft) can decrease the effectiveness of tamoxifen, as these drugs compete for the CYP2D6 enzyme which is needed to metabolize tamoxifen into its active forms.[60] A U.S. study presented at the American Society of Clinical Oncology’s annual meeting in 2009 found that after two years, 7.5% of women who took only tamoxifen had a recurrence, compared with 16% who took either paroxetine, fluoxetine or sertraline, drugs considered to be the most potent CYP2D6 inhibitors. That difference translates to a 120% increase in the risk of breast cancer recurrence. Patients taking the SSRIs; Celexa (citalopram), Lexapro (escitalopram), and Luvox (fluvoxamine), did not have an increased risk of recurrence, due to their lack of competitive metabolism for the CYP2D6 enzyme.[61] A newer study demonstrated a clearer and stronger effect from paroxetine in causing the worst outcomes. Patients treated with both paroxetine and tamoxifen have a 67% increased risk of death from breast cancer, from 24% to 91%, depending on the duration of coadministration.[62]

Recent research has shown that 7–10% of women with breast cancer may not receive the full medical benefit from taking tamoxifen due to their genetic make-up. DNA Drug Safety Testing can examine DNA variations in the CYP2D6 and other important drug processing pathways. More than 20% of all clinically used medications are metabolized by CYP2D6 and knowing the CYP2D6 status of a person can help the doctor with the future selection of medications.[63] Other molecular biomarkers may also be used to select appropriate patients likely to benefit from tamoxifen.[64]

Tamoxifen interacts with certain other antiestrogens.[3] The aromatase inhibitor aminoglutethimide induces the metabolism of tamoxifen.[3] Conversely, the aromatase inhibitor letrozole does not affect the metabolism of tamoxifen.[3] However, tamoxifen induces the metabolism of letrozole and significantly reduces its concentrations.[3]

Infertility

Tamoxifen is used for ovulation induction to treat infertility in women with anovulatory disorders. It is given at days three to seven of a woman’s cycle.[24]

Tamoxifen improves fertility in males with infertility by disinhibiting the hypothalamic–pituitary–gonadal axis (HPG axis) via ER antagonism and thereby increasing the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and increasing testicular testosterone production.[25]

Gynecomastia[edit]

Tamoxifen is used to prevent and treat gynecomastia.[26][27] It is taken as a preventative measure in small doses, or used at the onset of any symptoms such as nipple soreness or sensitivity. Other medications are taken for similar purposes such as clomifene and the anti-aromatase drugs which are used in order to try to avoid the hormone-related adverse effects.

Tamoxifen doses and rates of bicalutamide-induced breast symptoms in men 

Early puberty[edit]

Tamoxifen is useful in the treatment of peripheral precocious puberty, for instance due to McCune–Albright syndrome, in both girls and boys.[30][31][32] It has been found to decrease growth velocity and the rate of bone maturation in girls with precocious puberty, and hence to improve final height in these individuals.[30][31]

Available forms[edit]

Nolvadex (tamoxifen) 20 mg tablets.

Tamoxifen is available as a tablet or oral solution.[33][34]

Contraindications[edit]

Tamoxifen has a number of contraindications, including known hypersensitivity to tamoxifen or other ingredients, individuals taking concomitant coumarin-type anticoagulant therapy, and women with a history of venous thromboembolism (deep vein thrombosis or pulmonary embolism).[4]

Tamoxifen

Tamoxifen, sold under the brand name Nolvadex among others, is a medication that is used to prevent breast cancer in women and treat breast cancer in women and men.[8] It is also being studied for other types of cancer.[8] It has been used for Albright syndrome.[9] Tamoxifen is typically taken daily by mouth for five years for breast cancer.[9]

Serious side effects include a small increased risk of uterine cancerstroke, vision problems, and pulmonary embolism.[9] Common side effects include irregular periods, weight loss, and hot flashes.[9] It may cause harm to the baby if taken during pregnancy or breastfeeding.[9] It is a selective estrogen-receptor modulator (SERM) and works by decreasing the growth of breast cancer cells.[9][10] It is a member of the triphenylethylene group of compounds.[11]

Tamoxifen was initially made in 1962, by chemist Dora Richardson.[12][13] It is on the World Health Organization’s List of Essential Medicines, the safest and most effective medicines needed in a health system.[14] Tamoxifen is available as a generic medication.[9] The wholesale price in the developing world is about US$0.07–0.23 per day.[15] In the United States, it costs about $1 per day.[9] In 2016, it was the 238th most prescribed medication in the United States, with more than two million prescriptions.[16]

Medical uses[edit]

Breast cancer[edit]

Tamoxifen is used for the treatment of both early and advanced estrogen receptor-positive (ER-positive or ER+) breast cancer in pre- and post-menopausal women.[17] Additionally, it is the most common hormone treatment for male breast cancer.[18] It is also approved by the FDA for the prevention of breast cancer in women at high risk of developing the disease.[19] It has been further approved for the reduction of contralateral (in the opposite breast) cancer. The use of tamoxifen is recommended for 10 years.[20]

In 2006, the large STAR clinical study concluded that raloxifene is also effective in reducing the incidence of breast cancer. Updated results after an average of 6.75 years of follow up found that raloxifene retains 76% of tamoxifen’s effectiveness in preventing invasive breast cancer, with 45% fewer uterine cancers and 25% fewer blood clots in women taking raloxifene than in women taking

Self-Care Tips:

  • Do not stop taking this medication unless your healthcare provider tells you. You may be on it for as long as 5 years.
  • If you are experiencing hot flashes, wearing light clothing, staying in a cool environment, and putting cool cloths on your head may reduce symptoms. Consult you health care provider if these worsen, or become intolerable
  • This medication causes little nausea.  But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals.  Sucking on lozenges and chewing gum may also help.
  • Avoid sun exposure.  Wear SPF 15 (or higher) sunblock and protective clothing.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your health care professional while you are taking tamoxifen, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) may also be ordered by your doctor.

