FEMARA
Comments
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I don't think numb hands is something that gets worse over time, it's just there. Do you take your pill at night
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marijen - No, I take it in the morning. So you think it will just stay the same? I wonder if it would return to normal if I stopped the Letrozole.
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Yes I think it will stay the same or get better and when you go off the letrozole I think it will go away. It's more of a nuisance. But I have only been on letrozole for two years, maybe someone who's been on it longer can say better. Since it's only two weeks it may go away or get a little worse. I just read that SEs depend on your age, the younger you are the more estrogen is being cut off an therefore worse sides.
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Marijen, my letrozole is Accord brand.
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marijen - Thanks! I'm 54. My ER + is only 3% so not sure if it's worth taking the AI....
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Send to
Curr Opin Obstet Gynecol. 2010 Feb;22(1):56-60. doi: 10.1097/GCO.0b013e328334e44e.Managing the toxicities of the aromatase inhibitors.
Author information
Abstract
PURPOSE OF REVIEW:
The aromatase inhibitors are increasingly used as adjuvant therapy in postmenopausal women with hormone receptor positive breast cancer. With additional experience using these agents, unanticipated side effects have become apparent. Women who experience side effects from adjuvant endocrine therapy are the individuals who derive the greatest benefits. Because noncompliance is highest among those who experience side effects, it is important that these symptoms be palliated.
RECENT FINDINGS:
The symptomatic effects of aromatase inhibitors include: hot flashes, arthralgias, vaginal dryness and dyspareunia. Hot flashes may successfully be treated with either serotonin reuptake inhibitors or gabapentin. Counseling, vaginal moisturizers and lubricants can improve symptoms related to sexual functioning. The mechanism of arthralgias is uncertain and anti-inflammatory agents are seldom effective. Patients who experience severe musculoskeletal discomfort may necessitate switching to another endocrine agent such as tamoxifen. Physicians should be aware of 'silent' side effects. Screening for bone loss and hypercholesterolemia is critical and patients should be treated accordingly.
SUMMARY:
Patients and physicians should openly discuss the short and long-term side effects of the aromatase inhibitors as many of these symptoms can be managed effectively. By optimizing quality of life on adjuvant endocrine therapy, noncompliance may be minimized.
- PMID:
- 20019610
- DOI:
- 10.1097/GCO.0b013e328334e44e
- [Indexed for MEDLINE]
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Novmoon, I think I've seen users here that like accord. I'm on Breck for Breckenridge labs right now, it's ok but it has talc in it. I wonder if that's bad. I've stopped it until I see the eye doc anyways for possible letrozole induced PVD and vitreous clouding.
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Thanks Marijen, I told my eye doc that I was on this medication and he apparently knows what to look for. He changed my annual exam to twice a year and to call if any problems. Just a relief to have that area covered.
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My opthamologist knows about my BC and letrozole and he didn't offer me every six months. And this is a well known medical facility supposedly cutting edge. He's a young (handsome) male. My first one moved on to a smaller clinic. Will see what he says Monday.
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My MO says that the numbness in my right hand which started about a week after I started Letrozole is not a side effect. He suggested my PCP. I'm considering stopping the AI and see if the numbness goes away. Anyone know how long it takes to get out of your system?
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I stopped last Sat or Sun night and it's gone already. But I stopped for another reason - my eyes. Here's a bit of info: There are estrogen receptors in your eyes.
MOs and ROs deny a lot.
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What? Letrozole is radioactive? KB870 would please supply a working link to source. Very interesting - and I'm probably not reading it right.
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marijen - no - Letrozole is not radioactive
They labelled the letrozole in this study so that they could trace it in the urine and feces and determine how it was metabolized. This was only done for the study and the "radioactivity" is 14C - an isotope of carbon that can easily be identified and is not dangerous. The Letrozole we are taking is NOT radioactively labelled.
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There is no way I would stay on an AI for only a few months possible benefit. My benefit is over 600 days for putting up with the AI. There is substantial benefit from Tamoxifen also and many people tolerate it better, so that should also be on the table. If I develop side effects from the AI, I will go back to Tamox in a heartbeat.
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The last time I saw my MO she told me that I most likely would get a reassurance of BC when I was in my 80's. This concerned me and I was so shocked I did not ask her what she is basing that information on? Is there a study out there on stage 1 grade 2 younger women( I was 44 at dx) who get BC? This has been bothering me since she stated it. Isn't this why I had my ovaries out and am taking anti-hormonal meds to prevent this?
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Wow! That's something to look forward to. (sarcastic) Who does she think she is?? And in 30/40 years I'm pretty sure things will be a whole lot different. Sounds like she has a mean streak and a God complex.
