Estramustine (Oral)

Estramustine interferes with the growth and spread of cancer cells.

Overview

Estramustine is primarily used to fight prostate cancer. It does this by interfering with the reproduction of cancer cells, inhibiting its spread and causing the tumor to œwither on the vine, so to speak.

Estramustine was approved by the FDA to treat prostate cancer in 1981. Pharmacia and Upjohn, the company which developed estramustine, never marketed the drug. Today Pharmacia and Upjohn (or what is left of it after a series of mergers and spinoffs) is owned by Pfizer.

Conditions Treated

  • Prostate cancer

Type Of Medicine

  • Hormone (estrogen)

Side Effects

Estramustine can cause a variety of different side effects, along with its desired primary effect. Some of these side effects may be serious and require medical attention. Other side effects may be less serious. Patients who begin to experience any of the following side effects should contact their doctor immediately as medical attention may be necessary:

  • Blackened stool
  • Tarry stool
  • Coughing
  • Hoarseness
  • Fever
  • Chills
  • Sudden or severe headaches
  • Sudden loss of coordination or balance
  • Pain in the lower back
  • Pain in the side(s)
  • Difficult urination
  • Painful urination
  • Pain in the chest or groin
  • Pain in the leg, especially in the calves
  • Pinpoint red marks on the skin
  • Sudden, inexplicable shortness of breath
  • Sudden slurred speech
  • Unusual or rogue bleeding
  • Unusual or rogue bruising
  • Sudden changes to vision
  • Weakness or numbness in the arms or legs
  • Swelling of the feet
  • Swelling of the legs
  • Skin rash and fever
  • Unusual or inexplicable tiredness
  • Unusual or inexplicable weakness

Not all side effects are necessarily so serious that they require medical attention. Some side effects may simply be the byproduct of the patient's body adapting to the sudden influx of new medicine. These side effects may only be as serious as the discomfort they cause to the patient. Patients who experience any of the following side effects should contact their doctor to find out how they can mitigate or otherwise lessen any of the most unpleasant side effects:

  • Tenderness of the breasts
  • Breast enlargement
  • Loss of sex drive
  • Diarrhea
  • Nausea
  • Difficulty falling and/or staying asleep
  • Vomiting

The most frequent side effects reported affected the breasts. 66% of patients studied reported breast tenderness, while 60% reported inexplicable breast enlargement.

This is not necessarily a complete list of side effects. Patients who begin to experience new or worsening symptoms after taking estramustine should contact their doctor immediately. Patients can report new side effects to the FDA by calling 1(800) FDA-1088 or on the web by going to www.fda.gov/medwatch.

Dosage

Patients should follow the directions given to them by their doctor with respect to dosage amount. Patients should be certain that they do not take more or less than the amount prescribed to them.

Estramustine should be taken with water, but never with milk or other dairy products.

Patients should avoid eating for two hours before taking estramustine, as well as for two hours after taking estramustine.

It may take as long as 90 days for a patient to begin to feel the full effects of estramustine. Patients should follow the advice of their doctor with respect to the duration of the treatment.

Patients who miss a dose of estramustine should take the dose they forgot as soon as they remember. However, if it is nearly time for them to take their next dose, they should forgo the dose they forgot and just wait until it is time for their next dose, and take that normally. Patients should never take extra medicine in an attempt to retroactively make up for a dose they missed.

