FEMARA

TarheelMichelle, I don't know who told you you can't take Wellbutrin with letrozole (or any other AI). Tamoxifen, yes—both drugs compete for the same enzymatic pathway. But Wellbutrin is fine with an AI. Both my MO and shrink agree. Not sure what methadone would do to be contraindicated—I took opioids rehabbing after each of my knee replacement surgeries, and stayed on Wellbutrin at the time.

Artista, no disrespect to your former boss, but please get a second opinion on knee replacement surgery. “Minimally-invasive" or partial (unicompartmental) knee replacement surgery is a different animal—patients getting those operations are usually sent home the same day and expected to function with only home or outpatient PT. A high BMI would likely screw up those surgeons' success statistics. But I had conventional open TKR and my BMI at the time of my first one was 37 and my second a year later was 34. (My surgeon advised against simultaneous bilateral because of my age, which is why I spaced the surgeries out over a year). A BMI of 25 is ONE point above ideal…for a healthy woman with no orthopedic issues (which issues might well be impacting ability to exercise and therefore BMI).

Your former boss may be a great surgeon but he is by no means the only one in the greater Bay Area, nor is his specialty the only (nor even necessarily the best) type of knee replacement surgery that is standard-of-care today. (And here in Chicago, those surgeons doing minimally-invasive &/or same-day TKRs tend not only to cherry-pick the youngest and healthiest patients but also—nonetheless—to have higher complication and revision rates).

How does the bone pain caused by Femara feel like? Can it be on one side or is it in all joints simultaneously? Is the pain sharp or dull?

Can you explain the difference?

~Syringa~

I am trying to figure that out myself. I had muscle & joint pain in my knees back in January. I started walking as an exercise regimen, so I thought that was why I was hurting. But It's now three months later and I should be past the 'exercise shock'. The muscle pain is gone, but the joint pain has gotten worse. It doesn't hurt when I walk (or stretch), but my knees really hurt when I lower myself into a sitting position or try to get up. The pain is sharp. My fingers started to hurt early this month. I had to take off my wedding rings because that finger on my left hand swelled up. I also have trouble bending the middle finger of my right hand. All of my fingers hurt to some extent. The pain can be sharp and dull. I have had issues with stiffness and figured I'd have arthritis at some point, but I expected it to be gradual. This kind of blew up quickly, so I am not blaming the letrozole completely, but I do think it has aggravated it. My PCP has put me on an OTC arthritis-pain medication (acetaminophen; extended-release; 650mg twice a day), but it doesn't help much, especially at night. I will be seeing my MO in 12 days and will ask him about pain relief. I have heard that magnesium, extra D3 and even antihistamines may help. I can't speak to bone pain - mine is joint: fingers, knees & sometimes my left hip.

Windingshores- thank you for your post. I went to a research on oncologist at an NCI cancer center who couldn't answer that question... you found the answer in the packaging for the drug.

I am stage IV. I am going to play it safe and stay on 2.5mg for at least 2 years, difficult as it is. But I'll keep this info in my back pocket for later.

I think dropping the dose is something people should discuss with their doctor if the side effects are tough. Especially early stage.

None of my oncs are aware of this. I am going to find the info online and post it so people can bring it with them. Will search tonight.

Thanks Wind.

Z

I am happy to report that after 1 year on exemestane and a half year on letrozole, my MO is transitioning me to Tamoxifen. In two weeks (after six weeks off AIs), I will make the switch.

In the meantime, I am taking PT for a painful knee, walking in the pool, and aiming to walk some every day. Doesn't sound like much, but I have become crippled the last few months and unable to walk my dogs more than one block.

It is such a rush to hope for a return to myself.

BTW, I asked him about Cymbalta, and he said he didn't see a conflict with Tamoxifen--that the drug is good for anxiety, depression, and pain. I will still get a prolia shot in June.

After life being unbearable so long, I'm so willing to give this a try. Maybe Cymbalta will reduce the SERM effectiveness some, but if I can gain some BC protection from Tamoxifen, get pain relief, reduce depression, and maybe get to dance and garden again, I will at least have a chance to be the old me. It is hard not to feel like I'm in a card game, with percentages and chances to win for each card played. On AIs, I was willing to die. Now I want to truly win with a treatment I can embrace.

Ozoner -- I can hear the relief and happiness in your voice. Your plan makes great sense and I am praying for you. Yay!!!! Your future is bright! Many blessings to you.

ozoner smart move. Keep us posted.

Z

I am a bit confused regarding the TEVA and ACCORD brands of letrozole. Is it the fillers? I have been on letrozole since late July of last year and I have always gotten the TEVA. You all seem able to have chosen your pharmacy. I was not given that option. My letrozole is mailed to me every month from the pharmacy that is part of the oncology practice I go to. When I asked my MO if I could use my own pharmacy where all my other meds are dispensed, he said he preferred to use the practice's pharmacy. He was emphatic, so I didn't push it.

peaches1, I am happy to hear that you aren't experiencing debilitating SEs from this stuff. Femara is in my treatment plan and while I've gone along with everything so far, I have seriously been considering refusing it, after reading here of all the horror people seem to experience. Maybe I'll have a go at it and just wait and see.