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No problem KB - thanks for the link.
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Ndgrrl - maybe your MO was trying to make you feel less anxious? Saying that you don't need to worry about a recurrence any time soon? Anyway, by the time you are in your 80's, I hope they will have a cure or at least much better options for stage 4 treatments 0
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Breast. 2007 Jun;16(3):223-34. Epub 2007 Mar 21.
Aromatase inhibitor-associated arthralgia syndrome.
Author information
Abstract
Aromatase inhibitors (AIs) are widely used as an adjuvant endocrine treatment in postmenopausal women with early-stage breast cancer. Clinical trials have assessed 5 years of AI therapy, either as an alternative to tamoxifen for primary adjuvant therapy of breast cancer, or after 5 years of adjuvant tamoxifen. Treatment of 2-3 years' duration after 2-3 years of tamoxifen has also been studied. AI therapy brings side effects related to estrogen deprivation, and this side effect profile differs in clinically relevant ways from that seen with tamoxifen. In particular, the selective estrogen receptor modulatory effects of tamoxifen contribute to menopausal symptoms, vaginal discharge, and the rare but worrisome risks of thromboembolism and uterine carcinoma. By contrast, the low levels of estrogen achieved with aromatase inhibition contribute to menopausal symptoms, vaginal dryness and sexual dysfunction, and accelerated bone demineralization with risk of osteoporosis and osteoporotic fracture. Clinical experience also suggests that AI therapy is associated with a novel musculoskeletal side effect consisting of an arthralgia syndrome. The actual incidence of AI-associated arthralgias or musculoskeletal symptoms is not known, though such symptoms are quite prevalent and appear more commonly with AI use than with tamoxifen. Arthralgias can be a reason for discontinuation of AI treatment. The possible mechanisms of AI-associated arthralgia are unclear. Estrogen deficiency causes bone loss, which in turn contributes to arthralgia. Less well-studied functions of estrogen include regulating immune cells and cytokines involved in bone remodeling, and modulating pain sensitivity at the level of the central nervous system. Arthralgia and arthritis have seldom been rigorously differentiated in clinical trials of AIs. Assessment of inflammatory and rheumatologic markers, as well as detailed evaluation of patient symptoms using appropriate quality-of-life instruments, may be warranted in order to understand both the symptoms and the etiology of the arthralgia syndrome. Treatment options for arthralgia (primarily non-steroidal anti-inflammatory drugs) are currently inadequate, but areas of active research include high-dose vitamin D and new-targeted therapies to inhibit bone loss.
- PMID:
- 17368903
- DOI:
- 10.1016/j.breast.2007.01.011
- [Indexed for MEDLINE]
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Marijen, I will be interested to find out what your ophthalmologist says. I discovered a fairly large "floater" and was sent by my MO to the ophthalmologist. He said I did have some strands but he didn' think it was the AI...hmmmm. Now I have one in the other eye and a very light cloudiness. I have switched to tamoxifen and am feeling better in all respects. I am glad the doc has images of my strands on his computer in case there are any new problems.
Noticing floaters is somewhat subjective. Did I have them before and just ignored them?It's like not listening to the ringing in your ears.
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Right sometimes it's there all the time so you don't notice. I'll let you know - he'll probably tell me it's not bad enough to do anything about but I hope he checks for retina tears because my vision has decreased in the last five months since I saw him. For a while I thought it was glasses for a little too near and a little to far. I have cataract implant lenses. So how does my vision deteriorate with implants. I thought it was this that and the other thing, such as allergies and colds and sinus. Yes, I will let you know Monday afternoon.
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Look—any MO who says your symptoms aren't caused by Letrozole doesn't know the first thing about endocrinology (or is so hidebound and wedded to the protocols they're used to that they've lost all sense of logic). ANYTHING that reduces the amount of estrogen in your system will either mimic the symptoms of menopause & aging, or accelerate or enhance them if already present to a slight degree before beginning treatment. That is basic, basic biochemistry. Here are some things that can (sometimes usually) get worse after menopause: hypertension (BP), glucose & a1c, hyperlipidemia (total cholesterol & LDL-C), cataracts & presbyopia (if your vision can't be corrected, get checked for cataracts; if you have lens implants but still have vision issues, ask to be checked for “capsular clouding," which can be zapped in a few seconds with a laser), joint pain (all joints), low metabolism (regardless of thyroid levels), hot flashes, night sweats, hair thinning, dry skin, skin thinning, age spots, insomnia, vaginal/vulvar dryness, UTI susceptibility, bone loss (osteopenia & osteoporosis), loss of muscle & connective tissue (tendons, ligaments) strength & elasticity, trigger fingers, mood. If you didn't have these after menopause & before AIs, you could get them from AIs. If you already had them, AIs can make them worse or worsen them faster. Even acne, which isn't usually attributable to the gradual estrogen decline from natural menopause, can pop up on AIs because while without an AI, the androgen (male hormone) your adrenal glands & fat cells make gets converted by aromatase into estrogen, on an AI the aromatase can't convert enough androgen to estrogen—and you have more “unopposed" circulating male hormone (which is a major cause of acne in adolescents).