Interactions

Estramustine can interact with a wide range of different drugs in a patient's body. Patients should avoid taking any of the following drugs concurrently with estramustine. If patients are taking any of the following drugs and must begin to take estramustine they should consult with their doctor. Alternative treatments may be required. Patients should make sure their doctor is aware of any and all drugs, supplements, and medications they are taking prior to deciding to take estramustine:

  • Acarbose
  • Acetohexamide
  • Albiglutide
  • Alogliptin
  • Amphotericin b
  • Anastrozole
  • Anisindione
  • Benazepril
  • Betamethasone
  • Budesonide
  • Calcitriol topical
  • Calcium acetate
  • Calcium carbonate
  • Calcium citrate
  • Calcium glubionate
  • Calcium gluconate
  • Calcium glycerophosphate
  • Calcium lactate
  • Tribasic calcium phosphate
  • Canagliflozin
  • Captopril
  • Chlorpropamide
  • Corticorelin
  • Corticotropin
  • Cortisone
  • Cosyntropin
  • Dapagliflozin
  • Dicumarol
  • Dulaglutide
  • Empagliflozin
  • Exemestane
  • Exenatide
  • Fludrocortisone
  • Fosinopril
  • Glimepiride
  • Glipizide
  • Hydrocortisone
  • Insulin
  • Insulin aspart
  • Insulin aspart protamine
  • Insulin degludec
  • Insulin detemir
  • Insulin glargine
  • Insulin glulisine
  • Insulin isophane
  • Insulin lispro
  • Insulin lispro protamine
  • Insulin regular
  • Insulin zinc
  • Insulin zinc extended
  • Lamotrigine
  • Letrozole
  • Levothyroxine
  • Linagliptin
  • Liothyronine
  • Liotrix
  • Liraglutide
  • Lisinopril
  • Lixisenatide
  • Metformin
  • Miglitol
  • Moexipril
  • Nateglinide
  • Omacetaxine
  • Perindopril
  • Pioglitazone
  • Pramlintide
  • Prednisolone
  • Prednisone
  • Quinapril
  • Raloxifene
  • Ramipril
  • Repaglinide
  • Ropinirole
  • Rosiglitazone
  • Saxagliptin
  • Sitagliptin
  • Testolactone
  • Thyroid desiccated
  • Tolazamide
  • Tolbutamide
  • Trandolapril
  • Triamcinolone
  • Triamcinolone ophthalmic
  • Troglitazone
  • Vitamin e
  • Warfarin

The following drugs will interact with estramustine, but in a very moderate fashion. Patients who are taking any of the following drugs who must begin taking estramustine should consult with their doctor to determine what their best course of action is. Alternative treatments and dosage adjustments may be necessary. Patients should make sure their doctor is aware of all the medications, supplements, and drugs they are taking before they decide to take estramustine.

  • Amitriptyline
  • Amoxapine
  • Clomipramine
  • Desipramine
  • Doxepin
  • Hyaluronidase
  • Imipramine
  • Nortriptyline
  • Protriptyline
  • Trimipramine

Patients should avoid taking estramustine concurrently with thalidomide (which, among other things, can be used to treat leprosy). When estramustine and thalidomide are taken at the same time the patient will be at dangerous risk of forming dangerous blood clots. This risk will be compounded by factors which include age, cigarette smoking and blood pressure. Patients who are taking thalidomide who must begin taking estramustine should contact their doctor to find out how best to proceed. Alternative treatments may be necessary. Patients should disclose a complete list of all drugs, supplements, and medications they are taking to their doctor before they decide to take estramustine.

Patients should avoid taking estramustine concurrently with tranexamic acid (which can be used to treat extreme menstrual flows). When taken with tranexamic acid, estramustine can put the patient at serious risk of dangerous blood clots. Patients who are taking tranexamic acid who must begin taking estramustine should consult with their doctor to find out what their best course of action is. Alternative treatments may be necessary. Patients should make sure their doctor is fully apprised of any and all drugs. Medications, and supplements they are taking prior to deciding to take estramustine.

Food, and especially milk, will decrease estramustine levels in a patient's body. For this reason, patients should not eat within two hours (before and after) of taking estramustine.

This is not necessarily a complete list of interactions between estramustine and other drugs. Patients should rely on their doctor to identify any potential interaction between estramustine and any drug they are currently taking. In order to enable their doctor to do this., patients should disclose a complete list of all drugs medications, and supplements they are taking to their doctor.

