Aromasin (exemestane) is a potent, steroidal aromatase inhibitor designed for the targeted management of estrogen levels in postmenopausal women with hormone-receptor positive breast cancer. By irreversibly binding to the aromatase enzyme, it effectively suppresses estrogen synthesis, a key driver in cancer progression. This medication is a cornerstone of adjuvant therapy, often prescribed following initial treatment to reduce the risk of recurrence. Its selective action and well-studied profile make it a trusted option for long-term hormonal control, aligning with modern oncological standards for safety and efficacy.

Features

• Active ingredient: Exemestane 25 mg
• Classification: Steroidal aromatase inhibitor (irreversible, Type I)
• Administration: Oral tablet
• Bioavailability: Approximately 42% following oral administration
• Half-life: 24 hours
• Metabolism: Hepatic, primarily via CYP3A4
• Excretion: Urine and feces
• Packaging: Blister packs of 30 tablets

Benefits

• Significantly reduces the risk of breast cancer recurrence in postmenopausal women
• Lowers systemic estrogen levels by >90% through irreversible enzyme inhibition
• May help preserve bone density compared to non-steroidal inhibitors when managed appropriately
• Does not require corticosteroid replacement therapy
• Convenient once-daily dosing supports treatment adherence
• Demonstrated overall survival benefit in clinical trials

Common use

Aromasin is primarily indicated for the adjuvant treatment of postmenopausal women with estrogen-receptor positive early breast cancer who have received 2-3 years of tamoxifen and are switched to complete a total of 5 years of adjuvant hormonal therapy. It is also used for the treatment of advanced breast cancer in postmenopausal women whose disease has progressed following tamoxifen therapy. Off-label uses may include estrogen control in certain endocrine disorders or as part of fertility treatments, though these applications require specialist supervision.

Dosage and direction

The recommended dosage is one 25 mg tablet taken orally once daily after a meal. Administration with food enhances bioavailability. Treatment should continue for the duration prescribed by the healthcare provider, typically until disease progression or completion of adjuvant therapy. Tablets should be swallowed whole with water and not crushed or chewed. Dosage adjustment is not typically required for elderly patients but may be necessary in those with severe hepatic impairment.

Precautions

Regular monitoring of bone mineral density is recommended due to potential bone loss. Baseline and periodic lipid profiles should be obtained. Patients should be advised about potential dizziness and cautioned against driving or operating machinery until they know how Aromasin affects them. Use with caution in patients with pre-existing liver conditions or those taking medications metabolized by CYP3A4. Pregnancy must be excluded before initiation as the medication can cause fetal harm.

Contraindications

Aromasin is contraindicated in premenopausal women, pregnant women, and nursing mothers. It should not be used in patients with known hypersensitivity to exemestane or any component of the formulation. Concomitant use with estrogen-containing medications is contraindicated. Patients with severe hepatic impairment (Child-Pugh Class C) should not use this medication without careful risk-benefit assessment.

Possible side effects

Common side effects (≥10%) include hot flashes, fatigue, arthralgia, headache, insomnia, and increased sweating. Less frequently (1-10%), patients may experience nausea, depression, dizziness, carpal tunnel syndrome, and peripheral edema. Serious but rare side effects (<1%) include osteoporosis with fractures, cardiovascular events, and elevated liver enzymes. Most side effects are mild to moderate and often diminish with continued therapy.

Drug interaction

Strong CYP3A4 inducers (rifampicin, phenytoin, St. John’s wort) may decrease exemestane concentrations. Concomitant use with estrogen-containing therapies may diminish its pharmacological effect. Caution is advised with drugs that prolong QT interval. Exemestane may increase the blood levels of drugs metabolized by CYP2B6, CYP2C8, and CYP2C9. Healthcare providers should review all concomitant medications before initiation.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. In that case, skip the missed dose and resume the regular schedule. Do not double the dose to make up for a missed one. Maintain consistent dosing timing to ensure stable estrogen suppression.

Overdose

There is limited experience with Aromasin overdose. Single doses up to 800 mg have been administered without serious adverse effects. In case of suspected overdose, symptomatic and supportive treatment is recommended. Dialysis is unlikely to be beneficial due to high protein binding. Contact poison control or emergency services immediately for guidance.

Storage

Store at room temperature (20-25°C or 68-77°F) in the original container. Protect from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Do not transfer tablets to other containers as this may affect stability.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Aromasin is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual results may vary. Always consult with your physician for diagnosis and treatment options appropriate for your specific medical condition.

Reviews

Clinical studies demonstrate Aromasin’s efficacy in reducing breast cancer recurrence by approximately 25% compared to continued tamoxifen therapy. The IES (Intergroup Exemestane Study) showed significant improvement in disease-free survival. Many patients report satisfactory tolerance, though individual experiences with side effects vary. Long-term follow-up data confirms maintained efficacy with an acceptable safety profile over extended treatment periods.