Home Drug Guide Exemestane

Drug Guide

Generic Name

Exemestane

Brand Names Aromasin

Classification

Therapeutic: Antineoplastic agent, Aromatase inhibitor

Pharmacological: Steroid irreversible aromatase inhibitor

FDA Approved Indications

  • Treatment of estrogen receptor-positive breast cancer in postmenopausal women

Mechanism of Action

Exemestane irreversibly binds to aromatase enzyme, decreasing estrogen synthesis, which reduces estrogen-dependent tumor growth in hormone receptor-positive breast cancer.

Dosage and Administration

Adult: 25 mg orally once daily, preferably after a meal

Pediatric: Not approved for pediatric use

Geriatric: Adjust dosage based on clinical response; no specific dosage change required solely due to age

Renal Impairment: No dose adjustment required

Hepatic Impairment: Use with caution; no specific dose adjustment recommended

Pharmacokinetics

Absorption: Well absorbed after oral administration

Distribution: Widely distributed; plasma protein binding approximately 90%

Metabolism: Metabolized in the liver primarily via reduction and conjugation

Excretion: Excreted mainly in urine as conjugates; minor fecal excretion

Half Life: Approximately 26 hours

Contraindications

  • Hypersensitivity to exemestane or any components of the formulation

Precautions

  • Use cautiously in patients with a history of osteoporosis or at risk for osteoporosis; monitor bone mineral density.
  • Not recommended for premenopausal women. Use in pregnancy is contraindicated due to potential fetal harm and teratogenic effects.
  • Lactation: No data available; caution advised, breastfeeding is not recommended.

Adverse Reactions - Common

  • Hot flashes (Common)
  • Fatigue (Common)
  • Night sweats (Common)
  • Nausea (Common)
  • Arthralgia (Common)

Adverse Reactions - Serious

  • Osteoporosis and fractures (Less common)
  • Hyperglycemia (Less common)
  • Allergic reactions including rash, pruritus, angioedema (Rare)

Drug-Drug Interactions

  • Tamoxifen (may reduce effectiveness)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor bone mineral density periodically; assess for symptoms of osteoporosis; evaluate liver function before and during treatment.

Diagnoses:

  • Risk for osteoporosis
  • Ineffective coping due to menopausal symptoms

Implementation: Administer with food; counsel patient on calcium and vitamin D intake to support bone health; monitor liver function tests periodically.

Evaluation: Assess for relief of tumor symptoms; monitor bone density and calcium levels.

Patient/Family Teaching

  • Report any new or worsening symptoms such as bone pain, fractures, or severe hot flashes.
  • Maintain adequate calcium and vitamin D intake.
  • Inform about potential osteoporosis risk.
  • Do not double dose if a dose is missed.
  • Avoid pregnancy; use effective contraception during treatment and for some time after discontinuation.

Special Considerations

Black Box Warnings:

  • Potential to cause osteoporosis and fractures; monitor bone health regularly.

Genetic Factors: Limited data on genetic variations affecting response.

Lab Test Interference: May affect liver function tests.

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, hypotension, somnolence

Treatment: Supportive care; standard measures for overdose; no specific antidote.

Storage and Handling

Storage: Store at room temperature (20°C to 25°C / 68°F to 77°F), away from moisture and light.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.