Women will need a gynecologic (GYN) examination before therapy, and during therapy, at regular intervals.  Discuss the appropriate schedule with your health care provider.

How This Drug Works:

Hormones are chemical substances that are produced by glands in the body, which enter the bloodstream and cause effects in other tissues.  For example, the hormone testosterone, made in the testicles and is responsible for male characteristics such as deepening voice and increased body hair.  The use of hormone therapy to treat cancer is based on the observation that receptors for specific hormones that are needed for cell growth are on the surface of some tumor cells.  Hormone therapy can work by stopping the production of a certain hormone, blocking hormone receptors, or substituting chemically similar agents for the active hormone, which cannot be used by the tumor cell.  The different types of hormone therapies are categorized by their function and/or the type of hormone that is affected.

Tamoxifen is an antiestrogen.  Antiestrogens bind to estrogen receptor site on cancer cells thus blocking estrogen from going into the cancer cell.  This interferes with cell growth and eventually leads to cell death. The following are antiestrogen medications.

  • tamoxifen, toremifene

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Nolvadex

Generic name:  Tamoxifen

Chemocare.com uses generic names in all descriptions of drugs. Nolvadex is the trade name for Tamoxifen. In some cases, health care professionals may use the trade name Nolvadex when referring to the generic drug name Tamoxifen.

Drug type:  Nolvadex is a hormone therapy.  This medication is classified as an “anti-estrogen.”  (For more detail, see “How this drug works” section below).

What This Drug Is Used For:

  • Tamoxifen may be given as adjuvant therapy (treatment after successful surgery) in women or men with lymph node negative or lymph node positive breast cancer.  Cancers with positive estrogen and progesterone receptors are more likely to benefit from tamoxifen.  Tamoxifen reduces the risk of getting breast cancer in the opposite breast.
  • Tamoxifen may be prescribed in metastatic (cancer that has spread) breast cancer in both women and men.
  • Tamoxifen may be prescribed in women with ductal carcinoma in situ (DCIS) who have completed surgery and radiation therapy.  Tamoxifen may reduce the risk of invasive breast cancer.  Risks and benefits of tamoxifen therapy should be discussed in this setting.
  • Tamoxifen may be prescribed for women at high risk of breast cancer to reduce the incidence of developing breast cancer.  Risks and benefits of tamoxifen therapy should be discussed in this setting.
  • Tamoxifen may also be prescribed for treatment of ovarian cancer.
    Note:  If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How This Drug Is Given:

  • Tamoxifen is a pill, given by mouth.  The pill should be swallowed whole.
  • Tamoxifen should be taken at about the same time each day with a full glass of water.  If you miss a dose, do not take a double dose the next day.
  • The amount of tamoxifen that you will receive depends on many factors, including your general health or other health problems, and the type of cancer or condition being treated.  Your doctor will determine your dose, schedule and duration of treatment.

Side Effects:

Important things to remember about the side effects of tamoxifen:

  • Most people do not experience all of the side effects listed.
  • Side effects are often predictable in terms of their onset and duration.
  • Side effects are almost always reversible and will go away after treatment is complete.
  • There are many options to help minimize or prevent side effects.
  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking tamoxifen:

  • Hot flashes (see sexuality)
  • Vaginal discharge (see sexuality)
  • Swelling (fluid retention in feet, ankles, or hands)
  • Loss of libido (particularly in men) (see sexuality)

These side effects are less common side effects (occurring in about 10-29%) of patients receiving tamoxifen:

  • Nausea
  • Menstrual irregularities
  • Vaginal bleeding
  • Weight loss
  • Mood changes (see anxiety and/or depression)

rare, but serious side effect of tamoxifen is blood clots, including deep vein thrombosis (DVT) and pulmonary embolus.  You should seek emergency help and notify your health care provider immediately if you develop sudden chest pain and shortness of breath.  Notify your health care provider within 24 hours if you notice that one leg is swollen, red, painful and/or warm to touch and the other is not.

rare, but serious side effect of tamoxifen can be the development of uterine cancer.  Women who have not had a hysterectomy should have regular pap smears and gyn examinations.  Abnormal vaginal bleeding should be reported to your health care provider.

Your fertility, meaning your ability to conceive or father a child, may be affected by tamoxifen.  Please discuss this issue with your health care provider.

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Seek emergency help immediately and notify your health care provider, it you experience the following symptoms:

  • Sudden shortness of breath and/or chest pain

The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following:

  • Swelling, redness and/or pain in one leg or arm and not the other
  • New breast lumps
  • Excessive vaginal discharge or bleeding, menstrual (period) pain or irregularities
  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Depression (interfering with your ability to carry on your regular activities)
  • Changes in vision

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

  • Before starting tamoxifen treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
  • Let your health care professional know if you have ever had a blood clot that required medical treatment.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (tamoxifen may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
  • For both men and women: Do not conceive a child (get pregnant) while taking tamoxifen. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
  • Do not breast feed while taking this medication.