Miya Pearson
Tamoxifen is a common treatment for breast cancer, but it can cause insomnia—a common sleep disorder that makes it difficult to fall asleep, stay asleep, or go back to sleep after waking up too early. This can be caused by the stress of a breast cancer diagnosis, the cancer itself, or other treatments. As a result, many people seek sleep aids to help them sleep. However, it is important to be cautious when taking sleep aids with tamoxifen as some over-the-counter options, such as diphenhydramine, melatonin products, and herbal supplements, can interfere with the effectiveness of tamoxifen or have other negative side effects. Prescription sleep aids, such as Rozerem (ramelteon) and Ambien (zolpidem), are generally preferred by doctors as they can be used long-term and do not pose a risk of dependence. Additionally, certain antidepressants may be safe to use with tamoxifen, but it is important to consult a doctor first as some antidepressants can alter tamoxifen metabolism.
| Characteristics | Values |
|---|---|
| Prescription sleep aids | Rozerem (chemical name: ramelteon), Ambien (chemical name: zolpidem), Lunesta (chemical name: eszoplicone) |
| Over-the-counter sleep aids | Melatonin, valerian, kava |
| Herbal supplements | Sage, sunflower oil, tart cherry juice, magnesium drinks |
| Other strategies | Yoga, Pilates, limiting liquids in the evening, cognitive behavioral therapy (CBT), CBD products, medical marijuana |
| Drugs to avoid | Diphenhydramine, paroxetine, fluoxetine, bupropion |
| Drugs that may interfere with tamoxifen | Antidepressants, sleeping pills |
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What You'll Learn
Sleep aids to avoid when taking tamoxifen
Sleep problems are a common side effect of menopause, which can be triggered by breast cancer treatment. Insomnia is a recognised issue for people with breast cancer, caused by the stress of diagnosis, the cancer itself, or certain treatments. Tamoxifen, a breast cancer treatment, can also cause insomnia.
It is not recommended to use over-the-counter sleep aids, as they often contain diphenhydramine, which can interfere with the effectiveness of tamoxifen. Melatonin products are also not recommended for everyday use, as they can raise melatonin levels much higher than they should be, and the dosage may not be as stated on the label. Herbal supplements such as valerian and kava are also not recommended, as kava is linked to liver damage, and the long-term effects of valerian are not well understood.
If you are struggling with insomnia, it is important to seek treatment from a medical professional. Your doctor may recommend prescription sleep medicines, such as Rozerem (ramelteon), which can be used long-term and does not pose a risk of dependence. Other prescription sleep aids include Ambien (zolpidem) and Lunesta (eszoplicone), which can be taken over a short period to help break the cycle of insomnia. Your doctor may also recommend combining prescription sleep medicines with cognitive behavioural therapy (CBT), especially for chronic insomnia.
Some people have reported success with natural remedies, such as yoga, Pilates, and limiting evening liquids to minimise nighttime bathroom trips.
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Prescription sleep aids that are safe to take with tamoxifen
It is important to consult a doctor before taking any sleep aids alongside tamoxifen, as some over-the-counter medications can interfere with its effectiveness. Most over-the-counter sleep aids contain diphenhydramine, which can disrupt sleep patterns and reduce the efficacy of tamoxifen. Melatonin supplements, valerian, and kava are also not recommended for similar reasons.
If you are experiencing insomnia as a side effect of tamoxifen, there are prescription sleep aids that may be safe to take. Rozerem (ramelteon) is a prescription sleep aid that functions similarly to the sleep hormone melatonin. It can be used long-term and does not pose a risk of dependence. Another option is Ambien (zolpidem) or Lunesta (eszoplicone), which can be taken occasionally over a short period to help break the cycle of insomnia. These medications are typically recommended for short-term use, and your doctor may suggest combining them with cognitive behavioral therapy (CBT) to address chronic insomnia.
Additionally, Quetiapine, an atypical antipsychotic, has been used to treat tamoxifen-induced insomnia in women with breast cancer. It is started at a low dose of 25 mg/day and adjusted upward based on therapeutic response.
It is important to note that the use of prescription sleep aids should be carefully monitored by a medical professional and only taken as directed.
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Natural sleep aids that are safe to take with tamoxifen
Sleep difficulties are a common side effect of tamoxifen treatment for breast cancer. This can be caused by the stress of a breast cancer diagnosis, the cancer itself, or other breast cancer treatments.
It is not recommended to use over-the-counter sleep aids with tamoxifen as they often contain diphenhydramine, which can interfere with the effectiveness of tamoxifen and disrupt sleep stages. Melatonin supplements, valerian, and kava are also not recommended for similar reasons.
