Xtane

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What Is Xtane?

Xtane is an oral tablet from Natco Pharma containing exemestane 25 mg. Exemestane is a third-generation, steroidal aromatase inactivator — structurally and mechanistically distinct from the non-steroidal aromatase inhibitors anastrozole and letrozole. It is used for adjuvant and metastatic treatment of hormone-receptor-positive (HR+) breast cancer in postmenopausal women. Originally developed by Pfizer (brand name Aromasin), exemestane is now a widely-used generic.

How Does Xtane Work?

Exemestane is a suicide substrate inhibitor (irreversible inactivator) of aromatase, the enzyme that converts androgens to oestrogens in postmenopausal peripheral tissue. Mechanistically:

• Steroidal structure resembling the natural androgen substrate (androstenedione) — binds the aromatase active site and is then irreversibly converted to a covalent enzyme adduct that permanently inactivates the enzyme molecule.
• Suppresses circulating oestrogen by ~95% within days — comparable to anastrozole and letrozole.
• No cross-resistance with non-steroidal AIs — patients who progressed on anastrozole or letrozole sometimes respond to exemestane (and vice-versa) because the mechanism is structurally distinct.
• Mild androgenic effect — exemestane and its main metabolite have weak androgen-receptor activity, which may slightly mitigate the bone-density loss seen with non-steroidal AIs (though clinical significance debated).

Toepassingen en Indicaties

• Adjuvant therapy for early HR+ breast cancer in postmenopausal women, typically as sequential therapy after 2–3 years of tamoxifen (per IES trial) or as primary AI
• Metastatic HR+ breast cancer after progression on a non-steroidal AI (anastrozole or letrozole)
• Combined with everolimus for HR+ HER2- metastatic breast cancer after non-steroidal AI failure (BOLERO-2)
• Off-label gebruik: chemoprevention in high-risk postmenopausal women (MAP.3 trial); ovulation induction in PCOS (specialist)

Xtane is niet indicated for: premenopausal women without ovarian suppression, HR-negative breast cancer, or non-cancer cosmetic indications.

Xtane Dosage and How to Take

Standaard dosering: 25 mg once daily after a meal. Food increases exemestane bioavailability by approximately 40% — so this is more than just a tolerability rule.

How to Take Xtane Properly

1. Take one 25 mg tablet once daily after a meal. Food significantly increases absorption — do NOT take on an empty stomach.
2. Same time each day for consistency.
3. Slik de tablet heel door met water.
4. Mandatory monitoring: baseline DEXA bone-density scan, repeat every 2 years. Annual lipid panel.
5. Bone protection: calcium 1,000–1,200 mg/day + vitamin D 800–2,000 IU/day. Bisphosphonate or denosumab if osteopenia develops.
6. Joint pain management: regular exercise, paracetamol/NSAIDs as needed. Switching to anastrozole of letrozole may help if exemestane arthralgia is intolerable.
7. Kuurlengte: 5 years total endocrine therapy (or longer in higher-risk disease) in adjuvant setting; until progression in metastatic.
8. Do not stop without oncologist instruction.

Side Effects of Xtane

Common (oestrogen-deprivation symptoms):

• Hot flushes (35–40%)
• Arthralgia and myalgia (~30%)
• Vaginal dryness, dyspareunia
• Mood changes, fatigue
• Mild hair thinning
• Increased sweating
• Nausea (mild, usually settles)

Important long-term:

• Accelerated bone-density loss and increased fracture risk — possibly slightly less than non-steroidal AIs (mild androgenic effect of exemestane), but clinical significance debated
• Mild androgenic side effects (acne, hair changes) — uncommon but distinctive
• Hyperlipidaemia (mild)

Less common but seek review:

• Hepatotoxicity (mild LFT rises common)
• Lymphocytopaenia, thrombocytopaenia
• Severe hypersensitivity
• Carpal tunnel syndrome

Waarschuwingen en voorzorgsmaatregelen

• Pregnancy: ABSOLUTE CONTRAINDICATION. Exemestane is teratogenic. Postmenopausal patients usually past childbearing potential, but perimenopausal patients need reliable contraception.
• Premenopausal women: ineffective unless combined with ovarian suppression under specialist guidance.
• Bone health: baseline DEXA, repeat every 2 years. Calcium + vitamin D + bisphosphonate/denosumab if osteopenia.
• Hepatic and renal impairment: no dose adjustment for mild-moderate; caution in severe.
• Concurrent oestrogen therapy: avoid — defeats the purpose.

