What is Exemestane?
Exemestane is a hormonal therapy. The usual purpose of this medicine is to reduce the risk of breast cancer recurrence and also control the spread of the breast cancer to distant parts of the body. The dose and duration of Exemestane therapy vary depending on the patient condition and doctor’s decision. [1,2]
The mechanism of action of Exemestane
The breast cancer progression often associated with rising level of estrogen. Estrogen is a sex hormone, which is naturally produced in the body to control several physiological functioning. But after menopause, ovaries unable to produce estrogen. Aromatose is an enzyme, which can change fatty tissues of the body to estrogen.
Exemestane acts as an Aromatose inhibitor and reduces the rising level of estrogen. Therefore, the early possibility of breast cancer due to the enhancement of estrogen is reduced.
However, tamoxifen is another hormonal therapy, which is primarily taken before the commencement of the Exemestane therapy. After continuing tamoxifen therapy for two to three years, Exemestane is recommended. [1,2,3]
Chemical description of Exemestane
The chemical name of the Exemestane is 6-methylenandrosta-1,4-diene-3,17-dione and the molecular formula is C20H24O2 with a molecular weight is 296.41. Exemestane is a slightly yellow crystalline powder and is readily soluble in N, N-dimethylformamide. It also soluble in methanol, but insoluble in water. 
Pharmaceutical industry prepared Exemestane as tablet dosage form and available in the pharmacy stores. The common brand name of Exemestane tablet is AROMASIN® . However, Exemestane is also available in capsule form. 
The usual dose of Exemestane is 25 mg once daily for a consecutive few years. Exemestane needs to take after a meal and maintain the same timing throughout the therapy.
Exemestane dosage form usually recommended as an adjuvant therapy for postmenopausal women who developed or have a high risk of estrogen-receptor positive breast cancer. The patients usually received 2 – 3 years tamoxifen. The goal of the switching to Exemestane is to complete the whole adjuvant hormonal therapy for five years.
Postmenopausal women with advanced breast cancer and following tamoxifen therapy also recommended Exemestane for completion of the therapy. [1,2]
Important Information related Exemestane Prescription
The chemotherapeutic agents usually interact with other medications and herbal supplements. It is always advisable to detail discussion of routine medications and supplemental products with your conchologist and pharmacist. Vitamins, over the counter medications and herbal supplemental products, are all included in the medication list, which needs to discuss.
- It is also recommended that additional hormonal therapy does not allow with Exemestane therapy.
- It is also suggested that individuals with Exemestane therapy require informing about the medication before pursuing any other treatment procedures including dental treatment.
- In the case of diabetic or other metabolic disorder, the patient should discuss with the doctor, as Exemestane therapy contains a small amount of sucrose (a type of sugar molecule). [1,2,3]
Precautionary Measure of Exemestane
The dosing of the Exemestane therapy is once a day, but it is very important to take the medication at the same time so that exact 24 hours cover. In short, if you are taking medication at morning, then throughout the therapy patient need to continue the therapy at morning time.
- In the case of missing any dose, the patient should not take a double dose at a time.
- Avoid direct exposure of the medications to sunlight or heat. Keep the medications at room temperature within the original package. The preferable storage temperature is 25 °C (77ºF). The allowable temperature exposure is 15°–30°C (59°–86°F).
- Exemestane need to keep in safe place and out of the reach of the children
- Before purchasing the medication, get a newly updated prescription for Exemestane therapy.
- During Exemestane therapy, proper rest is required, therefore arrange leave/ holidays to start the medication
- After stopping the Exemestane therapy, remaining medication needs to return to the pharmacist. [3,4,5]
Side effects associated with Exemestane
Some of the most common side effects are included with Exemestane therapy. The enlisted side effects may not appear all in each individual with Exemestane therapy. But apart from these enlisted side effects, some of the rare types of side effects may appear, which are not included here. It is always advisable that patient should discuss the side effects with their doctors. The included side effects are as follows:
- Hot flushes and sweats are common symptoms, but the intensity of the side effects vary from patients to patients. Avoiding intake of alcohol, coffee, nicotine can also reduce this side effect intensity. In the case of intolerable discomfort, the doctor may lower the dose or prescribe other medications depending upon the side effect.
- Joint stiffness and muscular pain associated with Exemestane therapy can reduce the body flexibility. Body weight management is very important to control this condition.
- Exemestane therapy can cause indigestion, pain in the stomach, and feeling of sickness. Therefore, Exemestane therapy needs to take with a meal and avoid to take in empty stomach.
- Exemestane therapy can cause a feeling of tiredness, sleepy, or lack of energy. Adequate rest, healthy life style can minimize the symptom.
- A headache is another side effect associated with Exemestane therapy. Painkiller may require in case of uncontrollable pain.
- Exemestane therapy related mild diarrhea is also common and for which adequate fluid (2 liters) intake is very important to reduce the scope of dehydration. But in the case of prolonging or severe diarrhea, then immediate medical advice required to control the condition.
- Sleep disturbance or insomnia is also considered as a side effect of Exemestane therapy. To combat this problem, warm shower or milky drink intake need to take before bed.
- Mood swing is also associated with Exemestane therapy. Discuss with the doctor for a solution.
- Skin rash can appear with Exemestane therapy, but it is very important to take medical advice immediately.
- Mild to moderate hair fall and thinning of hair is also associated with Exemestane therapy. But after stopping the therapy, hair growth regain.
- Dizziness may also associate with Exemestane therapy. [1,3,4]
- Exemestane (Aromasin ®). http://www.macmillan.org.uk/
- Cancer Research UK. http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/exemestane-aromasin
- Aromasin. http://www.rxlist.com/aromasin-drug.htm
- Exemestane. http://www.webmd.com/drugs/2/drug-17764/exemestane-oral/details
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