There is a potential interaction between tamoxifen and selective serotonin reuptake inhibitors SSRIs, particularly fluoxetine, paroxetine and sertraline as well as the serotonin noradrenaline reuptake inhibitor SNRI duloxetine and the noradrenaline dopamine reuptake inhibitor NDRI bupropion, because they inhibit cytochrome p450 2D6, preventing metabolism of tamoxifen to its active antiestrogenic metabolite, hydroxytamoxifen 7 coupons for cialis 20 mg