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Maxadvance
Member
Not really too hard to find if you look for it. The fact that it's usually a daily dose instead of once or twice weekly like arimidex, and the fact that physicians almost always opt for the latter med makes me question long term use of it.
Hepatotoxicity
Serum enzymes are reported to be elevated in 4% to 11% of women treated with exemestane, but these elevations are usually mild, asymptomatic and self-limited, rarely requiring dose modification. There have been very rare instances of clinically apparent liver injury associated with exemestane therapy, typically arising withinone to four months of starting treatment and typically presenting with a cholestatic pattern of enzyme elevations. Immunoallergic features (fever, rash, eosinophilia) are uncommon as are autoantibody formation. Some instances have been severe with signs of hepatic failure, but most cases were self-limited. Unlike tamoxifen, exemestane has not been associated with development of fatty liver disease, steatohepatitis or cirrhosis.
Mechanism of Injury
The acute form liver injury attributed to exemestane use is probably due to an idiosyncratic reaction to a metabolite of the medication rather than its antiestrogenic effects. Exemestane is metabolized in the liver by the cytochrome P450 system, largely via CYP 3A4. Drug-drug interactions can occur with CYP 3A4 inducers.
