FEMARA
Comments
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Am I being silly to think that if I keep taking the Letrozole my hot flushes might be over sooner than if I stopped taking it?
I'm trying to convince myself to keep taking it cuz right now I just want to throw it away.
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I have had the trigger finger since before BC, but I did some PT exercises and it got better. Once on the letrozole, it got bad again, and now I have more fingers heading in that direction. What you can do are some stretches of the fingers. Pull them out, massage them. Pull them back and forth. Open and close the hand. The trigger finger is caused by a tendon that tightens, so you need to loosen it. I have co workers who have had surgery to cut the tendon and release the trigger finger. I refuse to do that. Done with surgery unless it is to save my life (or maybe recon).
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The tendon swelled at the base of my thumb in the palm. When I tried to straighten my knuckle closest to the nail it snappe and clicked. Went to a hand specialist OT that showed me the exercises and said try not to let it snap as it just inflames the tendon more. It gets caught in the pulley I wore a thumb splint for 3 weeks and when it didn't resolve had my doctor inject it with cortisone. Still wearing the thumb splint to rest it for 3 weeks more
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Where it was injected was in the center of the photo at the left edge of the discoloration area. Splint is "cool comfort CMC thumb splint" on Amazon
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Lifelover--I seem to notice fewer hot flashes on letrozole lately. I only started taking it in June so you've been on them much longer. Maybe the cooler weather helps? I guess I'm really not great at answering your question, but I can say this, please don't stop taking unless you discuss with your doctor. You don't want to end up stage iv.
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anyone having rib pain. Just noticed yesterday that there is an area right under my good boob that had reconstruction where the rib is hurts when I press on it. Or reach for something. Came out of the clear blue never felt it before. Any thoughts. I am already worrying myself to death. Keep searching for reasons other than.what we ally worry about Stsrted trying to tell myself it may be from my underwire bra. Bruising the area. It seems it's right under my scar from the lift and reduction which was six months ago.
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Thanks Ellelou. No I'll keep taking it. I've convinced myself that it's helping me mostly because of the hot flushes which I didn't have until I started taking hormonal therapy. It's just so difficult some days as I keep wiping sweat off my face. But yes, it could be worse so I will cope as long as i have to.
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Don't forget sweat gets the toxins out, it's a good thing
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Okay--let me clear up a few misconceptions here. First, trigger finger is NOT caused by the tendon sheath tightening, but rather by a nodule forming on the tendon that causes the sheath to get hung up on it, resulting in abrupt “hitches" in the arc of range of motion. The larger the nodule grows, the more the sheath “catches" until eventually it takes the other hand to push or pull the thumb into the desired position (temporarily, at that). I should know--I've had it occur twice in the same thumb a few years ago, long before cancer and Femara. The nodule formation can be caused by weight gain, diabetes or aging, especially in women. The symptoms of aging in women are precipitated by a drop in estrogen. AIs prevent estrogen production. Now, PT can do only so much. A cortisone shot can cause the nodule to soften and shrink to the point of free motion returning for awhile, but eventually the nodule regrows and the triggering returns. There is a highly effective minor outpatient surgery that cures it by making a slit in the sheath. It is done under local anesthesia and you needn't even undress.
The first time my thumb “triggered," I was all set to have the surgery, but my hand surgeon convinced me to give cortisone a try (for 1/10 the price of surgery). I had full relief for 3 yrs. When it returned, my surgeon & I wanted to go ahead immediately with the operation, but I had a tour coming up so soon I wouldn't have had enough time to recover and play. (17 shows in 5 days, with a major music conference afterward). So he gave me another shot and we scheduled the surgery for the day after my return. He didn't want to leave the cortisone in there for too long, as the same mechanism by which it dissolves or shrinks the nodule can also weaken the tendon itself. (That's why you can get a cortisone shot in the same spot only 3 times in your lifetime). So the first step in the surgery was to flush out the remaining cortisone, then follow with slitting the sheath. I began PT on the second day post-op; had 3 more sessions over the next 2 weeks; sutures removed and I was playing again. As surgeries go, it's second in effectiveness only to tooth extraction and more effective than cataract surgery!
