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Letrozole (Femara®) is used in the treatment of certain types of hormone-dependent breast cancer in postmenopausal women.

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Page 1 LETROZOLE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name — letrozole LEH truh zole Brand name — Femara® FEH muh ruh Approved uses Letrozole is used in the treatment of certain types of hormone dependent breast cancer in postmenopausal women Dose and schedule Taking letrozole as instructed is important to allow your treatment to be as effective as possible so here are some key points to remember o Your dose may vary but the usual dose of letrozole is 2 5 milligrams 2 5 mg to be taken by mouth at a scheduled time once a day o Letrozole can be taken with or without food but at the same time each day o Letrozole should be taken whole and not crushed cut or dissolved If you are unable to swallow letrozole talk to your care provider or pharmacist for possible options o If you miss a dose of letrozole do not take an extra dose or two doses at one time Simply take your next dose at the regularly scheduled time Be sure to write down if you miss a dose and let your care provider know about any missed doses Storage and handling Handle letrozole with care Just like when chemotherapy is given into the vein this drug can be toxic and exposure of the drug to others should be limited o Store letrozole at room temperature 68°F–77°F in a dry location away from light o Keep letrozole out of reach of children and pets o Leave letrozole in the provided packaging until it is ready to be taken o Whenever possible give letrozole to yourself and follow the steps below If a family member friend or caregiver needs to give letrozole to you they also need to follow these steps 1 Wash hands with soap and water 2 Put on gloves to avoid touching the medication Gloves are not necessary if you give the drug to yourself 3 Gently transfer the letrozole from its package to a small medicine or other disposable cup 4 Administer the medicine immediately by mouth with water 5 Remove gloves and do not use them for anything else 6 Throw gloves and medicine cup in household trash 7 Wash hands with soap and water LETROZOLE ORAL CHEMOTHERAPY EDUCATION Page 2 o If a daily pill box or pill reminder is used a separate one should be used for letrozole Do not mix other medications into the box with letrozole The person filling the box or reminder should wear gloves gloves are not necessary if you are filling the box or reminder When empty the box or reminder should be washed with soap and water before refilling Be sure to wash hands with soap and water after the task is complete whether or not gloves are worn o If you have any unused letrozole do not throw it in the trash and do not flush it down the sink or toilet Talk to your care provider or pharmacist about proper disposal of letrozole o If you are traveling put your letrozole in a sealed plastic bag Ask your pharmacist if any additional travel precautions are needed Handling body fluids and waste Because letrozole remains in your body for several days after it is taken some of the drug may be present in urine stool sweat or vomit Once you have started to take letrozole it is important to follow the instructions below every day for as long as your treatment lasts This is to keep yourself loved ones and the environment as safe as possible o Pregnant women should avoid touching anything that may be soiled with body fluids from the patient o Toilet and septic systems You may use the same toilet septic tank and/or sewer that you usually use If you have a low flow toilet close the lid and flush twice to ensure all waste has been discarded If the toilet or toilet seat becomes soiled with urine stool or vomit clean the surfaces before other people use the toilet Wash hands with soap and water after using the toilet o If you need a bedpan be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day o If you do not have good control of bladder or bowels use a disposable pad with a plastic back a diaper or a sheet to absorb body waste o Wash any skin that has been exposed to body waste or letrozole with soap and water o Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing If you do not have a washer place the soiled linens in a plastic bag until they can be washed o Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids Drug and food interactions o Letrozole has many drug interactions Inform your care providers of all prescription medications over the counter medications vitamins and herbal products o Talk with your care provider or pharmacist before taking new medications or supplements or receiving any vaccines LETROZOLE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Letrozole The common side effects that have been known to happen in more than 30% of patients taking letrozole are listed in the left side of this table You MAY NOT experience these side effects Options to help manage any side effects that do occur are included on the right side of this table These should be discussed with your care provider If you experience any side effect you cannot manage or that is not listed here contact your care provider Possible Side Effect Management Changes in electrolytes and other laboratory values High cholesterol levels Changes in some laboratory values may occur and will be monitored by a simple blood test You may not feel any symptoms if the changes are mild and they usually are not a sign of a serious problem More severe changes may occur which can be a sign of a serious problem Notify your care provider if you have any of the following Shortness of breath Chest discomfort Weakness or fatigue New aches and pains Headaches Dizziness Swelling of your legs or feet Red or brown colored urine Hot flashes sudden sweating and feelings of warmth If hot flashes are bothersome Mild regular exercise program may help Consult first with your care provider Try staying in a cool environment Wear layers so that you can remove outer layers when experiencing a hot flash Avoid or limit caffeine spicy food alcohol and stress which may worsen hot flashes Inform your care provider if your hot flashes are bothersome as there may be medications that can help Muscle or joint pain or weakness Keep a diary of your pain including a description of when and where the pain is occurring what it feels like and how long it lasts Stay as active as possible but know that it is okay to rest as needed too Tell your care provider if pain interferes with your activity If the pain or weakness bothers you ask your provider how you may ease this discomfort Take only pain medication that has been prescribed or recommended by your care provider LETROZOLE ORAL CHEMOTHERAPY EDUCATION Page 4 If you experience ANY uncontrolled side effect call your physician or healthcare center immediately INSTITUTIONAL CONTACT INFO Pregnancy sexual activity and contraception o Women should not become pregnant and men should not get a partner pregnant while taking letrozole Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of one month after the last dose of letrozole o Do not breastfeed while taking letrozole and for one month after the last dose of letrozole o Inform your care provider if you become pregnant o It is safe to hug and kiss Special precautions may be needed for sexual activity while on oral chemotherapy and you are encouraged to ask your care provider Obtaining medication o Talk with your care provider about the process for obtaining your letrozole PHARMACY OR SPECIALTY PHARMACY CONTACT INFO Additional resources Product website www femara com Product prescribing information www pharma us novartis com/sites/www pharma us novartis com/files/ Femara pdf Updated – September 3 2017 LETROZOLE ORAL CHEMOTHERAPY EDUCATION Page 5 Additional instructions Important notice The Association of Community Cancer Centers ACCC Hematology/Oncology Pharmacy Association HOPA National Community Oncology Dispensing Association Inc NCODA and Oncology Nursing Society ONS have collaborated in gathering information for and developing this patient education guide This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources This guide does not cover all existing information related to the possible uses directions doses precautions warnings interactions adverse effects or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional Provision of this guide is for informational purposes only and does not constitute or imply endorsement recommendation or favoring of this medication by ACCC HOPA NCODA or ONS who assume no liability for and cannot ensure the accuracy of the information presented The collaborators are not making any representations with respect to the medications whatsoever and any and all decisions with respect to such medications are at the sole risk of the individual consuming the medication All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional Permission Oral Chemotherapy Education OCE sheets are provided as a free educational resource for patients with cancer in need of concise easy to understand information about oral cancer drugs Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information However commercial reproduction or reuse as well as rebranding or reposting of any type are strictly prohibited without permission of the copyright holder Please email permission requests and licensing inquiries to Contact@NCODA org Copyright © 2017 by Hematology/Oncology Pharmacy Association All rights reserved