Escitalopram co-prescription in anastrozole-treated breast cancer patients

OBJECTIVE: The purpose of the study was to evaluate the impact of escitalopram co-prescription on plasma anastrozole levels in post-menopausal breast cancer patients.
METHODS: A total of 24 post-menopausal operated breast cancer patients co-prescribed with escitalopram and anastrozole were included. Blood samples were collected, before and 1-month after the onset of escitalopram to analyze plasma anastrozole and estradiol levels.
RESULTS: No significant difference was noted in basal plasma anastrozole levels with respect to age, body mass index (BMI), tumor stage, previous antineoplastic treatments, concomitant medications, and serum estradiol levels. Overall, 17 patients completed the 1-month escitalopram treatment, while 7 patients discontinued escitalopram within the 1st week of the treatment. Basal anastrozole levels of 24 patients were 26.1±2.4 ng/mL. Among 17 patients who continued 1-month escitalopram treatment was associated with significant increase in plasma anastrozole levels (24.5±2.3 ng/mL to 32.2±3.2 ng/mL, p<0.05). Notably, 1-month escitalopram use was associated with significant increase in plasma anastrozole levels only in the subgroup of obese (BMI >29 kg/m2) patients (23.1±2.8 to 35.9±4.7 ng/mL, p<0.01), while no such interaction was noted among non-obese patients. The estradiol levels of the patients were below ≤10 pg/mL in 75% of patients and no change occurred after escitalopram administration.
CONCLUSION: Escitalopram co-prescription resulted in significant increase in plasma anastrozole levels without affecting the serum estradiol levels. Our findings emphasize the need for close monitoring in case of concomitant use of anastrozole and escitalopram, especially in obese patients and the potential role of therapeutic drug monitoring.

Anastrozol ile tedavi edilen meme kanseri hastalarýnda essitalopramýn eþ-zamanlý kullanýlmasý

Giriþ: Bu çalýþmada postmenopozal meme kanseri hastalarýnda eþ-zamanlý essitalopram tedavisinin plazma anostrozol düzeyleri üzerine etkisinin incelenmesi amaçlandý.
Yöntem: Eþ-zamanlý anastrozol ve essitalopam tedavisi alan toplam 24 post-menopozal opere meme kanseri hastasý çalýþmaya dahil edildi. Essitalopram tedavisine baþlanmadan önce ve 1 aylýk tedavi sonrasýnda kan örnekleri alýnarak, plazma anastrozol ve estradiol düzeyleri ölçüldü.
Bulgular: Bazal plazma anastrozol düzeylerinde, yaþ, vücut kitle indeksi (VKÝ), tümor evresi, önceki anti-neoplastik tedaviler, eþ-zamanlý ilaçlar ve serum estradiol düzeyleri açýsýndan anlamlý bir fark tespit edilmedi. Toplamda 17 hasta 1 aylýk essitalopram tedavisini tamamlarken, 7 hasta tedaviyi ilk hafta içinde býraktý. Bazal anastrozol düzeyleri 24 hasta genelinde 26.1±2.4 ng/mL olarak bulundu. 1 aylýk essitalopram tedavisini tamamlayan 17 hastada plazma anastrozol düzeylerinde anlamlý artýþ görüldü (24.5±2.3 ng/mL ve 32.2±3.2 ng/mL, p<0.05). Alt-grup analizlerinde 1 aylýk essitalopram tedavisi obez (VKÝ>29 kg/m2) hastalarda plazma anastrozol düzeylerinde anlamlý artýþa (23.1±2.8 ve 35.9±4.7 ng/mL, p<0.01) neden olurken obez olmayan hastalar arasýnda bu anlamlýlýk saptanmadý. Estradiol düzeyleri %75 hastada <10 pg/mL olup, essitalopram tedavisinin eklenmesi estradiol düzeylerinde anlamlý bir deðiþikliðe neden olmadý.
Sonuç: Eþ-zamanlý essitalopram tedavisi, plazma anastrozol düzeylerinde anlamlý artýþa yol açarken, serum estradiol düzeylerinde bir deðiþim gözlenmedi. Eþ-zamanlý anastrozol ve essitalopram tedavisi alan hastalarda, özellikle obez olanlarda, yakýn takibin önemini vurgulamakta ve terapötik ilaç monitorizasyonunun bu açýdan potansiyel rolüne iþaret etmektedir. (NCI-2021-11-8/R1)