8 Exemestane (Aromasin) Side Effects and How to Manage Them

GoodRx Health

Exemestane (Aromasin) is a type of oral hormone therapy called an aromatase inhibitor. It's used to treat estrogen-receptor (ER) positive breast cancer in women who have experienced menopause. The medication treats breast cancer by lowering the amount of estrogen in the body.

When taken as prescribed, exemestane is a beneficial treatment. But the side effects can sometimes make it hard for people to stick to their prescribed medication schedule. This can make exemestane less effective.

If you're taking exemestane, it's important to be aware of the possible side effects. Being able to quickly recognize and manage exemestane side effects will ensure you get the maximum benefit from the treatment.

Exemestane side effects at a glance

Lowering the amount of estrogen in the body is an effective way to stop the growth of ER-positive breast cancers. However, sudden drops in estrogen can also cause unwanted side effects. These side effects can be uncomfortable and resemble symptoms of menopause, which may cause some people to stop treatment altogether.

Common exemestane side effects include:

• Hot flashes

• Headaches

• Nausea

• Joint pain

• Hair thinning

• Increased appetite

• Increased sweating

• Fatigue, or tiredness

• Insomnia, or trouble sleeping

While rare, some people taking exemestane have experienced serious heart problems or bone thinning.

Below, we'll take a closer look at eight key exemestane side effects to look out for and what you can do to manage them.

1. Hot flashes and sweating

Hot flashes are one of the most common side effects of exemestane. During a hot flash, you may feel warmth throughout your upper body, including your face, neck, and chest. Sweating is also common, since this is the body's way of cooling down.

Hot flashes are uncomfortable and can have a substantial impact on your daily life. If you start having hot flashes while taking exemestane, it's best to reach out to your oncologist (cancer specialist) to discuss management options.

In the meantime, there are a few things you can do to manage hot flashes on your own:

• Wear loose-fitting clothing and dress in layers.

• Avoid spic

• Use fans and open windows to increase air flow.

• Participate in activities that you find to be stress relieving, such as yoga or meditation.

2. Thinner bones

Osteopenia is a health condition in which bones begin to thin and lose their strength. Over time, osteopenia can turn into osteoporosis, which increases the risk of bone fractures or breaks. In clinical studies, some people taking exemestane developed osteoporosis.

Exemestane can cause bone thinning because it reduces estrogen levels in the body. Estrogen normally slows down the natural breakdown of bone in the body.With less estrogen available, bone is broken down faster than it can be replaced.

Before you start taking exemestane, your oncologist will likely check your calcium and vitamin D levels and perform a bone mineral density test (DEXA scan). Calcium and vitamin D are both key players in bone health.

Your oncologist may recommend that you take calcium and vitamin D supplements while taking exemestane - especially if your levels are low. It's also helpful to incorporate foods that are rich in calcium and vitamin D, such as milk and fish, into your diet.

3. Joint pain

Joint symptoms are the most common reason that people stop taking exemestane. While it typically begins around 6 weeks after starting exemestane, joint pain can happen at any time during treatment. And it can affect any joint in the body, including the knees, wrists, and hips. Joint stiffness and swelling are also possible.

You can get ahead of joint pain by exercising regularly; engaging in any physical activity that you enjoy can help manage pain and improve joint mobility. If your body mass index (BMI) is greater than 30, losing weight can also relieve some pressure off of the joints, if possible.

For mild joint pain, pain relievers such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) may also provide relief. But you shouldn't take them long term.

Your oncologist can help you figure out the best management options if you begin to experience joint pain while taking exemestane.

4. Fatigue or insomnia

Fatigue, or tiredness, is very common among people living with cancer. Fatigue can happen for many different reasons, including because of the cancer itself or the medications, such as exemestane, used to treat it.

On the other hand, it's also possible to experience insomnia while taking exemestane. This can make you feel fatigued the following day.

Insomnia may or may not be related to nighttime hot flashes (night sweats). But experiencing night sweats with exemestane can make it harder to sleep soundly. Talking to your oncologist about how to best manage night sweats may be enough to help with your insomnia.

It can also help to:

• Set a regular time to go to bed and to wake up, including on the weekends

• Avoid eating or exercising 3 hours before bedtime

• Limit caffeine and alcohol throughout the day

• Avoid liquids a few hours before bedtime

5. Headaches

Headaches related to exemestane are generally mild. But you can lower your risk for headaches by exercising regularly, getting plenty of sleep, and staying well hydrated throughout the day. If you do experience headaches, placing a cold compress over your head or taking a pain reliever can help.

If you have persistent headaches, look out for possible patterns. Are there any foods or smells that set off your headaches? Do you find that you get headaches if you're hungry or haven't had enough sleep? Recognizing things that trigger your headaches may be the best way to prevent them from happening in the future.

6. Nausea

It's possible to experience nausea while taking exemestane. But the risk of vomiting is low.

Still, before you start treatment, your oncologist may prescribe you an antiemetic (anti-nausea) medication like ondansetron. And then, you can take it if you begin to experience nausea.

In addition to antiemetic medications, there are certain strategies you can try to keep nausea at bay:

• Temporarily stick to bland foods, such as bananas, toast, and rice.

• Eat five to six smaller meals a day instead of three large ones.

• Don't skip meals, since an empty stomach can make nausea worse.

If you continue to have nausea with exemestane, reach out to your oncologist. They may prescribe you a different antiemetic medication or recommend you take an antiemetic more regularly.

7. Certain changes on lab tests

It's possible to develop a lower-than-normal amount of white blood cells while taking exemestane. Since white blood cells are necessary to fight infections, this could raise your risk of infection.

Serious infections don't happen very often with exemestane. But it's important to let your oncologist know if you have any symptoms of infection - including fever, chills, or cough - as a precaution.

Another potential change is elevated liver enzymes. This is rare and mostly happens in people whose cancer has spread to their liver or bones. But the risk is also higher if you're taking other medications that interact with exemestane, such as phenytoin (Dilantin) or carbamazepine (Tegretol).

8. Heart problems

While rare, serious heart problems have occurred in some people taking exemestane. This includes heart attacks, heart failure, and irregular heart rhythms. High blood pressure is also possible.

The risk for serious heart problems is higher in people who take exemestane for more than 4 years, have certain medical conditions, or are older than 75.

If you're taking exemestane as an adjuvant treatment, your oncologist may recommend switching to a different hormone therapy, such as tamoxifen (Soltamox), after 2 to 3 years. This can reduce the risk of heart problems without compromising your treatment. Or they may suggest a different medication entirely.

Let your oncologist know right away if you experience any concerning heart-related side effects. And if you have any symptoms of a heart attack, such as chest pain, shortness of breath, or sweating, call 911 or go to the nearest ER right away.

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