When it comes to treating advanced breast cancer patients or reducing the side effects of estrogens while coming off their anabolic steroid cycle, Nolvadex, also known as Tamoxifen citrate and LiquiNolva, is one of the most popular antiestrogens.

Since Nolvadex has the ability of inhibiting the growth of tumors that respond to estrogens, it is one of the most popular drugs for treating node-positive breast cancer in women following total mastectomy or segmental mastectomy, axillary dissection, and breast irradiation. The antiestrogen is also recommended for treating metastatic breast cancer in women and men and Nolvadex is an alternative to oophorectomy or ovarian irradiation in premenopausal women with metastatic breast cancer. Medically, it is advised for the treatment of breast cancer that has spread to other parts of the body (metastatic breast cancer) and is also advised to treat breast cancer in certain patients after surgery and radiation therapy and may even be suggested to minimize the chances of breast cancer in high-risk patients.

Each Nolvadex tablet includes 30.4 mg of tamoxifen citrate that s equivalent to 20 mg of tamoxifen and the list of inactive ingredients includes carboxymethylcellulose calcium, magnesium stearate, mannitol, and starch. The drug is the trans-isomer of a triphenylethylene derivative and has the chemical name of (Z)2-[4-(1,2-diphenyl-1-butenyl) phenoxy]-N, N-dimethylethanamine 2 hydroxy-1,2,3- propanetricarboxylate (1:1). The molecular weight of Tamoxifen citrate is 563.62 g/mol at the base and its molecular formula is C32H37NO8. The pKa’ is 8.85, the equilibrium solubility in water at 37°C is 0.5 mg/mL and in 0.02 N HCl at 37°C, it is 0.2 mg/mL.

One of the biggest advantages of this antiestrogen is that patients whose tumors are estrogen receptor positive are more likely to benefit from it. In addition to that, it can minimize the occurrence of contralateral breast cancer in patients receiving adjuvant therapy for breast cancer. In women with Ductal Carcinoma in Situ (DCIS) after breast surgery and radiation, Nolvadex can minimize the risk of invasive breast cancer. It is worthwhile to note that Tamoxifen citrate is well tolerated in males with breast cancer and safety profile of the drug in males is similar to that noticed in women.

Sportsmen using anabolic steroids and performance enhancing drugs like Dianabol, Anadrol, and Testosterone derivatives often make use of Nolvadex and medical studies in the past have suggested that use of this antiestrogen is associated with dramatic improvements in levels of luteinizing hormone, follicle-stimulating hormone, testosterone, and estrogen control.  Since use of Nolvadex is featured by its mild yet highly effective properties, it is often preferred compared to Arimidex, Femara, and Aromasin since it does not prevent aromatization but plays the role of an estrogen antagonist, which is also useful in burning fat.

The recommended dose of Nolvadex for patients with Ductal Carcinoma in Situ (DCIS) is 20 mg daily for 5 years while sportsmen on steroids use it in doses of 20-45 mg per day, with or without food.

Nolvadex is not recommended to those having a history of blood clots (e.g., deep vein thrombosis, pulmonary embolism, stroke) or health conditions that require treatment with a “blood thinner” (like warfarin) or bupropion, estrogens, hormonal forms of birth control (e.g., birth control pills, patches, implants), phenobarbital, rifamycins (e.g., rifampin), St John’s wort. The drug is also not advised to those suffering from kidney damage, liver damage, high blood pressure, and stroke. The drug is contraindicated in women requiring concomitant coumarin-type anticoagulant therapy or in women with a history of deep vein thrombosis or pulmonary embolus. Before seeking medical advice, it is important to communicate medical history, especially if the same is characterized by high cholesterol/triglycerides, limited or no ability to walk (immobility), diabetes, high blood pressure, smoking, cataracts, and liver disease.

Nolvadex abuse can lead to side effects, which may be mild or severe, including hypercalcemia, peripheral edema, distaste for food, pruritus vulvae, depression, dizziness, light-headedness, headache, hair thinning and/or partial hair loss, and vaginal dryness. In very rare cases, side effects like erythema multiforme, Stevens-Johnson syndrome, bullous pemphigoid, interstitial pneumonitis, and rare reports of hypersensitivity reactions including angioedema may happen.

Women keen to use Tamoxifen citrate should avoid getting pregnant for two months after last stopping its use and others should best use birth control methods that don’t use hormones like diaphragms with spermicide or plain intrauterine devices (IUDs). Moreover, breast-feeding is not recommended while using this drug as it is unknown of Nolvadex passes into breast milk or may cause potential risk to the infant. Nolvadex is not recommended to individuals suffering with high amount of calcium in the blood, severely decreased platelets, decreased white blood cells, cataracts, problems with eyesight, blood clot in lung, stroke, obstruction of a blood vessel by a blood clot, blood clot in a deep vein, pregnancy, or a mother who is producing milk and breastfeeding. A loss of sexual ability or interest may occur in men making use of Nolvadex

Medical advice should be sought on an immediate basis after stopping use of Nolvadex if side effects such as pain or pressure in pelvis, vaginal bleeding, changes in the amount or timing of bleeding or increased clotting, sudden chest pain, shortness of breath, coughing up blood, pain, tenderness, or swelling in one or both of your legs , sudden trouble seeing in one or both eyes , sudden severe headache with no known cause, sudden trouble walking, dizziness, loss of balance or coordination, or lack of appetite and yellowing of your skin or whites of eyes is noticed after making use of the antiestrogen.

To maintain its efficacy and shelf life, Nolvadex is required to be stored at a controlled room temperature of 20° to 25°C (68° to 77°F) with excursions permitted to 15° to 30°C (59° to 86°F) and must be kept in a well-closed and light-resistant container. It must be protected against unauthorized use, pets, sunlight, moisture, and children. In case of expired Nolvadex tablets, the same should be discarded after having a word with a pharmacist or local waste disposal company on how to safely discard Nolvadex.

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