| Name of active substance | Trade name | Affected micronutrients |
| Clomiphene | Clomiphen „Arcana“® | Vitamin D |
| Raloxifene | Evista® | |
| Tamoxifen | Nolvadex®, Ebefen® | Vitamin D Vitamin C Vitamin E Coenzyme Q10 Vitamin B2 Niacin |
| Mechanism of interaction | |
| Vitamin D | In vitro there is an increased expression of the biologically active Transforming Growth Factor β. Calcitriol also increases synthesis and release of this factor. A combination of tamoxifen and calcitriol shows an increased inhibition of carcinogenesis in animal experiments. |
| Vitamin C Vitamin E Coenzyme Q10 Vitamin B2 Vitamin B3 (niacin) |
Due to their antioxidative (vitamin C, vitamin E) and mitochondrial (coenzyme Q10, vitamin B2, vitamin B3) properties, these nutrients positively counteract the tamoxifen side effects. In addition, there is the anti-angiogenetic effect of coenzyme Q10, vitamin B2 and vitamin B3. Vitamin C and vitamin E reduce tamoxifen-induced hypertriglyceridemia. |
| Positive consequences of the interaction | Possible symptoms | |
| Vitamin D | Synergistic effect | Increase in carcinogenic inhibition Rate of arthralgia decreases Fatigue decreases Rate of myalgia decreases |
| Vitamin C Vitamin E Coenzyme Q10 Vitamin B2 Vitamin B3 |
Reduction of side effects | Risk of recurrence and metastasis decreases Risk of tamoxifen-induced hypertriglyceridemia decreases |
| Medical substance | Recommended supplementation | Dosage |
| SERM | Vitamin D | 40000 I.U./Week p.o. |
| Vitamin C | 500 mg/d p.o. | |
| Vitamin E | 400 I.U./d p.o. | |
| Coenzyme Q10 | 100 mg/d p.o. | |
| Vitamin B2 | 10 mg/d p.o. | |
| Vitamin B3 | 50 mg/d p.o. |
| References |
| Boivin G et al. Contribution of raloxifene and calcium and vitamin D3 supplementation to the increase of the degree of mineralization of bone in postmenopausal women. J Clin Endocrinol Metab. 2003 Sep;88(9):4199-205. Gröber U. Mikronährstoffe. Metabolic Tuning – Prävention – Therapie. 3. Auflage, 2011 Gröber U. Arzneimittel und Mikronährstoffe. Medikationsorientierte Supplementierung. 3. Akt. und erw. Auflage, 2014 Stargrove Mitchell Bebel, Treasure Jonathan, McKee Dwight L.: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. 2008 Yuvaraj S et al. Effect of Coenzyme Q(10), Riboflavin and Niacin on Tamoxifen treated postmenopausal breast cancer women with special reference to blood chemistry profiles. Breast Cancer Res Treat. 2009 Mar;114(2):377-84. doi: 10.1007/s10549-008-0012-7. Epub 2008 Apr 22. Vu TD et al. Hypocalcemia induced by raloxifene. Curr Drug Saf. 2012 Apr;7(2):176-8. |
