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Treatment Name: Letrozole (Femara®)

Letrozole (Femara®) is a Chemotherapy Regimen for Breast Cancer - metastatic

How does letrozole (Femara®) work?
Letrozole is designed to block an enzyme (a type of protein) in your body called aromatase. Aromatase is responsible for helping produce estradiol (a type of estrogen). When letrozole inhibits, or stops aromatase, there is less estrogen produced. When estrogen is not able to bind to the receptors on breast cancer cells, the cancer cells are not able to grow or divide. Patients with breast cancer that are not estrogen-receptor positive rarely respond to treatment with letrozole.

Goals of therapy:
Letrozole is commonly taken to slow the progression of breast cancer and prevent it from spreading further. Ask your doctor if you are unsure as to whether you are considered pre- or post-menopausal.


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  • Usual starting dose: Letrozole 2.5 mg oral tablet by mouth daily

Letrozole is usually taken at home.

Letrozole is taken until the drug no longer works or until unacceptable side effects occur. Letrozole is only indicated for use in post-menopausal women and should not be used by pre-menopausal women.

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.


How often is monitoring needed?
Labs (blood tests) may be checked every one to three months. Labs often include: complete blood count (CBC), comprehensive metabolic panel (CMP), triglycerides, and blood cholesterol levels.

How often is imaging needed?
Imaging may be checked before treatment and every two to six months during treatment. Imaging may include: bone scans, magnetic resonance imaging (MRI), and computerized tomography (CT) scans. DEXA (dual energy x-ray absorptiometry) scans may be performed to monitor your bone mineral density.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue letrozole as planned, delay treatment, or switch therapy.

ChemoExperts Tips

  • Unless specifically discussed with your doctor, avoid estrogen replacement therapy or other medications that contain estrogen as they may decrease the effectiveness of letrozole
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for breast cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to to search for other centers offering study medications.

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Letrozole (Femara®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Letrozole (Femara®). Depending upon your income, they may be able to help cover the cost of:

  • Letrozole

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Letrozole (Femara®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Letrozole (Femara®)

Individual Drug Label Information

Letrozole (Femara®)

  • Letrozole is an oral tablet 
  • Letrozole can be taken with or without food. Swallow tablets whole and do not crush tablets. If you miss a dose, take the dose as soon as you remember if it is still the same day. If it is the next day, take your regular dose as scheduled. Do not double your dose to make up for the missed dose 
  • Letrozole should be stored at room temperature in a cool, dry place 
  • Dosage adjustments may be required due to side effects or liver dysfunction 
  • May cause fetal harm; avoid pregnancy 
General Letrozole (Femara) Side Effects 
  • One of the most common side effects reported is hot flashes. Talk to your doctor about ways to minimize and treat hot flashes. Do not take any medicines, herbs, or natural supplements without speaking with your doctor or pharmacist first 
  • Joint pain 
  • Decreased bone strength 
  • Increase in blood cholesterol 
  • May cause dizziness and/or drowsiness 
  • High blood pressure 
  • Increase risk of blood clots 
  • Mood swings 
  • Fluid retention 
  • Skin rash 
  • Decreased sexual drive 
  • Nausea and vomiting 
  • Constipation
  • Click on the letrozole (Femara) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingFatigue Fatigue ConstipationConstipationPainPainBlood ClotsBlood Clots

See DailyMed package insert.

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1) Mouridsen H, Gershanovich M, Sun Y, et al. Phase III Study of Letrozole Versus Tamoxifen as First-Line Therapy of Advanced Breast Cancer in Postmenopausal Women: Analysis of Survival and Update of Efficacy From the International Letrozole Breast Cancer Group. J Clin Oncol. 2003;21:2101-2109.

Created: February 23, 2017 Updated: October 8, 2018

What is Breast Cancer - metastatic?

What is Metastatic Breast Cancer?
A disease of the milk-producing glands known as lobules, milk ducts, or other cells found in the breast. Metastatic breast cancer is one that has moved from the breast to other areas of the body, which may include the brain, liver, or bone. Breast cancer is one of the most common types of cancers in women, but may rarely affect men as well. Known causes of breast cancer include genetic causes, such as the BRCA mutation, or obesity. The effectiveness of the treatment may depend upon the stage at diagnosis.

Types of metastatic breast cancer:
1. Hormone-receptor positive or negative (60 - 65% of patients)

  • Estrogen Receptor positive (ER)+ or negative (ER)-
  • Progestin Receptor positive (PR)+ or negative (PR)-

2. Hormone Epidermal growth factor Receptor-2 (HER-2) positive or negative (20 - 25% of patients)

  • HER-2 +
  • HER-2 -

3. Triple Negative (15 - 18% of patients)

  • ER- and PR- and (HER-2)-
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

14) Serum calcium