Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Nolvadex D (Tamoxifen). If you are concerned about side effects, discuss the risks and benefits of Nolvadex D (Tamoxifen) with your doctor.

The following side effects have been reported by at least 1% of people taking Nolvadex D (Tamoxifen). Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• bone pain
• changes in menstrual period
• Constipation
• Diarrhea
• genital itching
• hair loss (partial) or hair thinning
• headache
• hot flashes
• leg cramps
• lightheadedness
• mild nausea and vomiting
• muscle pain
• skin rash
• swelling of the feet, ankles, or lower leg
• taste alterations
• tiredness and weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• blurred vision or vision changes
• cough and shortness of breath
• increased pain or growth of tumour
• numbness or tingling of the skin
• pain or feeling of pressure in the pelvis
• severe nausea or vomiting
• signs of Anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
• signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• symptoms of inflammation of the pancreas (e.g., severe upper right abdominal pain)
• symptoms of low white blood cells (infection; Fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• vaginal growths, bleeding or discharge

Stop taking the medication and seek immediate medical attention if any of the following occur:

• blistering, peeling, or loosening of the skin or mucous membranes
• Hives
• signs of a Anaphylaxis (severe allergic reaction) (e.g., hives; difficulty breathing; swelling of the face, lips, tongue, or throat)
• swelling of the hands, feet, or ankles
• symptoms of a blood clot in the leg (e.g., pain, swelling or redness of the calf or leg)
• symptoms of a blood clot in the lungs (e.g., chest pain and shortness of breath)
• symptoms of a Stroke (e.g., sudden weakness or numbness of the arms or legs, sudden difficulty speaking, sudden dizziness, sudden severe headache)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Nolvadex D (Tamoxifen).

Each off-white to white, octagonal, film-coated, biconvex tablet, intagliated with "NOLVADEX-D" on one face and plain on the reverse, contains Nolvadex D (Tamoxifen) citrate 30.4 mg equivalent to 20 mg of Nolvadex D (Tamoxifen). Nonmedicinal ingredients: cornstarch, croscarmellose sodium, gelatin, lactose, macrogol 300, magnesium stearate, methylhydroxypropyl methylcellulose, and titanium dioxide.

Do not take Nolvadex D (Tamoxifen) if you:

• are allergic to Nolvadex D (Tamoxifen) or any ingredients of the medication
• are pregnant or planning to become pregnant

There may be an interaction between Nolvadex D (Tamoxifen) and any of the following:

• Amiodarone
• Anagrelide
• Anastrozole
• angiotensin receptor blockers (ARBs; e.g., candasartan, Irbesartan, Losartan)
• antipsychotics (e.g., Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• Aprepitant
• asunaprevir
• "azole" antifungal medications (e.g., fluconazole, ketoconazole, Voriconazole)
• barbiturates (e.g., Phenobarbital, secobarbital)
• Bosentan
• Bupropion
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• Carbamazepine
• chloroquine
• Cinacalcet
• conivaptan
• Darifenacin
• Deferasirox
• Disopyramide
• dofetilide
• Domperidone
• Dronedarone
• estrogens (e.g., conjugated estrogen, Estradiol, ethinyl estradiol)
• Flecainide
• Gemfibrozil
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• hydroxychloroquine
• Leflunomide
• Letrozole
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• Methadone
• mifepristone
• milk thistle
• Mirabegron
• nefazodone
• Omeprazole
• other cancer medications (e.g., Capecitabine, Doxorubicin, Fluorouracil, Methotrexate, Paclitaxel)
• Phenytoin
• Pimozide
• Pioglitazone
• primidone
• procainamide
• protein kinase inhibitors (e.g., Crizotinib, Dasatinib, imatinib, Nilotinib)
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, Norfloxacin, Ofloxacin)
• Repaglinide
• rifabutin
• rifampin
• Rosiglitazone
• St. John's wort
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• serotonin antagonists (anti-emetic medications; e.g., Granisetron, Ondansetron)
• simeprevir
• Sotalol
• "statin" anti-cholesterol medications (e.g., Atorvastatin, Lovastatin, Simvastatin)
• "sulfa" antibiotics (e.g., sulfadiazine, sulfamethoxazole, sulfisoxazole)
• terbinafine
• Tetrabenazine
• Tocilizumab
• Tolbutamide
• tretinoin (systemic)
• tricyclic antidepressants (e.g., Clomipramine, Desipramine, Trimipramine)
• Trimethoprim
• Warfarin
• Zafirlukast

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Nolvadex D (Tamoxifen). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Nolvadex D (Tamoxifen).

Blood Clots: Nolvadex D (Tamoxifen) may increase the chance of developing blood clots in the lungs or legs. This chance may be further increased if Nolvadex D (Tamoxifen) is given with other forms of chemotherapy. If you have a history of blood clots, discuss with your doctor how Nolvadex D (Tamoxifen) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Nolvadex D (Tamoxifen), and whether any special monitoring is needed.

A blood clot in the blood vessels of the brain can prevent blood from reaching parts of the brain, causing a stroke. If you experience signs of a stroke such as confusion, difficulty speaking, loss of coordination, sudden headache or vision changes, contact your doctor as soon as possible.

Cataracts: Nolvadex D (Tamoxifen) may cause cataracts or worsen existing cataracts for some people. If you experience any vision changes while taking Nolvadex D (Tamoxifen), contact your doctor.

High blood calcium levels: Nolvadex D (Tamoxifen) may cause an increase in blood calcium levels for women with breast cancer that has spread to other parts of the body. Your doctor will monitor for this with blood tests.

Uterine cancers: Nolvadex D (Tamoxifen) may increase the chance of developing certain types of Uterine Cancer. Talk to your doctor about whether any special monitoring is needed. If you experience any vaginal bleeding while or after taking Nolvadex D (Tamoxifen), contact your doctor immediately.

White blood cells and platelets: People with low white blood cells or platelets should discuss with their doctor how Nolvadex D (Tamoxifen) may affect their medical condition, how their medical condition may affect the dosing and effectiveness of Nolvadex D (Tamoxifen), and whether any special monitoring is needed.

Worsening symptoms: For some women taking Nolvadex D (Tamoxifen), pain may worsen and the size of the affected tissue may increase at the beginning of treatment. This usually resolves within a few weeks of starting Nolvadex D (Tamoxifen). If you experience these effects, contact your doctor.

Pregnancy: Nolvadex D (Tamoxifen) may cause birth defects or death to the developing fetus and should not be used during pregnancy. Effective birth control should be used while taking Nolvadex D (Tamoxifen) and for about 2 months after finishing it. Tell the doctor immediately if you become pregnant while taking Nolvadex D (Tamoxifen).

Breast-feeding: It is not known if Nolvadex D (Tamoxifen) passes into breast milk. If you are a breast-feeding mother and are taking Nolvadex D (Tamoxifen), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Nolvadex D (Tamoxifen) have not been established for children.