exemestane: clinical use

Prescribing considerations

• Confirm postmenopausal endocrine status when clinically uncertain, using LH, FSH and oestradiol where appropriate.
• Assess baseline bone health in early disease when osteoporosis is present or likely; assess advanced-disease patients individually.
• Consider checking vitamin D before aromatase-inhibitor treatment and correct deficiency.
• Use caution in hepatic or renal impairment because systemic exposure may be increased.

Contraindications and cautions

• Hypersensitivity to exemestane or a formulation excipient
• Premenopausal endocrine status
• Pregnancy
• Breastfeeding
• Selected film-coated product: rare glucose-galactose malabsorption
• Aromasin: rare fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency

Monitoring

• Menopausal status when clinically uncertain
• Bone mineral health and fracture risk
• Vitamin D status where appropriate
• Treatment response and adverse effects, including hepatic or severe skin symptoms

Clinical pharmacology

Exemestane is an irreversible steroidal aromatase inhibitor. It is metabolised through CYP3A4 and aldoketoreductases; food increases bioavailability, and its metabolites are inactive or less active than the parent compound.

Formulation and product differences

• The selected generic is a yellow film-coated tablet containing glucose and is described as essentially sodium-free.
• Aromasin is an off-white coated tablet containing sucrose and methyl parahydroxybenzoate; the preservative may cause delayed allergic reactions.
• Tablet appearance and excipients differ, so check the individual product when allergy or carbohydrate-malabsorption concerns apply.

Tablet

Route: Oral

Strengths: 25 mg