How does this medication work? What will it do for me?

Exemestane belongs to the group of cancer-fighting medications known as antineoplastics. Exemestane is often used to treat breast cancers that depend on estrogen for growth and survival. It is used to treat breast cancer in women who are past menopause and who are no longer responding to the beneficial effects of tamoxifen, another antineoplastic medication. Exemestane may also be used to treat advanced breast cancer in post-menopausal women who have had the disease continue to grow, even after anti-estrogen treatment.

Exemestane fights cancer by attaching to and inactivating an enzyme called aromatase. This prevents the aromatase enzyme from supplying the estrogen that allows certain types of breast cancers to grow and survive.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each white, film-coated, round, biconvex tablet with "EM" on one side and a logo on the other side, contains exemestane 25 mg. Nonmedicinal ingredients: butylated hydroxyanisole, butylated hydroxytoluene, colloidal anhydrous silica, crospovidone, hydroxypropylcellulose, lecithin, magnesium stearate, mannitol, polysorbate, polyvinyl alcohol, sodium starch glycolate, talc, titanium dioxide, and xanthan gum.

How should I use this medication?

The recommended dose of exemestane is 25 mg once daily, at the same time each day, taken after a meal.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a different dose than the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Exemestane should be stored at room temperature and kept out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take exemestane if you:

  • are allergic to exemestane or any ingredients of this medication
  • are pregnant or breast-feeding
  • have not entered menopause

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal or stomach pain
  • anxiety
  • burning, tingling, or prickly sensations
  • confusion
  • constipation
  • decreased sense of touch
  • diarrhea
  • dizziness
  • general feeling of tiredness or weakness
  • headache
  • hot flashes
  • increased appetite
  • increased sweating
  • itching
  • joint pain
  • loss of appetite
  • loss of hair
  • muscle pain or cramps
  • nausea
  • pain
  • rash
  • runny nose
  • trouble sleeping
  • vomiting
  • weakness
  • weight gain

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • anxiety
  • back pain
  • bone pain
  • flu-like symptoms (e.g., cough, hoarseness, sore throat, fever or chills)
  • increased blood pressure
  • signs of carpal tunnel syndrome (pain or burning in the hands or wrists)
  • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
  • symptoms of liver damage (e.g., yellow skin or eyes, dark urine, clay-coloured stools, loss of appetite, nausea and vomiting, or itching)
  • signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
  • signs of a urinary tract infection (e.g., difficult or painful urination, blood in the urine, frequent urge to urinate, lower back or side pain)
  • swelling of hands, ankles, feet, or lower legs
  • unexplained broken bones
  • vaginal bleeding

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
  • signs of a blood clot in blood vessels, such as sudden vision change or dizziness, chest pain, pain and swelling in one leg muscle
  • sudden development of breathing problems (e.g., shortness of breath, trouble breathing, wheezing, tightness in chest, or fast or irregular breathing)
  • signs of a severe allergic reaction (e.g., hives; difficulty breathing; swelling of the face, lips, tongue, or throat)
  • signs of bleeding in the stomach or intestines (e.g., dark and tarry stools, blood coming from rectum, vomiting blood or material that looks like coffee grounds, fast heartbeat, weakness or fainting)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Heart problems: Exemestane may cause an increase in the risk of heart disease. If you have a history of heart disease, heart attack or angina, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you experience symptoms of heart problems such as chest pain, shortness of breath, and swelling of the wrists or legs, contact your doctor immediately.

Kidney function: If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: If you have reduced liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Osteoporosis: Exemestane may cause a decrease in the density and strength of bones. If you are at risk for developing osteoporosis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pre-menopause: Exemestane does not affect the estrogen that is produced by the ovaries (the main source of estrogen before menopause). The safety and effectiveness of exemestane has not been established for women who have not reached menopause. For these reasons, exemestane is not recommended to treat breast cancer occurring in women who have not reached menopause.

Stomach problems: This medication may increase the risk of stomach problems, including the development of ulcers. If you are taking medications that may cause ulcers, such as nonsteroidal anti-inflammatory medications (NSAIDs), or you have a history of stomach problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: Although the effect of exemestane is unclear, there is some evidence suggesting that taking this medication during pregnancy may cause harm to an unborn baby. Exemestane should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if exemestane passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between exemestane and any of the following:

  • aripiprazole
  • bosentan
  • carbamazepine
  • dabrafenib
  • deferasirox
  • dexamethasone
  • efavirenz
  • estrogens
  • etravirine
  • fosphenytoin
  • methadone
  • modafinil
  • oxcarbazepine
  • pentobarbital
  • phenytoin
  • primidone
  • rifabutin
  • rifampin
  • St. John's wort

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.