Second, NSAIDs such as Aleve and ibuprofen, while they can be toxic to the kidneys in large amounts (as can ALL analgesics), do not cause swelling except in people allergic to them (not very common)--as anti-inflammatories they reduce swelling better than anything out there short of a steroid (e.g., cortisone). They do, however, increase bleeding and can even cause GI bleeds if taken to excess or for too long. For pure pain without swelling, the most effective analgesics are opioids with or without acetaminophen; if going strictly OTC, straight acetaminophen is best (especially if you have GERD or ulcers or are on blood thinners). If pain is caused strictly by inflammation, acetaminophen, especially with an opioid, will reduce the pain but it will have no effect on the inflammation itself.
Finally, if an AI is going to give you side effects it won't be until you've cleared all the preexisting estrogen from your system. That can take a few days to a few weeks. The side effects will wane once your body gets used to not having circulating estrogen. For most people, that's pretty quickly, but for some it can take months. (For a few, it takes much longer).
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lifeover....have you tried taking magnesium supplements for your hot flashes? It has helped a lot of women. I was taking them before BC but stopped briefly and encountered a few hot flushes...now I'm back on them. You have to play around with the amount you take that will be the most effective for you. Helps with a bunch of other stuff too....ie restless leg syndrome, heart palpitations, irregularity, sleeplessness.
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Just a note on magnesium. I have to watch how much I take. Too much gives me diarrhea.
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wow, that is some pretty good information there chiSandy! Thanks.
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Update ladies.......I was on Letrozole for three and a half years and my s/e got progressively worse......joint, muscle and bone pain. My energy level was practically non existent. For the past two months I have been taking Femera (name band) and the difference is quite remarkable. I can actually bend my knees now and my energy level has gone from zero to about a seven. My muscle, bone and joint pains have also gone from a ten down to a four. ....I'll take it. I've learned that there is quite a difference in fillers between
generic and brand name.
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Scottiee1, I'm on Letrozole. Do you know the difference in cost
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That is pretty interesting as i was on Letrozole and have had a major issue with liver enzymes which they think is this drug. I wonder if getting the name brand would help......
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Marijen, my insurance company has approved it. (Sunlife)......It is very expensive if you have to pay yourself......more than $200 for a one month suppl
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are the active ingredients the same???
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yes, just a difference in fillers
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Scottiee, I ran a pricing check through Silverscript - what I have and AARP Medicare Preferred RX and they both don't cover.
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I might have to check into that. I have been on it for ten months. Developed the start of osteoporosis trigger finger and joint pain. Did you end withosteoporosis?
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I have a bone density test scheduled for January.....will keep you updated
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I just found out that my Medicare Part D plan (Humana Enhanced, which I chose for its larger formulary) will NOT cover brand name drugs as long as there are generics available. From everything I've read here, the side effects of generic letrozole are far worse than those of Femara, despite conventional wisdom (Consumer Reports, even BCO's research pages) that “the only difference is the name and the price." I know this is bullshit--my psychiatrist warned me off a certain generic version (uncoated, tan, football-shaped, acetic smell) of bupropion (brand name is Wellbutrin) because this particular version was reported to cause seizures in normal doses whereas seizures were attributed to branded Wellbutrin only when taken in excessive doses. I also used to get marvelous blood pressure control with the brand-name Avalide; but then my insurance company discontinued covering it and insisted I switch to the generic version of a DIFFERENT angiotensin-receptor blocker, Hyzaar, though even the branded Hyzaar didn't control my blood pressure as well as Avalide. I was able to achieve control at less than “rack rate" only by finding a co-pay card program for a better ARB--Benicar--than either of those other drugs.
Same thing, only crazier, with my unique interval-time-release PPI, Dexilant--they insisted I switch to an inferior first-generation PPI (Prilosec or Prevacid)--and to add insult to injury, go out of pocket by buying it over the counter. Before Dexilant came out, I had been on Protonix. When Protonix went off-patent, I figured I'd save some dough by getting generic pantoprazole....but my pharmacy was charging more for it than for the brand name, so my insurer would cover only Protonix (because it was cheaper, not necessarily because it was more effective).
