Description

Exemestane 25 mg (Aromasin®) – Oral Aromatase Inhibitor for ER‑Positive Breast Cancer

Exemestane 25 mg, marketed as Aromasin®, is a steroidal aromatase inhibitor taken once daily by mouth. It non-reversibly blocks aromatase, reducing estrogen synthesis in post‑menopausal women. 

✅ Indications & Dosing

• Adjuvant treatment for post‑menopausal women with ER-positive early breast cancer after 2–3 years of tamoxifen, to complete a total of 5 years. 
• Treatment for advanced or metastatic breast cancer in women whose disease progressed following tamoxifen. Exemestane 25 mg once daily is continued until progression. 

⚙️ Mechanism of Action

As a steroidal AI, exemestane irreversibly binds to and inactivates aromatase (Type I “suicide inhibitor”), which permanently inhibits estrogen production, limiting ER-positive tumor growth. 

⚠️ Side Effects & Precautions

• **Common**: hot flashes, fatigue, joint pain/arthralgia, headache, insomnia, sweating, increased appetite. 
• **Serious risks**: reduced bone mineral density/osteoporosis, fracture risk, heart problems (angina, MI), possible blood clots. Bone density should be monitored. 
• Other: nausea, dizziness, hair thinning, depression, elevated blood pressure. 

🩺 Monitoring & Safety Advice

• Baseline and periodic bone density scans and vitamin D evaluation, especially in patients with osteoporosis risks. 
• Advise calcium and vitamin D supplementation as needed and lifestyle measures. 
• Contraindicated in pre‑menopausal women (including pregnancy and lactation) and males. 
• Avoid CYP3A4 inducers like rifampin, which may reduce exposure and effectiveness. 

🌿 Benefits of Aromasin

• A steroidal AI that offers irreversible enzyme inactivation—structure similar to androgen substrate. 
• Simple once-daily dosing improves compliance. No routine dose calculations required. 
• Well-studied in large trials showing reduced recurrence risk when switching post‑tamoxifen. 

❓ Frequently Asked Questions (FAQs)

1. Can I take Aromasin without food?

Yes—take it with or after a meal to minimize gastric upset, but maintain consistent timing daily. 

2. What if I miss a dose?

If remembered the same day, take it; if not, skip and resume regular schedule. Do not double. 

3. How long is treatment recommended?

Treatment typically lasts up to 5 years in early breast cancer; for metastatic disease, continue while clinically effective. Early discontinuation increases recurrence risk. 

4. What measures prevent bone loss?

Use calcium/vitamin D, weight‑bearing exercise, and bisphosphonates or denosumab when indicated. Bone density monitoring is critical.

5. Do men ever use exemestane?

Exemestane is not FDA-approved in men. Use in post‑menopausal women only, except in off‑label settings like male breast cancer as per specialist advice.