Clinical characteristics, management, and outcome of tamoxifen-induced hyperlipidemia: a systematic review

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Background Evidence linking tamoxifen to hypertriglyceridemia (HTG) is mainly derived from case reports. This study aimed to evaluate clinical characteristics and provide evidence to improve identification and management. Methods Databases including China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Web of Science, PubMed, Embase, and Elsevier were searched up to 25 February 2026. Case reports and case series on tamoxifen-induced hypertriglyceridemia (HTG) were collected and descriptively analyzed. Results A total of 49 patients (2 males, 47 females) were included, with a median age of 49 years (range 34–74). Acute pancreatitis (AP) occurred in 31 patients (63.3%). Median triglyceride (TG) levels increased from 274 mg/dL before treatment to 2,534 mg/dL after tamoxifen initiation. Median time to HTG onset was 6 months, and to AP symptoms 9 months. Compared with the non-AP group, the AP group was younger (median 47 vs. 50.5 years, (p = 0.005)), had a higher prevalence of hypertension (25.6% vs. 0%, (p = 0.029)), and had higher post-treatment TG levels (3,358 vs. 1,566 mg/dL, (p = 0.051)). Logistic regression identified younger age as an independent risk factor for AP, with risk decreasing by approximately 15% per year of age (OR 0.849, 95% CI 0.750–0.961, (p = 0.01)). In three patients who underwent rechallenge, HTG recurred significantly faster (median 17.5 days). Tamoxifen was discontinued in most patients (39/49), and 81.6% received lipid-lowering therapy. TG normalization time was shorter in the AP group (median 11.5 vs. 60 days, (p = 0.003)). Forty-six patients improved. One died of liver failure, one left the hospital voluntarily due to septic shock, and one had unreported outcome. Causality was judged “probable” in 85.7% (Naranjo scale). Conclusion Tamoxifen-induced HTG is a significant and frequent risk factor for AP, which can be severe. Younger age is inversely correlated with AP risk. Close lipid monitoring, especially during the first year of treatment and in patients with metabolic disorders, is crucial. Prompt drug discontinuation, aggressive lipid-lowering therapy, and supportive care are key to management.

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