Instead, natural sleep aids that may be safe to take with tamoxifen include:
- Sage and sunflower oil: Some people have reported using these to ease hot flushes, a common side effect of tamoxifen that can interfere with sleep.
- Cool pillows: These can also help with hot flushes.
- Yoga and Pilates: These activities can ease joint stiffness that may otherwise keep you awake.
- Avoiding caffeine and alcohol: These substances can disrupt sleep.
- Exposure to bright light in the morning: This can help reset your inner clock and improve sleep.
- Cognitive behavioral therapy (CBT): This can help you develop strategies to deal with factors that interfere with your sleep.
Additionally, one study found that the prescription sleep aid quetiapine may improve tamoxifen-induced insomnia in women with breast cancer. However, it is important to consult your doctor before taking any sleep aids, natural or prescription, to ensure they are safe and suitable for you.
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Antidepressants that can be taken with tamoxifen
Tamoxifen is a medication used to treat estrogen-receptor-positive breast cancer. It works by blocking the effects of estrogen on cancer cells, slowing or stopping the spread of cancer.
Tamoxifen is what is known as a "pro-drug", meaning that it needs to be converted into its active form, endoxifen, by the liver enzyme CYP2D6. Many antidepressants are known to inhibit this enzyme, potentially reducing the efficacy of tamoxifen. These include fluoxetine, paroxetine, bupropion, citalopram, escitalopram, venlafaxine, and sertraline.
However, it is important to note that studies on the interaction between tamoxifen and antidepressants have yielded conflicting results. While some research has shown that the concurrent use of tamoxifen and antidepressants may reduce the effectiveness of tamoxifen, other studies have found no consistent negative effects on clinical outcomes.
Given the recognized risks associated with avoiding or switching antidepressants, evidence-based guidelines suggest that the low risk of adverse events supports the combination of antidepressants and tamoxifen. Depression is a common condition among women being treated for breast cancer, and it is important to carefully select antidepressants to avoid significant interactions with tamoxifen.
Additionally, antidepressants may help ease some of the side effects of tamoxifen, such as hot flashes and night sweats, which are known as vasomotor symptoms. The SSRI paroxetine, for example, has been shown to reduce hot flashes and has been licensed for such use by the FDA under the brand name Brisdelle.
If you are experiencing insomnia or other sleep disturbances while taking tamoxifen, it is recommended to consult with a medical professional. They may recommend prescription sleep medicines or cognitive behavioral therapy (CBT) to help improve your sleep.
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CBT as an alternative to sleep aids
If you are taking tamoxifen and experiencing insomnia, it is not recommended to use over-the-counter sleep aids. This is because most contain diphenhydramine, which can interfere with the effectiveness of tamoxifen and disrupt your sleep stages.
Instead, you could consider Cognitive Behavioral Therapy (CBT), which is often recommended for chronic insomnia. CBT involves working with a mental health professional to develop strategies for dealing with factors that may be interfering with your sleep. This could include stimulus control, sleep restriction, and relaxation training, and mindfulness techniques. CBT can help you identify thoughts, feelings, and behaviors that are contributing to your insomnia. It can take time to learn and practice the skills learned in treatment, but many people who try CBT for insomnia experience improvements in their sleep quality.
During CBT for insomnia, you may be encouraged to challenge negative thinking, relax your mind, and switch off. You may also be advised to restrict stimulants such as caffeine, alcohol, and exercise before bedtime. Keeping a thought diary to record and challenge sleep-related thoughts can also be helpful.
If you are experiencing insomnia, it is important to discuss this with your doctor, who can help determine if any medications are contributing to your sleep difficulties and recommend treatments such as CBT.
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Frequently asked questions
It is advised to consult a doctor before taking any sleep aid with tamoxifen. Some prescription sleep aids that may be recommended include Rozerem (ramelteon), Ambien (zolpidem), and Lunesta (eszoplicone). Quetiapine, an atypical antipsychotic, has also been used to treat tamoxifen-induced insomnia. Over-the-counter sleep aids are generally not recommended due to potential interactions with tamoxifen.
Tamoxifen has been associated with side effects such as hot flashes, night sweats, and joint stiffness, which can disrupt sleep.
Some natural remedies that may help improve sleep include limiting evening liquids to reduce nighttime bathroom trips, yoga, and Pilates. Exposing yourself to bright light in the morning can also help reset your internal clock and improve sleep.
It is important to consult a doctor to review the medications you are taking and discuss possible adjustments. Your doctor may recommend prescription sleep medicines, cognitive behavioral therapy (CBT), or other treatments to improve your sleep.
