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Estramustine

(es-truh-MUS-teen)

Trade/other name(s): Emcyt, Estracyte

Why would this drug be used?

Estramustine is a combination of nitrogen mustard and estradiol phosphate. It is used to treat advanced prostate cancer.

How does this drug work?

Estramustine, a chemotherapy drug used as an alkylating agent, works by stopping the growth of cancer cells and causing them to die. It also serves as an estrogen (female sex hormone) which can help stop prostate cancer cells from growing.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have ever had any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, high blood pressure, diabetes, gout, peptic (stomach) ulcers, parathyroid problems, or if you have an infection. These conditions may require that your medicine dose, regimen, or timing be changed, or that you be more closely watched during treatment.
  • Tell your doctor if you have ever had blood clots in your legs or anywhere else in your body, including a stroke or heart attack. Estramustine may raise the risk that this will happen again.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Anyone taking this drug needs to use some kind of birth control. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. This drug is only approved for use in men, but if a woman takes it the drug may pass into breast milk and harm the baby.
  • If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

If you are taking antacids or calcium supplements, take them at least 2 hours before or 1 hour after taking this drug. Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

This medicine should be taken on an empty stomach.

Calcium blocks this medicine from entering the bloodstream. Avoid milk or milk products at least 2 hours before or 1 hour after taking estramustine.

Check with your doctor, nurse, or pharmacist about whether other foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Estramustine is usually taken by mouth 3 or 4 times per day. Take each dose with a glass of water, at least 1 hour before and 2 hours after eating. Do not take with milk, milk products, calcium supplements, or foods high in calcium. The dose depends on your size and the type of cancer being treated. Estramustine can also be given by an injection into a vein.

Take your anti-nausea medicine 1 hour before taking each dose. If you still feel nauseated, talk to your doctor about a stronger anti-nausea medicine.

Take this drug exactly as prescribed and directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you. Store the medicine in a tightly closed container in the refrigerator, away from heat and moisture, and out of the reach of children and pets.

Precautions

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor's OK. Estramustine may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get live virus vaccines during treatment or for some time afterward. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine.

Very rarely, this drug may cause blood clots. They may start in the leg or arm (deep vein thrombosis), and then travel elsewhere to cause a stroke or blockage in the lungs (pulmonary embolism). Call your doctor or nurse right away if you have pain in your lower leg (calf), redness or swelling of your arm or leg, shortness of breath, chest pain, changes in your thinking, headache, or trouble speaking or moving.

If you have diabetes, it is important to monitor your blood sugar level often. Estramustine may cause it to go up. Your doctor may prescribe extra lab work while you are taking this drug. Your medicine for diabetes may need to be changed.

If you have high blood pressure, you will need to check it more often while on estramustine. Estramustine can cause your blood pressure to rise.

Estramustine may be given intravenously. If the drug leaks out of the vein and under the skin, it may damage the tissue, causing pain, ulceration, and scarring. Tell the nurse right away if you notice redness, pain, or swelling at or near the IV.

Avoid conceiving a child during and for a few months after treatment in order to prevent harm to the fetus. Talk with your doctor about what kind of birth control you can use with this medicine.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • breast enlargement
  • nipple tenderness
  • decreased sex drive
  • impotence (erectile dysfunction)
  • itching
  • dry skin
  • night sweats

Less common

  • itching and pain in the genital area
  • numbness of mouth
  • rash
  • peeling skin of fingertips
  • thinning hair
  • tiredness (fatigue)
  • pain in eyes
  • nausea
  • vomiting
  • diarrhea
  • higher blood sugar*
  • higher blood pressure*

Rare

  • blood clots in legs, lungs, heart, or brain (deep vein thrombosis, pulmonary embolus, heart attack, stroke)*
  • low calcium level in the blood, with symptoms such as weakness, muscle stiffness, twitching or jerking
  • low white blood cell count with increased risk of infection
  • low platelet count with increased risk of bleeding
  • anemia (low red blood cell counts) which can cause weakness, paleness, shortness of breath, and other symptoms
  • allergic reaction with swollen face, mouth, or eyes, tightness in the throat, trouble breathing or swallowing, rash, itching, dizziness, or hives (welts) on the skin

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984.)

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 01/08/2010
Last Revised: 01/08/2010