Warnings

Estramustine is a class X drug in terms of pregnancy. This means that estramustine has been demonstrated to have adverse effects on human fetuses. Patients who are pregnant should not take estramustine. Patients who may become pregnant should consult with their doctor before deciding to take estramustine. Effective contraception will be necessary.

Patients with high blood pressure should exercise extreme caution when considering taking estramustine. Risk of heart attack and stroke can be increased by high blood pressure. Estramustine can increase blood pressure, leading to an increased risk of heart attack and stroke. For this reason, it is inadvisable for patients with high blood pressure to take estramustine. Patients with high blood pressure who must take estramustine should consult with their doctor to determine the best course of action. Additional medical monitoring may be necessary.

Patients with thromboembolism should exercise extreme caution when considering taking estramustine. Patients with thromboembolism who take estramustine will put themselves at elevated risk of thrombotic events, myocardial infarction, and stroke. Patients with thromboembolism who must begin taking estramustine should consult with their doctor to find out what the best course of action for them is.

Patients with cardiovascular disease should exercise extreme caution when considering taking estramustine. By taking estramustine, patients with a cardiovascular disease put themselves at heightened risk of myocardial infarction and stroke. Patients with a cardiovascular disease who must begin taking estramustine should consult with their doctor to find out what the best course of action for them is.

Patients with breast cancer induced hypercalcemia (excessive calcium in the blood) should exercise extreme caution when considering taking estramustine. Patients with breast cancer induced hypercalcemia will put themselves at risk of severe hypercalcemia when they take estramustine. Patients with breast cancer should consult with their doctor before deciding to take estramustine.

Patients with hypercalcemia should exercise extreme caution when considering taking estramustine. Although less serious than breast cancer induced hypercalcemia, estramustine will exacerbate hypercalcemia, putting the patient at risk of the condition becoming dangerous. For this reason, patients with hypercalcemia should consult with their doctor prior to deciding to take estramustine.

Estrogen is primarily metabolized by the liver, so patients with liver disease should exercise caution when considering taking an estrogen. Estramustine is an estrogen, so patients with liver damage should exercise caution when considering taking estramustine. Patients with liver damage who take estramustine will be at increased risk of adverse effects. Patients with liver damage should consult with their doctor prior to deciding to take estramustine.

Patients who naturally retain a great deal of fluid should exercise caution when considering taking estramustine. Estramustine will cause patients to retain fluid, which can compound existing fluid retention issues and lead to migraines and kidney problems. Patients who have preexisting fluid retention issues should consult with their doctor prior to deciding to take estramustine.

Patients with a glucose intolerance (typically caused by diabetes) should exercise caution when considering taking estramustine. Estramustine will increase insulin secretion and can mess with insulin resistance. For this reason, patients with glucose intolerance should avoid taking estramustine. Patients with a glucose intolerance who take estramustine will require additional medical monitoring.

Estramustine will throw off a thyroid function test. Patients may want to receive a thyroid function test prior to deciding to take estramustine. Patients who are taking estramustine who must receive a thyroid function test should ensure that the doctor administering the test is aware that they are taking estramustine.

This is not necessarily a complete list of the risks of taking estramustine. Patients should rely on their doctor to inform them of all of the risks associated with taking estramustine. Patients should not take estramustine unless they fully understand the risks associated with that choice.

Storage

Estramustine should be stored in a closed container in the refrigerator. Patients should never freeze their estramustine.

Summary

Estramustine is a powerful cancer drug used in the treatment of prostate cancer. As far as cancer drugs go, it is relatively light on the side effects. However, because it is an estrogen, it can have some decidedly unpleasant side effects for men, including breast enlargement. When faced with the choice between breast enlargement and runaway prostate cancer, though, the choice is usually quite simple. Patients who give estramustine the respect that it is due as a powerful drug and hormone should be able to use the drug relatively safely, provided they have access to sufficient medical monitoring.