drug adverse effects of aromatase inhibitors

Adverse effects

• see specific aromatase inhibitor
• osteoporosis
  • evaluated fracture risk in all women starting aromatase inhibitor
  • bisphosphate or other therapy for women with T-score <-2.0 SD, T-score < -1.5 SD + 1 other fracture risk factor (i.e. age >65 or low body-mass index) or > 1 risk factor
  • zoledronate yearly or denosumab every 6 months
  • oral bisphosphonate may be less effective
• joint pain musculoskeletal pain (arthralgias & myalgias) may be caused by diminished estrogen levels; estrogen is thought to have anti-inflammatory properties & to inhibit pain signals
  • clinically significant musculoskeletal complications develop in ~50% of women treated with aromatase inhibitors
  • development of musculoskeletal pain & arthragias during treatment is linked to better breast cancer outcomes
  • a 2nd aromatase inhibitor should be tried if patient develops severe musculoskeletal symptoms
  • duloxetine & exercise may be of benefit
  • if musculoskeletal symptoms persist, tamoxifen should be tried
  • acupuncture 2 sesson/week for 6 weeks of benefit
• vaginal dryness (20%)
  • safety of vaginal estrogens not known
  • systemic absorption occurs with use of vaginal estrogens
    • tends to decrease as therapy continues
    • absorption highes with creams, lowest with Estrig
  • vaginal lubricants (Astroglide, Replens, Lubrin) safer than vaginal estrogens
• ovarian stimulation in premenopausal women
• ESR1 gene mutations confer resistance to aromatase inhibitors
  • occur most frequently on exposure to aromatase inhibitors

More general terms

• drug adverse effect(s)