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Pharmacologic class: Estrogen receptor antagonist
Therapeutic class: Antineoplastic
Pregnancy risk category D
Inhibits cell division by binding with and downgrading estrogen receptor protein in breast cancer cells
Prefilled syringes: 125 mg/2.5 ml, 250 mg/5 ml
Indications and dosages
➣ Hormone receptor-positive advanced metastatic breast cancer in postmenopausal women with disease progression who have received antiestrogen therapy
Adults: 250 mg I.M. q month as a single 5-ml injection or two concomitant 2.5-ml injections
• Hypersensitivity to drug
Use cautiously in:
• bleeding disorders, hepatic dysfunction, thrombocytopenia
• breastfeeding patients.
• Expel air bubble from syringe before giving injection.
• Administer I.M. injection slowly.
CNS: depression, light-headedness, dizziness, headache, hallucinations, vertigo, insomnia, paresthesia, anxiety, weakness
CV: chest pain, vasodilation, peripheral edema
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, anorexia
GU: urinary tract infection, pelvic pain
Musculoskeletal: back pain, bone pain, arthritis
Respiratory: dyspnea, increased cough
Skin: flushing, rash, diaphoresis
Other: food distaste, fever, hot flashes, injection site reactions, pain, flulike symptoms
Drug-drug. Anticoagulants: increased bleeding risk
• Monitor CBC.
• Assess liver function test results.
• Advise patient to report signs and symptoms of infection, especially urinary tract infection.
• Caution patient to avoid driving and other hazardous activities until she knows how drug affects concentration and alertness.
☞ Tell patient to notify prescriber immediately if she thinks she is pregnant.
• Teach patient comfort measures to minimize hot flashes and rash.
• Instruct patient to minimize GI upset and sore throat by eating frequent, small servings of healthy food and drinking adequate fluids.
• Tell patient that drug may cause headache, muscle aches, or bone pain. Encourage her to discuss activity recommendations and pain management with prescriber.
• Advise patient to establish effective bedtime routine to minimize sleep disorders.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs mentioned above.
Pharmacologic: estrogen receptor antagonists
Time/action profile (effect on estrogen receptors)
|IM||rapid||7 days||30 days|
Adverse Reactions/Side Effects
Central nervous system
- headache (most frequent)
- weakness (most frequent)
Ear, Eye, Nose, Throat
- pharyngitis (most frequent)
- cough (most frequent)
- dyspnea (most frequent)
- vasodilation (hot flushes) (most frequent)
- chest pain
- abdominal pain (most frequent)
- constipation (most frequent)
- diarrhea (most frequent)
- nausea (most frequent)
- vomiting (most frequent)
- pelvic pain
- urinary tract infection
- pain/inflammation at injection site (most frequent)
- back pain (most frequent)
- bone pain (most frequent)
- flu syndrome
Drug-Drug interactionNone known.
Hepatic ImpairmentIntramuscular (Adults) Moderate hepatic impairment—250 mg on days 1, 15, and 29, and then once monthly (given as a single injection).
- Assess patient for pain and other side effects periodically throughout therapy.
Potential Nursing DiagnosesAcute pain (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- A negative pregnancy test should be determined prior to initiation of treatment.
- Intramuscular: Follow proper technique for injection using the manufacturer's instructions for the use of the SAFETYGLIDE syringe and needle. Inject slowly over 1–2 min into the gluteus muscle as two 5–mL injections, one in each buttock.
- Inform patient that fulvestrant may cause mild pain and inflammation at injection site.
- Advise patient to use contraception during treatment with fulvestrant. May cause teratogenic effects and fetal death.
- Inform patient of potential for adverse reactions and advise her to notify health care professional.
- Advise patient to report an increase in pain so treatment with analgesics can be initiated.
- Slowing of disease progression in women with advanced breast cancer.