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Query about using Clomifene/Tamoxifen in GA.

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I am due to have a circumcision with a General Anaesthesia and I'm taking pro-hormones/designer steroids for 6 weeks. I will be using Clomifene or Tamoxifen for 4 weeks thereafter and the operation should be either during this period or shortly after.

Is it safe to use Clomifene or Tamoxifen and have a General Anaesthesia?

If not, how long before the General Anaesthesia should one cease Clomifene or Tamoxifen use?


Category: General Surgeon

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Category: Pediatric Surgeon
Dr. Hari Charan Perigela is online now

Expert:  Dr. Hari Charan Perigela replied 4 Days.

Hello,

Thank you for choosing DoctorSpring.

I discussed your concern with our team Anaesthesiologist.

Whether Tamoxifen / Clomiphene needs to be stopped before Surgery is a decision to be taken by the Anaesthesiologist. These drugs are most likely safe with GA (General Anaesthesia) , but since this is an elective Surgery Tamoxifen is better stopped at least 1 week prior. This is to be 100% safe.

However the concern here would be the anabolic steroid you are taking. This could cause serious concerns during Surgery. (even if you were taking the drugs in the immediate past). May I know what kind of steroid you are taking (Name ? / Duration / dose). With this information I might be able to give you a better recommendation.

PS: Steroids + Tamoxifen if used without guidance can have long term side effects. I am sure you have considered the risk /benefit ratio.

Hope this helps
You can reply as a followup
Thank you


Patient replied :

The steroids are legal pro-hormones, I plan to use one called Epistane which contains the active ingredient 2,3a-epithio-17a-methyletioallocholanol, I would this at 30mg for one day and step it up to 40mg per day, for a total duration of 4-6 weeks (depending on surgery date.) Immediately followed thereafter by 4 weeks of Tamoxifen or Clomiphene. So neither of these two have a long enough half life to interfere or would not interfere at all with a General Anaesthesia?

I used Epistane in January-February of this year also right after a Superdrol clone called Methastadrol which contains 2a-17a-di-methyl-etiocholan-3-one,17b-ol I ran this at 20-30mg for 4 weeks.


Expert:  Dr. Hari Charan Perigela replied 3 Days.

Hello,

I understand that you are taking Prohormones - not anabolic steroid per say. Still they do have a glucocorticoid (steroid) action, although much less potent. It is not about the half life, it is more about the suppression of HPA axis of the body (Which produce steroids under stress situations like Surgery). Methastadrol/ Epistane does seem to have some glucocorticoid action.

So here are my recommendations :

1. You should stop all supplements and medications at least 1 week prior to Surgery. Although Tamoxifen and Clomiphene are relatively safe they can cause low platelet and cause bleeding.
2. You will need to (MUST) disclose this to your Anaesthesiologist. They hear this all the time, and most likely won't mind. This will help them decide on the type of Anaesthesia is better for you and whether you need steroid supplementation.
3. As I said you are most likely - 99% safe with these drugs and supplements, but being an elective Surgery even 1% risk is not worth it
4. The best course of action would be to postpone the supplements and medications till the Surgery is over.

Hope this helps
Feel free to ask followups
Thank you


Patient replied :

So if I ran Epistane for 4-6 weeks at 30-40mg and then Tamoxifen at 20mg for 2 weeks and 10mg for 2 weeks or Clomiphene at 50mg for 2 weeks then 25mg for 2 weeks (which would be better and have less chance of interfering?) and stopped at least a week prior to surgery, what could that 1% complication be? Am I risking death? Irreversible complication with my penis? Wouldn't the bleeding or blood clotting be noticed and dealt with in theatre?


Expert:  Dr. Hari Charan Perigela replied 2 Days.

Hello,

The possible complications could be bleeding, low platelets, elevated liver enzymes, hypotension. To say which drugs is better is not possible as there is no data regarding this kind of treatment approach (All these are off label and non approved uses, so not well studied).

If you stop drugs before 1 week it brings down your risk. But still you will have to declare this to the Anaesthesia team.
And of course legally I am required to warn you non prescription use of these medication may lead on to undesirable side effects.

Thank you


Dr. Hari Charan Perigela
Category: Pediatric Surgeon
Experience: 
Fellowship: DNB, General Surgery, National Board of Examinations, New Delhi, 2001
Residency: MS, General Surgery, Sri Venkateswara Medical College,Tirupathi, 2000
Medical School: MBBS, Kurnool Medical college, 1995
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