Table 2. Precautions for Patients Taking Aromatase Inhibitors.

Aromatase inhibitors are the gold standard for postmenopausal women with breast cancer. Daily use of an aromatase inhibitor has been shown to improve survival and reduce the risk of developing recurrent invasive breast cancer by up to 40%.

Medications to Avoid or Use With Caution While Taking Anastrozole or Letrozole Certain medications should be avoided or used with caution while taking anastrozole or letrozole. Neuroleptics such as aripiprazole (Abilify) and pimozide (Orap) Cardiac medications such as dofetilide (Tikosyn) Pain medications such as hydrocodone (Vicodin) or methadone (Dolophine, Methadose)

Medications to Avoid or Use With Caution While Taking Exemestane Certain medications should be avoided or used with caution while taking exemestane. Diabetes medications such as saxagliptin (Onglyza) Antidepressants such as St. John's wort Anticonvulsants such as carbamazepine (Epitol, Equetro, Tegretol), oxcarbazepine (Trileptal), phenobarbital (Solfoton, Luminal), and phenytoin (Dilantin, Phenytek) Pain medications such as hydrocodone (Vicodin) and methadone (Dolophine) Anti-infective agents such as azithromycin (Zithromax), clarithromycin (Klaricid), efavirenz (Sustiva), nevirapine (Viramune), ritonavir (Norvir), cobicistat (Tybost), elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (Genvoya), elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (Stribild), rifampin (Rimactane), rifabutin (Mycobutin), voriconazole (Vfend), ketoconazole (Nizarol), and itraconazole (Sporanox) Heart/blood pressure medications such as amiodarone (Pacerone), diltiazem (Adizem), and verapamil (Isoptin)

Other Precautions Estrogen products/estradiol derivatives: Discuss all estrogen products with your health-care provider. Alcohol should be avoided or limited while taking aromatase inhibitors, as alcohol consumption may decrease the efficacy of this medication. Avoid grapefruit juice and particularly the specific class of Seville or “bitter” oranges, as they can interfere with the efficacy of exemestane. Normal store-bought orange juice is ok.

Supplements Some herbs, supplements, and other products can impact the effectiveness of your cancer treatment. Talk with your provider or health-care team if you are taking any of these products. The products listed below may cause problems with breast cancer or breast cancer treatment when taken in concentrated doses such as supplement form. These products are not normally harmful if they are found in the food that you eat as part of your regular diet. Aletris Alfalfa Androstenediol Androstenedione Anise/Star anise Black/Blue cohosh Chasteberry Chamomile Dandelion Diindolylmethane (DIM) Dong quai Echinacea Fennel Flaxseed Ginseng Grapefruit juice Guggul Hu zhang Isoflavones/Plant estrogens Kudzu Maca Milk thistle Noni juice Panax ginseng Red clover Red raspberry leaf Resveratrol Saw palmetto Scarlet pimpernel St. John's wort Turmeric/Curcumin Valerian (Whey) High protein supplements

Note. Generic drug names and common brand names listed only. Always tell your provider or health-care team all the medications, herbs, supplements, vitamins, minerals that you are taking. Please consult your health-care provider for more information. Reprint permission granted.

© 2023 Mary Heery, John Healey, Rachel Sieber, Emily McAllister, Ellen Konspore, Lisa Phuong, and George Zahrah.