From the Guidelines
Anastrozole is associated with several side effects, including hot flashes, joint pain, and decreased bone density, and its use should be carefully considered based on the individual patient's risk-benefit profile, as recommended by the most recent guidelines 1.
Side Effects of Anastrozole
The side effects of anastrozole include:
- Hot flashes
- Joint pain
- Muscle aches
- Weakness
- Fatigue
- Mood changes
- Depression
- High blood pressure
- Decreased bone density with increased fracture risk Less common but serious side effects include:
- Heart problems
- Liver issues
- Blood clots
Risk-Benefit Profile
The pharmaceutical industry has been criticized for potentially downplaying these side effects in marketing materials while emphasizing benefits 1.
Monitoring and Prevention
Regular monitoring for bone density loss and cardiovascular issues is recommended during treatment 1.
Patient Education
Patients should discuss all potential side effects with their healthcare provider before starting anastrozole and report any adverse reactions promptly 1.
Prescribing Considerations
Healthcare providers should consider the full risk-benefit profile when prescribing anastrozole, particularly for preventive use in high-risk but otherwise healthy individuals 1.
Guidelines
The American Society of Clinical Oncology (ASCO) recommends that anastrozole be discussed as an alternative to tamoxifen, raloxifene, or exemestane to reduce the risk of invasive breast cancer in postmenopausal women at increased risk of developing breast cancer 1.
Bone Density
Prior to initiating an aromatase inhibitor, clinicians should evaluate patients for baseline fracture risk and measure bone mineral density, and consider the use of bone-protective agents such as bisphosphonates and receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors 1.
From the FDA Drug Label
ADVERSE REACTIONS Serious adverse reactions with anastrozole occurring in less than 1 in 10,000 patients, are: 1) skin reactions such as lesions, ulcers, or blisters; 2) allergic reactions with swelling of the face, lips, tongue, and/or throat This may cause difficulty in swallowing and/or breathing; and 3) changes in blood tests of the liver function, including inflammation of the liver with symptoms that may include a general feeling of not being well, with or without jaundice, liver pain or liver swelling [see Adverse Reactions ( 6. 2)]. Common adverse reactions (occurring with an incidence of ≥10%) in women taking anastrozole included: hot flashes, asthenia, arthritis, pain, arthralgia, hypertension, depression, nausea and vomiting, rash, osteoporosis, fractures, back pain, insomnia, headache, bone pain, peripheral edema, increased cough, dyspnea, pharyngitis and lymphedema. Anastrozole tablets may cause serious side effects including: ...bone thinning or weakness (osteoporosis). Anastrozole lowers estrogen in your body, which may cause your bones to become thinner and weaker. This may increase your risk of fractures, especially of your spine, hip and wrist. ...increased blood cholesterol (fat in the blood). ...skin reactions. Stop taking anastrozole tablets and call your doctor right away if you get any skin lesions, ulcers, or blisters. ...severe allergic reactions. Get medical help right away if you get: swelling of your face, lips, tongue, or throat. trouble swallowing or breathing ...liver problems. Anastrozole can cause inflammation of your liver and changes in liver function blood tests.
Anastrozole Side Effects:
- Serious side effects: skin reactions, allergic reactions, liver problems, bone thinning or weakness (osteoporosis)
- Common side effects: hot flashes, asthenia, arthritis, pain, arthralgia, hypertension, depression, nausea and vomiting, rash, osteoporosis, fractures, back pain, insomnia, headache, bone pain, peripheral edema, increased cough, dyspnea, pharyngitis, lymphedema The side effects of anastrozole are numerous and can be serious. Patients should be closely monitored for any adverse reactions, especially those with pre-existing conditions such as osteoporosis or liver disease 2 2.
From the Research
Anastrozole Side Effects
- The most common adverse events reported with anastrozole include gastrointestinal (GI) disturbances, with an incidence of 29 to 33% 3.
- Other adverse events reported with anastrozole include headache (< or = 18%), asthenia (< or = 16%), pain (< or = 15%), hot flushes and bone pain (both < or = 12%), back pain and dyspnoea (both < or = 11%) and peripheral oedema (< or = 9%) 3.
- Anastrozole is generally well tolerated in the majority of patients, with GI disturbances being generally mild or moderate and transient 3.
- A significant survival advantage was observed in patients treated with anastrozole 1 mg/day compared with megestrol in a follow-up combined analysis of patients enrolled in both studies (median time to death 26.7 vs 22.5 months) 4.
Advertiser Efforts
- There is no direct information available on advertiser efforts related to anastrozole in the provided studies.
- However, the studies suggest that anastrozole is a valuable treatment option for postmenopausal women with advanced breast cancer, with a good tolerability profile and a significant survival advantage compared to megestrol 3, 4.
- The effectiveness of anastrozole in reducing breast cancer recurrence and improving overall survival has been demonstrated in several studies, which could be used to inform advertiser efforts 5, 6.
Management of Side Effects
- Many side effects of aromatase inhibitors, including anastrozole, are related to estrogen deprivation 7.
- Management of these side effects, such as vasomotor symptoms, vaginal dryness, dyspareunia, bone loss, arthralgias and myalgias, can lead to improved adherence and persistence with therapy 7.
- Aromatase inhibitors are not associated with serious adverse events typical for tamoxifen, such as endometrial cancer and thromboembolic disease 7.