Action

Inhibits conversion of androgens to estrogen, which reduces estrogen concentrations and limits cancer cell growth in estrogen-dependent breast tumors

Availability

Tablets: 25 mg

Indications and dosages

➣ Advanced breast cancer

Adults: 25 mg P.O. once daily after a meal

Contraindications

• Hypersensitivity to drug or its components

• Premenopausal women, including pregnant women

Precautions

Use cautiously in:

• moderate to severe hepatic insufficiency or renal impairment

• concurrent use of estrogencontaining drugs

• breastfeeding patients

• children (safety and efficacy not established).

Administration

• 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.

Adverse reactions

CNS: headache, dizziness, confusion, asthenia, fatigue, weakness, hypoesthesia, paresthesia, pain, anxiety, insomnia, depression

CV: hypertension, chest pain

EENT: sinusitis

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

Interactions

Drug-drug. CYP3A4 inducers: decreased exemestane blood level

Patient monitoring

• 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.

Patient teaching

• 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.