Tell your MO you're not an idiot: you know what can happen when you lose estrogen, especially when you lose it as fast as you do on an aromatase inhibitor, and they darn well know it too. And if they deny the connection, call them out on it. They will back down.
Back to the eye stuff. Cataracts, capsular clouding after cataract surgery, and floaters are all due to proteins in your eye fluid coagulating—and that, too, is characteristic of aging. Nothing you can do about the floaters, but rule out retinal damage due to any blurring of vision or other “artifacts" like flashes, spots that don't move, narrowing of vision. (Hate to say it, but if you are prone to macular degeneration, it gets worse with aging…and repeat after me: in women, stuff that gets worse with aging is caused by losing estrogen).
Who gives a trigger-finger cortisone shot into the knuckle?* (Osteoarthritis, yeah, but trigger finger)? Don't they know that the cause of a trigger finger is the tendon sheath getting caught up on a tendon nodule at the base of your finger or thumb (like a clothesline pulley getting caught on a knot in the rope)? At the very most, there's a small chance that the pain in the knuckle might temporarily resolve (after the pain of the shot wears off), but the cause of the triggering will remain? The reason to give a shot down by the base is that's where the nodule (&/or the swelling in the sheath) is, and the cortisone can ease the swelling and shrink or even dissolve the nodule. Also, triggering can be self-limiting—it can inexplicably disappear by itself. (I had one on my L thumb before bc that went away after a shot and 3 yrs later came back with a vengeance and I had to have the release surgery—a slit cut in the sheath so the tendon moves freely again).
BTW, I did the Cancermath thing—and it says that an AI will lengthen my life by a whole six months! (Adding chemo would give me a year—but that chemo year would be a lot more miserable than the six extra months of life on letrozole). My PCP warned me the other day not to get smug about the mildness of my symptoms after 18 months, because he sees his older bc patients on AIs get worse towards the end of their therapy. So I'm not throwing away my cane. My symptoms are tolerable now, but when they aren't any more, I will bring up the subject with my MO. She is the one who reassured me chemo wouldn't be worth it, so maybe she'd be sympathetic about the AI.
* as stupid as giving a novocaine shot for jaw or arm pain from a heart attack in progress instead of finding and treating the cause.
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ChiSandy - if there was a "like" button I'd be pressing it.
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So just to be clear, I have three things going on with my eyes. PCO or capsular clouding from cataract surgery, both eyes, just a tiny bit. PVD Posterior Viteous Detachment and Vitreous clouding. I believe PVD can lead to retina detachment and bleeding. Worse case - blindness.
Nice comments on aging, most people that get cancer are in their sixties and older. DNA breaking down and mutating from AGING? Low estrogen ages us faster
There's something I don't understand about estrogen: used to be everyone got HRT treatment upon menopause, then they said it caused cancer, now it's the opposite, AI treatment is .decreasing estrogen to slow cancer. What's wrong with this picture?
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Medical knowledge evolves. (BTW, not everyone got HRT upon menopause, especially those of us who had an easy menopause). It used to be given to prevent bone loss, hot flashes and the increased cardiac risks of aging. Then studies (both epidemiological and double-blind ones) were released showing that the increased risk of ER+ breast cancer was more than the decreased risks of letting nature take its course. Who says “it’s the opposite?” No, it doesn’t cause hormone-negative breast cancer, but definitely increases the risk of ER+ (by far the commonest form of) breast cancer—especially when natural estrogen exposure was early & long (early menarche, late menopause, delayed or no childbearing, limited or no breastfeeding, long-term use of birth control pills or implants). Cancer cells that depend on estrogen to fuel their proliferation are likelier to divide enough to become tumors if there is enough estrogen present.
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ChiSandy - good for you for posting an informational response on the effects of estrogen deprivation. I'm in my fifth year of AI's and I can say that every year since I started has been marked by a diagnosis of a new problem, some of which were not surprising, like Osteoporosis, but some like Episcleritis and then Vitreous Hemorrhage, were baffling. My proactive Opthalmalogist sent me to a Rheumatologist who ruled out auto immune syndrome but also researched Anastrazole and found connections between estrogen deprivation and ocular disease. I got the article link from her and discovered structures in the eye are dependent on estrogen, including simple functions like the moist film produced when the eye blinks. The researcher said in his introductory paragraph that the effects of Anastrazole were the same as advanced aging, producing a low hormonal state usually found in the elderly.