Geneesmiddelinteracties

Bewaaradvies

• Bewaren bij kamertemperatuur, 15–30°C. Keep in original blister.
• Buiten bereik van kinderen en huisdieren houden.
• Return unused tablets to a pharmacy for disposal.

Gerelateerde alternatieven op MedsBase

Other oncology medications stocked alongside this product:

• Anaridex (anastrozole 1 mg)
• Fempro (letrozole 2.5 mg)
• Letroheal (letrozole 2.5 mg)
• Tamilong (tamoxifen 10 / 20 mg)
• Tamodex (tamoxifen 10 / 20 mg)
• Tamoxilon (tamoxifen 10 / 20 mg)
• Cytotam (tamoxifen 10 / 20 mg)
• Caditam (tamoxifen 20 mg)

Browse all anti-cancer medications →

Waarom bestellen bij MedsBase

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Related Anti-Cancer Medications

Other oncology medications stocked alongside this product:

• Anaridex (anastrozole 1 mg)
• Letroheal (letrozole 2.5 mg)
• Fempro (letrozole 2.5 mg)
• Tamilong (tamoxifen 10/20 mg)
• Tamodex (tamoxifen 10/20 mg)

Veelgestelde vragen

Why must Xtane be taken with food?

Food increases exemestane bioavailability by approximately 40% — this is a true pharmacokinetic effect, not just a tolerability rule. Taking exemestane on an empty stomach significantly underdoses you. Take after the first major meal of the day for consistent absorption.

How is Xtane different from anastrozole and letrozole?

Exemestane is a steroidal aromatase inactivator that irreversibly destroys aromatase enzyme molecules. Anastrozole and letrozole are non-steroidal reversible inhibitors. The clinical implications: (1) no cross-resistance — patients who progress on anastrozole or letrozole may still respond to exemestane; (2) mild androgenic effect of exemestane (sometimes used to argue marginally lower bone-loss, though clinical significance debated); (3) different food-effect (exemestane absorption increases 40% with food).

When is Xtane preferred over anastrozole or letrozole?

Three common scenarios: (1) sequential therapy after 2–3 years of tamoxifen (the IES trial used exemestane in this setting); (2) after progression on anastrozole or letrozole — the structurally distinct mechanism may give renewed response; (3) after intolerable arthralgia on a non-steroidal AI — about 30% of patients tolerate one AI but not another.

How long do I take Xtane for?

Standard adjuvant duration is 5 years total endocrine therapy (this may include tamoxifen or another AI in the first 2–3 years if exemestane is used in sequential setting). For higher-risk node-positive disease, extended therapy to 7–10 years is increasingly used. For metastatic disease, until progression or intolerable toxicity.

Will Xtane weaken my bones?

Yes — like all aromatase inhibitors. Some data suggest exemestane may produce slightly less bone-loss than anastrozole or letrozole because of its mild androgenic effect, but the clinical significance is debated and the safe assumption is that bone protection is needed. Mandatory baseline DEXA, repeat every 2 years. Calcium + vitamin D supplementation. Bisphosphonate (zoledronic acid IV every 6 months) or denosumab (60 mg SC every 6 months) if osteopenia.

How do I manage joint pain on Xtane?

Same approach as other AIs: regular exercise (yoga, walking, swimming), vitamin D supplementation, paracetamol or short NSAID courses, weight management. If intolerable, switching to anastrozole of letrozole sometimes helps. Acupuncture has modest evidence in AI-induced arthralgia.

Can I use HRT or vaginal oestrogen on Xtane?

Generally not — even low-dose vaginal oestrogen produces measurable systemic absorption that can defeat AI therapy. First-line for vaginal symptoms: non-hormonal moisturisers (Replens, hyaluronic acid gels) and water-based lubricants. Specialists occasionally consider very low-dose vaginal oestriol on an individual risk-benefit basis.

Are there drug interactions I need to worry about?

The main one is strong CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, St John's wort) which significantly reduce exemestane levels. If a CYP3A4 inducer is essential, the dose may be doubled to 50 mg/day under specialist guidance. Avoid St John's wort entirely. Otherwise, exemestane has relatively few drug interactions.

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