Exemestane – Quick Guide for Patients and Providers

Exemestane is a steroidal aromatase inhibitor used mainly after surgery or radiation for post‑menopausal women with hormone‑responsive breast cancer. It blocks estrogen production, slowing tumor growth that depends on the hormone.

How Exemestane Works

Unlike non‑steroidal inhibitors, Exemestane binds permanently to the aromatase enzyme, essentially turning it off for good. With less estrogen in the bloodstream, cancer cells lose a key growth signal. The drug is taken orally, reaches peak levels in about two hours, and has a half‑life of roughly 27 hours, so once‑daily dosing keeps estrogen suppression steady.

Practical Dosing and Safety Tips

The standard dose is 25 mg taken once a day, with or without food. Swallow the tablet whole; crushing it can change absorption. If a dose is missed, take it as soon as you remember unless it’s almost time for the next one – then just skip the missed dose.

Common side effects include hot flashes, joint or muscle pain, fatigue, and mild nausea. Bone loss is a real concern because estrogen helps protect bones. To counter this, many doctors recommend calcium 1,200 mg and vitamin D 800–1,000 IU daily, plus weight‑bearing exercise. If you notice severe joint pain, talk to your provider about NSAIDs or a short break from the drug.

Watch out for drug interactions. Strong CYP3A4 inhibitors such as ketoconazole can raise Exemestane levels, while inducers like rifampin may lower them. Anticoagulants like warfarin may need closer monitoring because Exemestane can affect blood clotting times.

Kidney function doesn’t impact Exemestane much, but severe liver disease can increase exposure. In those cases, dose reduction or a different aromatase inhibitor might be safer.

Before starting therapy, baseline labs are useful: liver enzymes, lipid profile, and a bone‑density scan. Follow‑up testing every six months helps catch any problems early.

Patients often wonder how long they need to stay on Exemestane. Typical treatment courses run for five years, but some clinicians stop earlier if the disease is fully controlled and side effects become hard to manage. Always discuss the plan with your oncologist.

Finally, lifestyle matters. Limit alcohol, avoid smoking, and keep a balanced diet rich in fruits and vegetables. These habits can lessen hot flashes and support overall health while you’re on the medication.

Exemestane is a proven tool in the fight against estrogen‑driven breast cancer. Knowing how it works, the right way to take it, and how to manage side effects can make the treatment smoother and more effective.