Posted on April 28th, 2009 by
Class: Hormonal therapy
Generic Name: Exemestane (ecks-uh-MESS-tane)
Trade Name: Aromasin®
For which conditions is this drug approved? Exemestane is FDA approved for the treatment of hormone-positive breast cancer in postmenopausal women who have already been treated with the anti-estrogen agent tamoxifen (Nolvadex®). It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Exemestane belongs to a group of drugs referred to as anti-aromatase agents. Exemestane produces its anti-cancer effects by inhibiting the production of the female hormone estrogen in the body. A significant portion of breast cancers, referred to as estrogen- or hormone-positive, are stimulated to grow by estrogen, which circulates in the blood stream and binds to cancer cells. By inhibiting estrogen production, the growth stimulus of the cancer cells is removed, causing cancer cells to stop growing and/or die.
How is exemestane typically given (administered)? Exemestane is taken orally, once per day after a meal. Patients should try to take exemestane around the same time every day.
How are patients typically monitored? Patients will usually have scheduled meetings for follow-up during treatment with exemestane. Physicians may perform a physical examination, scans or other measures to assess side effects and response to therapy. If a physician feels that a patient is at risk for osteoporosis (reduction in bone density), scans to determine bone density may be ordered prior to or during treatment with exemestane, as the risk of bone fractures may be increased during treatment.
What are the common (occur in 30% or more of patients) side effects of treatment with exemestane?
There are no documented side effects that occur in 30% or more of patients treated with exemestane.
What are the less common (occur in 10% to 29% of patients) side effects of treatment with exemestane?
• Hot flashes
• Bone pain
• Difficulty sleeping
• Difficulty breathing
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What can patients do to help alleviate or prevent discomfort and side effects?
• Patients who experience hot flashes may wish to wear light clothing, stay in a cool environment, and place cool cloths on their body or head to relieve their symptoms.
• Over the counter pain medications may help to alleviate the aches or pains that may be caused by treatment; it is important to thoroughly discuss these options with a physician.
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• Eat small meals frequently to help alleviate nausea.
Are there any special precautions patients should be aware of before starting treatment?
• Patients should inform their physician if they are pregnant or breastfeeding as exemestane is typically only administered to postmenopausal women.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Due to potential dizziness, drowsiness or confusion, patients should avoid driving or other tasks which require mental alertness until their individual response to the medication is known.
When should patients notify their physician?
• Prolonged or severe nausea
• Severe weakness or fatigue
• Bone pain after a fall or trauma, as this may indicate a bone fracture
• Extreme pain
• Extreme depression or anxiety
What is a package insert? A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
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