Tamoxifen hepatotoxicity

TAMOXIFEN AZATHIOPRINE t risk of myelosuppression and immunosuppression. Deaths have occurred following profound myelosuppression and severe sepsis Additive myelotoxic effects Azathioprine is metabolized to 6-mercatopurine in vivo, which results in additive myelosuppression, immunosuppression and hepatotoxicity Avoid co-administration... 

Boelsterli UA (2002) Nimesulide and hepatic adverse effects roles of reactive metabolites and host factors. Int J Clin Pract 56(Suppl 128) 30-36 Boelsterli UA, Ho HK, Zhou S, and Leow KY (2006) Bioactivaticm and hepatotoxicity of nitroaromatic drugs. Curr Drug Metab 7 715-727 Boocock DJ, Maggs JL, White IN et al (1999) a-Hydroxytamoxifen, a genotoxic metabolite of tamoxifen in the rat identification and quantificaticm in vivo and in vitro. Carcinogenesis 20 153-160... 

A single case report describes allopurinol hepatotoxicity in a man given tamoxifen. 

An elderly man who had been taking allopurinol 300 mg daily for 12 years developed fever and marked increases in his serum levels of lactic dehydrogenase and alkaline phosphatase within a day of starting to take tamoxifen 10 mg twice daily. He rapidly recovered when the allopurinol was stopped. The reasons for the reaction are not understood, but the authors suggested that the increased hepatotoxic effect may have resulted from tamoxifen inhibiting allopurinol metabolism, thereby increasing the serum levels of allopurinol and its metabolite. The general importance of this isolated report is not known. 

Shah KA, Levin J, Rosen N, Greenwald E, Zumoff B. Allopurinol hepatotoxicity potentiated by tamoxifen. NY State J Med ( 9S2) 82, 1745-6. 

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