• Metastatic breast cancer in postmenopausal women with estrogen receptor–positive or unknown tumors.

Contraindicated in:

• Hypersensitivity
• History of thromboembolic disease
• Congenital or acquired QT prolongation, hypokalemia, or hypomagnesemia
• OB: Pregnancy
• Lactation: Lactation.

Use Cautiously in:

• Bone metastases (↑ risk of hypercalcemia)
• HF
• Hepatic impairment
• Pre-existing endometrial hyperplasia (avoid long-term treatment).

CV: angina, arrhythmias, edema, HF, MI, QT interval prolongation, thrombophlebitis, TORSADES DE POINTES.

Derm: sweating.

EENT: blurred vision, cataracts, corneal keratopathy, dry eyes, glaucoma.

Endo: hot flashes.

F and E: hypercalcemia.

GI: nausea, HEPATOTOXICITY, vomiting.

GU: vaginal discharge, ENDOMETRIAL CANCER, endometrial hyperplasia/hypertrophy, uterine polyps, vaginal bleeding.

Hemat: anemia.

Neuro: depression, dizziness, headache, lethargy.

Resp: PULMONARY EMBOLISM.
Misc: tumor flare.

Drug-Drug:

• QT interval prolonging drugs may ↑ the risk of torsades de pointes; avoid concurrent use.
• Strong CYP3A4 inhibitors, including ketoconazole, itraconazole, clarithromycin, atazanavir, nefazodone, nelfinavir, ritonavir, and voriconazole, may ↑ levels; avoid concurrent use.
• Strong CYP3A4 inducers, including dexamethasone, phenytoin, carbamazepine, rifampin, rifabutin, and phenobarbital, may ↓ levels and effectiveness.
• Concurrent use of agents that ↓ urinary excretion of calcium (thiazide, diuretics) may ↑ the risk of hypercalcemia.
• May ↑ the effects of warfarin and phenytoin.

Drug-Natural Products:

• St. John's wort may ↓ levels and effectiveness.

(Generic available)

• Tablets: 60 mg;

• PO (Adults): 60 mg once daily.

Fareston

• Exerts antiestrogenic effects by competing for estrogen-binding sites found in breast cancers.

• Regression of breast cancer.

Therapeutic Classification: antineoplastics

Pharmacologic Classification: antiestrogens

Absorption: Well absorbed following oral administration.

Distribution: Widely distributed to tissues.

Protein Binding: 99.5%.

Metabolism/Excretion: Extensively metabolized; undergoes enterohepatic circulation.

Half-life: 5 days.

(plasma concentrations)

†Steady-state plasma concentrations occur after 4–6 wk.

• Instruct patient to take medication exactly as directed. If a dose is missed, it should be omitted.
• Advise patient to report bone pain to health care professional promptly. Pain may be severe. Inform patient that this may be an indication of the drug’s effectiveness and will resolve over time. Analgesics should be ordered to control pain.
• Advise patient that medication may cause hot flashes. Notify health care professional if these become bothersome.
• Instruct patient to notify health care professional promptly if pain or swelling of legs, shortness of breath, weakness, sleepiness, confusion, nausea, vomiting, dizziness, headache, loss of appetite, or blurred vision occurs. Patient should also report menstrual irregularities, vaginal bleeding, or pelvic pain or pressure.
• May cause vaginal bleeding. Advise patient of importance of baseline and annual gynecological exams during therapy and to notify health care professional if vaginal bleeding, changes in vaginal discharge, or pelvic pain or pressure occur.
• May cause fetal harm. May also induce ovulation. Advise patient to use a nonhormonal method of contraception during and for 1 mo after the course of therapy and to avoid breastfeeding during therapy.

TORE-em-i-feen