Drugs metabolised by CYP3A4 that have narrow therapeutic ratio, oestrogens

Hot flushes, nausea,  arthalgia, fatigue, carpal funnel syndrome,
sweating, dizziness, headache, pain, rash, abdominal pain

Depression, anxiety, alopecia, breathlessness, leg and pripheral oedema,
dyspepsia, constipation, hypertension, fever.

Osteoporosis, fracture, hepatitis, thrombocytopenia, leucopenia, lymphopaenia,
Increased LFTs
 Rarely, blood syscrasias

Premenopausal women

Pregnancy
Lactation

Special Precautions-
Assess LH , FSH, ans ostridiol levels prior to treatment
Hepatic or renal impairment
Monitor bone marrow density during adjuvant therapy
Treat for osteoporosis as appropiate.
Liver, bone metastases

Adjuvant treatment of postmenopausal oestrogen receptor positive invasive breast cancer

Advanced postmenopausal breast cancer that has progressed following anti-oestrogen therapy

1 tablet daily after meals
In early breast cancer, continue treatment until completion 5 years combined sequential adjuvant
therapy with tamoxifen or earlier if tumor relapses.
In advanced breast cancer continue treatment until tumor progression is evident

Children- not applicable

Contraindicated for use during pregnancy and lactation