Why do otherwise responsible entities (and I'm not talking about those venal insurance companies that consider only their balance sheets) such as CR and BCO refuse to admit that in many cases the generics are inferior and that there are even differences between different manufacturers' versions of the same generic drug? Now that many generic drug manufacturers have begun jacking up their prices outrageously (simply because they can--see my pantoprazole story), there is no longer even a reason to encourage people to purchase what are often inferior versions of a drug simply to save money--because in some cases that price advantage doesn’t even exist. I am particularly outraged by those studies (such as the one cited by BCO) that report that women are likelier to remain on generic letrozole just because it's cheaper. Sorry, but my QOL is more important than my bottom line, and I'm not alone.
The time has come to stop this stupid near-gospel of “Generic is always better" as well as the myth that all drugs (branded and generic) within a given class (e.g., AIs, PPIs, ARBs, ACE inhibitors, antibiotics, etch.) are interchangeable. In many, many cases, you DO get what you pay for!!!!
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Nash54: Thanks for replying. I've been taking magnesium for about a year - quite a large dose but not too much so that I get diarrhoea. It helped until recently. Recently the sweating on my face has just been a nightmare for me.
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I have found that sometimes side effects are caused by or amplified by combinations with other meds. For me, taking my statin and letrozole at the same time caused major joint or muscle pain. I now take letrozole in the morning and my statin at night and the pain is significantly reduced.
Due to insurance reasons, I had to change statins this year. Last year with Crestor and changing the time of day I took it, my SEs were a lot better in all regards. I changed to Lipitor and developed significant muscle pain and edema. I changed to Zocor and the muscle pain was replaced with joint pain. I am now on Pravachol and have very little pain and no edema. Sometimes side effects are not caused by one med.
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Whenever I get my Letrozole refilled, I ask for the ones manufactured by Teva. I learned in a stage iv thread that the fillers vary by company and sometimes that can give certain people more se. The consensus was that Teva was the best of the generics.
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I got schooled today. After some wrangling, Costco e-mailed me the prices for generic letrozole vs. Femara--but the Femara is 100(!!!!) times as expensive as the brand-name. I am about to go on Medicare Part D Jan. 1. My current drug plan with United Choice Plus PPO covers Femara itself with no co-pay....but only if I buy 90 at a time. My MO wrote me a scrip for only 30, which I am to take starting no later than Jan. 1. but my follow-up with her isn’t till mid-to-late Feb. And United’s mail-order pharmacy, OptumRx, will accept faxed prescriptions only from doctors, not patients. So I put in a request for a new scrip from her with Optum, and I hope she complies in time for me to start taking them before I have to switch to Medicare.
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ChiSandy...I'm confused. Is Letrozole considered the brand-name or is Femara? Are you saying Femara cost 100 more than Letrozole?
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Letrozole is the generic, Femara the original brand name. And here is what Costco quoted me (mail-order--in-store might cost even more):
Letrozole (generic): 30 for $11.79 and 90 for $24.63.
Now, (per Samuel L. Jackson), hold on to your butt......
Femara: 30 for $726.44 and 90 for $2,158.24!!!!!!!
Not quite 100 times as expensive (more like 70 times for a month’s and nearly 100 times more for 3 months’ supply, respectively.
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Femara is the brand name - letrozole is the generic form and is available from different companies. Femara was developed by Novartis who held the patent for it. After the patent ran out, it became available in the generic form - letrozole.
I started on Femara in Feb 2010 as it was no yet available in generic form. It became available in generic/letrozole form 2011 (I don't remember rather it was May or June or maybe April). I had just gotten my 6 mths supply a couple of weeks before it becoming generic.
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Thanks again Chi for all the info. I do not want to give up on Letrozole yet and want to try the name brand but don't know yet what my Onc or insurance will say. And you are right, it is such BS how drugs are distributed, handled, priced. It is most definitely about QOL, but how do you mange with all the red tape???? Good advise Ellelou, I am going to ask for Teva too if I get the chance.
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