Discontinue treatment in case of signs & symptoms suggestive of severe cutaneous adverse reactions. Suppressed menstruation in a proportion of premenopausal women receiving treatment. Increased incidence of endometrial changes including hyperplasia, polyps, cancer & uterine sarcoma. Reports of 2nd primary tumours at sites other than the endometrium & the opposite breast. Increased risk for VTE. May increase risk of microvascular flap complications in delayed microsurgical breast reconstruction. Promptly investigate any patient who reports abnormal gynaecological symptoms, especially non-menstrual vag bleeding, or who presents w/ menstrual irregularities, vag discharge & symptoms (eg, pelvic pain or pressure). May induce or exacerbate symptoms of angioedema in patients w/ hereditary angioedema. Avoid concomitant use w/ potent CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine, cinacalcet, bupropion). Very rarely, reports of radiation recall in patients who received prior RT. Patients w/ rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine. Reports of fatigue; observe caution when driving or operating machinery. Advise women not to become pregnant during treatment & for 9 mth following the cessation of therapy; use barrier or other non-hormonal contraceptive methods. Carefully examine premenopausal patients before treatment to exclude pregnancy. Potential foetal risk. Not recommended during breastfeeding. Not recommended in childn. Girls 2-10 yr w/ McCune Albright syndrome. CYP2D6 poor metabolisers.
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