Estramustine

WHY is this medicine prescribed?

Estramustine is used to treat prostate cancer that has worsened or has spread to other parts of the body. Estramustine is in a class of medications called antimicrotubule agents. It works by stopping the growth and spread of cancer cells.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Estramustine comes as a capsule to take by mouth. It is usually taken with water 3 to 4 times a day at least one hour before or two hours after meals. Do not take estramustine with milk, milk products, or foods that contain large amounts of calcium. Take estramustine at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take estramustine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Estramustine may control the spread of your cancer but does not cure it. It may take up to 3 months before your doctor can tell if this medication is helpful for your condition. Be sure to tell your doctor how you are feeling during your treatment with estramustine. Continue to take estramustine even if you feel well. Do not stop taking estramustine without talking to your doctor.

What SPECIAL PRECAUTIONS should I follow?

Before taking estramustine,

• tell your doctor and pharmacist if you are allergic to estramustine, estradiol, nitrogen mustard, or any other medications.

• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

• if you are taking calcium supplements or antacids that contain calcium such as Alka-Mints, Tums, or Titralac, take them at least 2 hours before or 2 hours after estramustine.

• tell your doctor if you have or have ever had a blood clot, diabetes, high blood pressure, a stroke, congestive heart disease, migraines, seizures, any conditions that affect the balance of calcium and phosphorous in your body such as parathyroid disorder, or liver or kidney disease.

• you should know that estramustine is only for use in men. Estramustine may cause fetal harm. You should use effective birth control if there is a possibility that your partner could become pregnant while you are taking estramustine. Women who are or may become pregnant should not take estramustine. If you take estramustine while you are pregnant, call your doctor immediately.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Estramustine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• diarrhea
• breast tenderness and enlargement
• leg cramps
• tiredness
• difficulty falling asleep or staying asleep
• impotence (inability to have or maintain an erection)

Some side effects can be serious. If you experience any of these symptoms call your doctor immediately:

• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• hoarseness
• difficulty swallowing or breathing
• shortness of breath
• chest pain
• dizziness or faintness
• speech problems
• sudden, severe headache
• sudden partial or complete loss of vision
• weakness or numbness of an arm or a leg
• pain, redness or swelling of an arm or leg

Estramustine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store estramustine capsules in the refrigerator.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to estramustine.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.