Thank you for your inquiry.
Based on the fact that toremifene is structurally similar to tamoxifen, one should approach the administration of toremifene in a patient who has had a reaction to tamoxifen carefully. I would therefore suggest that should toremifene be the only alternative drug for your patient, a provocative dosage regimen be employed.
Unfortunately, to my knowledge, and based on a literature search, there are no published protocols for provocative dosing to toremifene (or for that matter, for tamoxifen) and therefore one is left with designing a protocol using a procedure analogous to those that have been employed for other drugs. Also, since toremifene is only available in a 60 mg pill, establishing appropriate dilutions might be difficult, but I would start with a dose 1/1,000th of the desired dose (usually 60 mg daily), and proceed with doubling doses over a two week period until which time the desired dose is reached. Of course, you should take into consideration the cumulative dose administered during this procedure. The frequency of dosing would have to be calculated based upon this rough format.
As you can see, this is not a convenient procedure, and if any other non-structurally related drug could substitute, it would be desirable. This of course would have to be the decision of the oncologist.
Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.