Peaches, Gordon's Pharmacy (the little indie in Andersonville with the kosher deli in front that had always been able to order me even Teva or Roxane) filled my 'scrip with Accord this time. Haven't noticed any differences other than muscle soreness—but that correlates directly to aftereffects of the personal training sessions (mostly weights in some form or another) I started three weeks ago.

Yes, the differences between generic mfrs. (as well as the original branded Novartis Femara) are due to dyes & fillers, as well as to the fact that a generic, by law, can have as little as 75% of the active ingredient of the branded drug. Could be that Accord has more letrozole in it than do Roxane or Teva. And as to dyes and fillers, not everyone has sensitivities or allergies to the same ones (nor to any at all). It's a crapshoot. You can't know till it happens.

For recent-onset knee pain, it's probably OA; it's a good idea to see an orthopedist for a baseline X-ray to check for degenerative changes—worn cartilage, bone spurs—to assess the need for therapies such as shots (cortisone or lubricating), “offloader" bracing (shifting your weight to the less worn side of the knee) and arthroplasty (knee replacement surgery). If sudden onset and sharp, you might have torn your meniscus (the cushion-shaped cartilage in your knee joint). MRI can confirm the diagnosis, but most orthopedists can diagnose it by manipulating your knee and listening to your description of the pain and its onset. Arthroscopic surgery (debridement or—if you're “lucky" enough to have torn the part of the meniscus with a blood supply, repair by suture) followed by PT used to be standard-of-care for meniscus tears; but studies have shown that PT and pain management alone are just as effective…until such time as you kneed a full replacement. (Take it from someone who's torn an ACL, R & L meniscus surgeries—L was sutured, R 17 yrs later debrided-- and had both knees replaced).

I found the info on dosing of Femara two years ago, in the actual insert that comes with the drug. I posted the link above, in the first post on this subject.

A mere .5mg. 20% of the usual dose, was found to be effective. I assume, therefore, that there is no benefit to using 2.5 versus .5mg because estrogen level was "undetectable" at the lower dose. I mean you can't subtract from zero. So why is the usual dose 2.5mg?

My oncologist says it was fine to take half and that she is glad I am taking it, period. She said some patients with side effects like joint pain ask her if they can take less, or alternate days.

I have no idea if this would help bones, fatigue or other side effects.

I am still taking the 2.5mg and it's been two years. I take brand name. I am seriously considering reducing down to 1.25mg which is still a lot higher than that .5.

Syringa, the Femara pain is joint pain, for me. Estrogen lubricates joints, so just as metal hinges get creaky, so do our joints. My hip and shoulder sockets hurt the worst. Carrying a very light handbag on my shoulder hurts. I have a lot of bone tumors and it's very easy for me to distinguish my cancer pain from Femara-induced pain. Also, cancer pain seems a lot easier to remedy with opioids.

ChiSandy, My previous post had an extraneous comma that made it appear as if letrozole was the issue. It's the methadone for pain that I was told is incompatible with Wellbutrin. I have taken Wellbutrin with AIs before (when I was first Stage IV diagnosed, with Aromasin). And I have taken many other opioids with Wellbutrin. When I tried Cymbalta for help with AI-related joint pain, it wasn't helping much, but my mood was definitely better, so once I completed the horrible Cymbalta withdrawal, I decided going back on Wellbutrin might be a good idea.

However ... now that you mention it, it wasn't my MO or my pain doctor who told me about the methadone-Wellbutrin interaction. It was a nurse who I do not know well, and who responds to me when I message my MO, and whose instructions have been wrong more than once. Harrumph. Oh, do not let me find out that she told me incorrectly!! Grrrrr .... I bear very long, hard grudges against doctors who have caused me heartache: the RO who assured me my spinal radiation wouldn't prevent me from running; the doctor whose removal of my tiny skin mets caused a huge, ugly scar, and many more.

I'm calling my pharmacist today (Sunday). I might be fuming right now, but you may have helped me immensely. (As you help so many of us here.) For that, I am VERY GRATEFUL!!! I'll let you know.

BTW, for all Femara users, I continue to be amazed at my reduction in joint pain with Femara by taking Claritin daily. If I miss just one dose of Claritin, the joint pain comes back. Claritin doesn't help the crushing fatigue, though. Every mild exercise session causes really sore bones the next day. I may have to discontinue Femara because it hurts meso much. The Ritalin for fatigue and Claritin for joint pain have been quite successful, but the treatment continues to mess with my QOL.

I'm wishing all my Femara sisters a decent day.

Well, I don't like the side effects of Femera, but will continue taking it for as long as I can

Gracie- I believe the AI becomes a must do for stage IV but for us lower stages it's not like that so we have a little more leeway in doing something or not.