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Some people notice stronger appetite suppression right away because of the GIP component

Since macrophages are key immune cells in the fight against cancer and pathogen invasion ( Molecular and Cellular Mechanisms of Tamoxifen Action On and Off-Targets Orally administered tamoxifen undergoes hepatic conversion into active metabolites, such as 4-hydroxytamoxifen (4HT), that compete with the endogenous sex steroid hormones, estrogens, for binding to intracellular receptors, estrogen receptor alpha (ER ) and beta (ER )

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Common effects include: Dry mouth Insomnia Increased heart rate Nervousness or restlessness Mild blood pressure elevation Best practices include early dosing, hydration, stimulant avoidance, and regular monitoring of blood pressure and heart rate