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Cancers 2019, 11(3), 403;

Impact of Curcumin (with or without Piperine) on the Pharmacokinetics of Tamoxifen

Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
Department of Internal Medicine, Elisabeth Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
Department of Internal Medicine, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
Department of Clinical Chemistry, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
Department of Hospital Pharmacy, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
Author to whom correspondence should be addressed.
Received: 14 February 2019 / Revised: 12 March 2019 / Accepted: 18 March 2019 / Published: 22 March 2019
PDF [959 KB, uploaded 22 March 2019]


Tamoxifen is a prodrug that is primarily metabolized into the pharmacologically active metabolite endoxifen and eventually into inactive metabolites. The herb curcumin may increase endoxifen exposure by affecting phase II metabolism. We compared endoxifen and tamoxifen exposure in breast cancer patients with or without curcumin, and with addition of the bio-enhancer piperine. Tamoxifen (20–30mg per day (q.d.)) was either given alone, or combined with curcumin (1200 mg three times daily (t.i.d.)) +/− piperine (10 mg t.i.d.). The primary endpoint of this study was the difference in geometric means for the area under the curve (AUC) of endoxifen. Genotyping was performed to determine CYP2D6 and CYP3A4 phenotypes. The endoxifen AUC0–24h decreased with 7.7% (95%CI: −15.4 to 0.7%; p = 0.07) with curcumin and 12.4% (95%CI: −21.9 to −1.9%; p = 0.02) with curcumin and piperine, compared to tamoxifen alone. Tamoxifen AUC0–24h showed similar results. For patients with an extensive CYP2D6 metabolism phenotype (EM), effects were more pronounced than for intermediate CYP2D6 metabolizers (IMs). In conclusion, the exposure to tamoxifen and endoxifen was significantly decreased by concomitant use of curcumin (+/− piperine). Therefore, co-treatment with curcumin could lower endoxifen concentrations below the threshold for efficacy (potentially 20–40% of the patients), especially in EM patients. View Full-Text
Keywords: tamoxifen; curcumin; piperine; pharmacokinetics; drug interactions tamoxifen; curcumin; piperine; pharmacokinetics; drug interactions

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Hussaarts, K.G.; Hurkmans, D.P.; Oomen-de Hoop, E.; van Harten, L.J.; Berghuis, S.; van Alphen, R.J.; Spierings, L.E.; van Rossum-Schornagel, Q.C.; Vastbinder, M.B.; van Schaik, R.H.; van Gelder, T.; Jager, A.; van Leeuwen, R.W.; Mathijssen, R.H. Impact of Curcumin (with or without Piperine) on the Pharmacokinetics of Tamoxifen. Cancers 2019, 11, 403.

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