Exemestane
AROMASIN
Pronunciation: ex-e-MES-tayn (a-ROEM-a-sin)
What it isSteroidal, irreversible aromatase inhibitor; hormone-receptor-positive breast cancer after menopause.
Why this oneUnlike anastrozole and letrozole, it permanently inactivates aromatase and can be used after a nonsteroidal inhibitor.
What limits itAccelerated bone loss and arthralgia limit treatment. It is ineffective before menopause unless ovarian function is suppressed.
FDA-approved for
- hormone-receptor-positive breast cancer (1999)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Adjuvant early breast cancer (ER+, after 2–3 yr tamoxifen) | Postmenopausal women | 25 mg QD after a meal | 25 mg QD after a meal | 25 mg QD |
| Advanced breast cancer (progressed after tamoxifen) | Postmenopausal women | 25 mg QD after a meal | 25 mg QD after a meal | 25 mg QD |
Renal No adjustment needed
Hepatic No adjustment needed
Instructions
- Take one 25 mg tablet once daily after a meal
Available strengths
- tab 25 mg
Cautions
- Reductions in bone mineral density over time — assess BMD by densitometry at baseline in at-risk women
- Assess 25-hydroxy vitamin D before starting; supplement if deficient
- Not indicated in premenopausal women
- Embryo-fetal toxicity — advise effective contraception during and for 1 month after last dose
- Do not coadminister with systemic estrogen-containing agents (interferes with action)
Adverse reactions
- Hot flushes
- Fatigue
- Arthralgia
- Headache
- Insomnia
- Increased sweating
- Nausea (advanced disease)
Pregnancy Can cause fetal harm (abortions, embryo-fetal toxicity in animals); advise risk to fetus
Lactation Advise not to breastfeed during treatment and for 1 month after final dose
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 25 mg | tab | 30 qd | $22.43 | offered |
Generic entry2011
NO BOXED WARNINGS
Principal riskAccelerated bone loss and arthralgia
Classes and tags
Clinical profile
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityThrombotic, metabolic, hepatic, skeletal or reproductive toxicity varies by hormonal target.