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Pharmacologic class: Aromatase inhibitor
Therapeutic class: Hormonal antineoplastic
Pregnancy risk category D
Inhibits conversion of androgens to estrogen, which reduces estrogen concentrations and limits cancer cell growth in estrogen-dependent breast tumors
Tablets: 25 mg
Indications and dosages
➣ Advanced breast cancer
Adults: 25 mg P.O. once daily after a meal
• Hypersensitivity to drug or its components
• Premenopausal women, including pregnant women
Use cautiously in:
• moderate to severe hepatic insufficiency or renal impairment
• concurrent use of estrogencontaining drugs
• breastfeeding patients
• children (safety and efficacy not established).
• Administer after meals with a full glass of water.
• Know that drug shouldn't be taken by premenopausal women or by patients receiving drugs that contain estrogen.
CNS: headache, dizziness, confusion, asthenia, fatigue, weakness, hypoesthesia, paresthesia, pain, anxiety, insomnia, depression
CV: hypertension, chest pain
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, anorexia
GU: urinary tract infection
Musculoskeletal: pathologic fractures, arthritis, back pain, skeletal pain
Respiratory: dyspnea, cough, bronchitis, upper respiratory tract infection
Skin: rash, itching, alopecia, diaphoresis
Other: increased appetite, fever, hot flashes, infection, flulike symptoms, edema, lymphedema
Drug-drug. CYP3A4 inducers: decreased exemestane blood level
• Monitor vital signs, especially blood pressure.
• Check for adverse GI reactions. Give antiemetics, as prescribed, for nausea and vomiting.
• Assess bowel elimination pattern. Increase fluids and administer stool softeners, as needed, to ease constipation.
• Monitor pain level. Administer analgesics, as prescribed, to relieve pain.
• Monitor liver function tests, CBC, and blood urea nitrogen, creatinine, and electrolyte levels.
• Advise patient to take with full glass of water after a meal.
• Tell patient to report depression, insomnia, or excessive anxiety.
• Instruct patient to wear cotton clothing to let skin breathe if drug causes increased sweating or hot flashes.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs mentioned above.
Pharmacologic: aromatase inhibitors
Time/action profile (suppression of circulating estrogen)
|PO||unknown||2–3 days||4–5 days|
Adverse Reactions/Side Effects
Central nervous system
- fatigue (most frequent)
- thromboembolism (life-threatening)
- endometrial hyperplasia
- uterine polyps
- visual disturbances
- alopecia (most frequent)
- hot flashes (most frequent)
- increased sweating (most frequent)
- arthralgia (most frequent)
- musculoskeletal pain
- carpal tunnel syndrome
- muscle cramps
Drug-Drug interactionCYP3A4 inducers including rifampin or phenytoin may ↓ levels and effectiveness; ↑ daily dose to 50 mg once daily.Estrogens can interfere with action.
Availability (generic available)
- Assess patient for pain and other side effects periodically during therapy.
- Lab Test Considerations: May cause ↑ GTT, AST, ALT, alkaline phosphatase, bilirubin, and creatinine levels.
- Assess 25-hydroxy vitamin D levels prior to starting therapy. Supplement vitamin D deficiency with vitamin D due to high prevalence of vitamin D deficiency in women with early breast cancer.
Potential Nursing DiagnosesAcute pain (Side Effects)
- Take 1 tablet daily after a meal.
- Instruct patient to take exemestane as directed at the same time each day. Take missed doses as soon as remembered unless it is almost time for next dose. Do not double doses. Advise patient to read the Patient Information leaflet before starting and with each Rx refill; changes may occur.
- Advise patient not to take other estrogen-containing agents; may interfere with action of exemestane.
- Inform patient that lower level of estrogen may lead to decreased bone mineral density over time and increased risk of osteoporosis and fracture.
- Advise patient to notify health care professional immediately if chest pain or signs of heart failure or stroke occur.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
- Exemestane is teratogenic; advise female patients to use effective contraception during therapy and to avoid breast feeding.
- Explain need for follow-up blood tests to check liver and kidney function.
- Slowing of disease progression in women with breast cancer.
AromasinAn irreversible, steroidal aromatase-inactivating anti-oestrogen used in postmenopausal women with oestrogen-dependent/oestrogen-receptor-positive breast cancer.
Hot flushes, nausea, fatigue, increased sweating.