fulvestrant

Faslodex

Pharmacologic class: Estrogen receptor antagonist

Therapeutic class: Antineoplastic

Pregnancy risk category D

Action

Inhibits cell division by binding with and downgrading estrogen receptor protein in breast cancer cells

Availability

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

Contraindications

• Hypersensitivity to drug

• Pregnancy

Precautions

Use cautiously in:

• bleeding disorders, hepatic dysfunction, thrombocytopenia

• breastfeeding patients.

Administration

• Expel air bubble from syringe before giving injection.

• Administer I.M. injection slowly.

Adverse reactions

CNS: depression, light-headedness, dizziness, headache, hallucinations, vertigo, insomnia, paresthesia, anxiety, weakness

CV: chest pain, vasodilation, peripheral edema

EENT: pharyngitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, anorexia

GU: urinary tract infection, pelvic pain

Hematologic: anemia

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

Interactions

Drug-drug. Anticoagulants: increased bleeding risk

Patient monitoring

• Monitor CBC.

• Assess liver function test results.

Patient teaching

• 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.

See 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.

fulvestrant

(ful-vess-trant) fulvestrant,

Faslodex

(trade name)

Classification

Therapeutic: antineoplastics
Pharmacologic: estrogen receptor antagonists
Pregnancy Category: D

Indications

Treatment of hormone receptor-positive metastatic breast cancer in postmenopausal women with progressive disease that has not responded to antiestrogen therapy.

Action

Competitively binds to estrogen receptors. Binding results in down-regulation of estrogen receptor protein in cancerous breast tissue.

Therapeutic effects

Decreased progression of hormone receptor-positive breast cancer.

Pharmacokinetics

Absorption: Well absorbed following IM administration.Distribution: Rapidly and extensively distributed.Protein Binding: 99%.Metabolism and Excretion: Mostly metabolized by the liver; negligible renal elimination.Half-life: 40 days.

Time/action profile (effect on estrogen receptors)

ROUTE	ONSET	PEAK	DURATION
IM	rapid	7 days	30 days

Contraindications/Precautions

Contraindicated in: Obstetric / Lactation: Pregnancy or lactation; Pediatric: Children; Hypersensitivity; Bleeding disorders, thrombocytopenia, concurrent anticoagulant therapy.Use Cautiously in: Moderate to severe hepatic impairment.

Adverse Reactions/Side Effects

Central nervous system

headache (most frequent)
weakness (most frequent)
anxiety
depression
dizziness
insomnia

Ear, Eye, Nose, Throat

pharyngitis (most frequent)

Respiratory

cough (most frequent)
dyspnea (most frequent)

Cardiovascular

vasodilation (hot flushes) (most frequent)
chest pain
edema

Gastrointestinal

abdominal pain (most frequent)
constipation (most frequent)
diarrhea (most frequent)
nausea (most frequent)
vomiting (most frequent)
anorexia

Genitourinary

pelvic pain
urinary tract infection

Dermatologic

rash
sweating

Local

pain/inflammation at injection site (most frequent)

Hematologic

anemia

Musculoskeletal

back pain (most frequent)
bone pain (most frequent)
arthritis

Neurologic

paresthesia

Miscellaneous

fever
flu syndrome

Interactions

Drug-Drug interaction

None known.

Route/Dosage

Intramuscular (Adults) 500 mg on days 1, 15, and 29, and then once monthly (given as two injections of 250 mg (5 mL) each).

Hepatic Impairment

Intramuscular (Adults) Moderate hepatic impairment—250 mg on days 1, 15, and 29, and then once monthly (given as a single injection).

Availability

Solution for injection: 50 mg/mL in 5–ml prefilled syringes

Nursing implications

Nursing assessment

Assess patient for pain and other side effects periodically throughout therapy.

Potential Nursing Diagnoses

Acute pain (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

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.

Patient/Family Teaching

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.

Evaluation/Desired Outcomes

Slowing of disease progression in women with advanced breast cancer.