Which antidepressants should be avoided with Tamoxifen?

The correct choice identifies fluoxetine and paroxetine as antidepressants that should be avoided with Tamoxifen due to their impact on the enzyme CYP2D6. Tamoxifen is a medication commonly used in breast cancer treatment, and it requires CYP2D6 for its metabolism into its active form, endoxifen.

Both fluoxetine and paroxetine are potent selective serotonin reuptake inhibitors (SSRIs) and strong inhibitors of the CYP2D6 enzyme. When taken concurrently with Tamoxifen, they can significantly reduce the effectiveness of Tamoxifen by inhibiting its conversion to the more active metabolite. This reduction can lead to suboptimal therapeutic effects in patients relying on Tamoxifen for cancer treatment.

Duloxetine, although included in the correct answer option, is also a moderate inhibitor of CYP2D6 but has a lesser degree of interaction compared to fluoxetine and paroxetine. Thus, avoiding the latter two is paramount to ensure the efficacy of Tamoxifen.

Understanding these interactions is critical for clinicians in prescribing practices to prevent any potential adverse effects on cancer treatment outcomes.