Last year I came upon an article by a psychiatrist about the effects of estrogen deprivation on the brain, including affecting decision making. Needless to say, every time I have an ailment now I google it along with 'aromatase inhibitors' and I usually find a connection. It doesn't get rid of my side effects but it helps me understand why they are happening. I just wish the oncologists who profess surprise at their patients' side effects would read up on these effects. That, or try taking an aromatase inhibitor for about a year and see how they feel if they think it's so harmless.
Best to all.
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Great comments Margo, I'm with you on all of it. Does it make you want to stop your AI therapy? Right, they should try it for a year, the menopausal doctors that is.
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Found this at ehealthme. I have to figure out where's the rest of the story at FDA unless someone wants to help? It's too late tonight.
Letrozole and Hypothyroidism - from FDA reports
Summary
Hypothyroidism is found among people who take Letrozole, especially for people who are female, 60+ old , have been taking the drug for 2 - 5 years, also take medication Fosamax, and have Hormone replacement therapy. This review analyzes which people have Hypothyroidism with Letrozole. It is created by eHealthMe based on reports of 6,677 people who have side effects when taking Letrozole from FDA, and is updated regularly.
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From FDA Data
Adult and Elderly Patients
The recommended dose of Femara® (letrozole tablets) is one 2.5 mg tablet administered once a day, without regard to meals. Treatment with Femara should continue until tumor progression is evident. No dose adjustment is required for elderly patients. Patients treated with Femara do not require glucocorticoid or mineralocorticoid replacement therapy.
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Prescribing information
https://www.accessdata.fda.gov/drugsatfda_docs/lab...- 28 In postmenopausal women, estrogens are mainly derived from the action of the aromatase
- 29 enzyme, which converts adrenal androgens (primarily androstenedione and testosterone) to
- 30 estrone and estradiol. The suppression of estrogen biosynthesis in peripheral tissues and in
- 31 the cancer tissue itself can therefore be achieved by specifically inhibiting the aromatase
- 32 enzyme.
- 33 Letrozole is a nonsteroidal competitive inhibitor of the aromatase enzyme system; it inhibits
- 34 the conversion of androgens to estrogens. In adult nontumor- and tumor-bearing female
- 35 animals, letrozole is as effective as ovariectomy in reducing uterine weight, elevating serum
- 36 LH, and causing the regression of estrogen-dependent tumors. In contrast to ovariectomy,
- 37 treatment with letrozole does not lead to an increase in serum FSH. Letrozole selectively
- 38 inhibits gonadal steroidogenesis but has no significant effect on adrenal mineralocorticoid or
- 39 glucocorticoid synthesis.
- 40 Letrozole inhibits the aromatase enzyme by competitively binding to the heme of the
- 41 cytochrome P450 subunit of the enzyme, resulting in a reduction of estrogen biosynthesis in
- 42 all tissues. Treatment of women with letrozole significantly lowers serum estrone, estradiol
- 43 and estrone sulfate and has not been shown to significantly affect adrenal corticosteroid
- 44 synthesis, aldosterone synthesis, or synthesis of thyroid hormones.
- 94 Geriatric Use
- 395 The median age of patients in the trial that compared Femara 2.5 mg daily to tamoxifen 20 mg
- 396 daily as first-line therapy was 65 years. About 1/3 of the patients were ≥ 70 years old. Femara
- 397 time to tumor progression and tumor response rate were better in patients ≥ 70 than in patients
- 398 < 70 years of age.
- 399 The mean age of patients in the two second-line randomized trials, that compared Femara (0.5
- 400 mg and 2.5 mg) to megestrol acetate and to aminoglutethimide, was 64 years. Thirty percent
- 401 of patients were ≥70 years old. The proportion of patients responding to each dose of Femara
- 402 was similar for women ≥70 years old and <70 years old.
- 459 Other less frequent (<2%) adverse experiences considered consequential for both treatment
- 460 groups , included peripheral thromboembolic events, cardiovascular events, and
- 461 cerebrovascular events. Peripheral thromboembolic events included venous thrombosis,
- 462 thrombophlebitis, portal vein thrombosis and pulmonary embolism. Cardiovascular events
- 463 included angina, myocardial infarction, myocardial ischemia, and coronary heart disease.
- 464 Cerebrovascular events included transient ischemic attacks, thrombotic or hemorrhagic
- 465 strokes and development of hemiparesis.
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