What is your approach to tamoxifen use in women who are unable to discontinue a strong CYP2D6 inhibitor and who are unable to use or tolerate an AI?

I ran into this very situation not too long ago. In dealing with the situation, I asked myself the following questions: 1) Did I speak to prescribing psychiatrist or psychopharmacologist (or if I was the prescriber or primary care provider refer to a more experienced physician?) 2) Did I do everythi...

There is data supporting the equivalency of toremifene in the adjuvant setting (Lewis et al., PMID 20209619). Since it is mostly metabolized through CYP3A4, it may be a good choice in this case.