Emcyt
Emcyt (estramustine) is an oral medication used to improve the quality of life (palliative care) for people with metastatic prostate cancer, meaning cancer that has spread to other parts of the body. It works to treat prostate cancer in 2 different ways, by damaging cancer cells directly and by lowering testosterone levels so cancer cells can’t grow and spread. But it’s not commonly used because there are other medications that work better to treat prostate cancer.
What is Emcyt (estramustine)?
What is Emcyt (estramustine) used for?
- Metastatic prostate cancer
How Emcyt (estramustine) works
Most prostate cancer cells need testosterone, a male sex hormone, to grow and spread. When you have higher levels of estradiol, a female sex hormone, your body makes less testosterone.
Emcyt (estramustine) is an estradiol linked to a nitrogen mustard (another anticancer medication).
- Estradiol works by blocking your body from making testosterone, so that prostate cancer cells either die or grow more slowly.
- Nitrogen mustard damages the cancer cells’ genetic material, which leads to cell death.
Drug facts
Side effects of Emcyt (estramustine)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Breast enlargement (75%)
- Breast tenderness (71%)
- Higher liver enzymes (up to 34%)
- Swelling or fluid buildup (20%)
- Nausea (16%)
- Diarrhea (13%)
- Stomach upset (12%)
- Difficulty breathing (12%)
- Leg cramps (9%)
Less Common Side Effects
- Loss of appetite
- Passing gas
- Vomiting
- Weakness
- Mood changes
- Difficulty sleeping
- Headache
- Anxiety
- Throat irritation or hoarseness
- Rash
- Itching
- Dry skin
- Bruising
- Thinning hair
Emcyt (estramustine) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: chest pain, shortness of breath, sweating, nausea, vomiting, abnormal heartbeat, dizziness, weakness
- Blood clot in the brain (stroke): sudden confusion, numbness or weakness in one side of the body, difficulty walking, slurred speech, vision problems, severe headache
- Blood clot in the lungs (pulmonary embolism): shortness of breath, chest pain, dizziness, racing heart, sweating, coughing or coughing up blood
- Blood clot in the veins (deep vein thrombosis): swelling in the affected limb (usually in the legs or arms), pain in the affected limb, red or discolored skin, feeling of warmth in the affected limb
The following Emcyt (estramustine) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
Black, tarry stools
blood in urine or stools
cough or hoarseness
fever or chills
headaches (severe or sudden)
loss of coordination (sudden)
lower back or side pain
painful or difficult urination
pains in chest, groin, or leg (especially calf of leg)
pinpoint red spots on skin
shortness of breath (sudden, for no apparent reason)
slurred speech (sudden)
unusual bleeding or bruising
vision changes (sudden)
weakness or numbness in arm or leg
Check with your doctor as soon as possible if any of the following side effects occur:
More common
Swelling of feet or lower legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Trouble in sleeping
vomiting
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Emcyt (estramustine)
Pros
- Oral pill
- Treats prostate cancer in 2 different ways: 1) by damaging cancer cells directly and 2) by lowering testosterone levels so cancer cells can’t grow and spread
Cons
- Typically not a recommended option for metastatic prostate cancer because it doesn't help much with improving survival or quality-of-life
- Can cause undesired side effects in men, including breast enlargement and tenderness
- Needs to be taken 3 to 4 times per day
Pharmacist tips for Emcyt (estramustine)
- Take Emcyt (estramustine) at least 1 hour before or 2 hours after meals. Swallow capsules whole with water. Don’t take Emcyt (estramustine) at the same time as milk or milk products, and calcium-rich foods or drugs (such as antacids like Tums).
- Emcyt (estramustine) can cause breasts to become larger or more tender. It can also make it more difficult for you to have an erection. These side effects are linked to the higher levels of estrogen in your body because of the hormone estradiol found in this medication. Talk to your provider if these side effects become bothersome for you.
- Ask your provider how often you need to have your electrolyte levels checked while you're taking Emcyt (estramustine). This medication can affect electrolyte levels. In particular, it can lower the amount of calcium in your body.
- If your partner is able to become pregnant, make sure to use appropriate birth control measures, such as condoms, while taking Emcyt (estramustine) due to the risk of birth defects.
- Ask your healthcare provider or pharmacist about the best way to handle and dispose of this anticancer medication. These medications can be hazardous to people who handle or come into contact with them, so you need to get rid of them safely.
Common questions about Emcyt (estramustine)
Emcyt (estramustine) isn’t a first-choice option for metastatic prostate cancer because research shows that this medication didn’t help much with improving quality of life and it can raise the risk for serious side effects, such as blood clots and heart failure. Current recommended treatments for late stage prostate cancer can include options such as surgery, radiation, chemotherapy, immunotherapy, and other kinds of hormone therapy. Talk with your provider if you have any questions about the benefits and risks for any of the treatment options.
You might need to take Emcyt (estramustine) for at least 1 to 3 months before your provider can figure out if it’s working for you. Then, your provider will decide how long to continue the medication, depending on how well your body responds to it.
Store Emcyt (estramustine) in the refrigerator at 36° to 46°F (2° to 8°C). Don't freeze it. If you're planning to travel, make sure to store your medication in a cooler bag with ice, so that it's at the right temperature. Talk with your provider or pharmacist if you have questions about storage or traveling with Emcyt (estramustine).
If you have liver problems, your body might have a difficult time breaking down Emcyt (estramustine). If you have kidney problems, you might experience more kidney-related side effects from Emcyt (estramustine), such as fluid build up and electrolyte levels being out of balance. Let your provider know if you have problems with your liver or kidney because you might be monitored more closely for liver or kidney health and side effects.
Generally, palliative care is treatment that tries to improve the quality-of-life of someone who has a serious medical condition, in addition to treating their condition. If you receive palliative care, your care team will focus on providing you physical comfort and easing side effects, as well as giving you emotional, social, and spiritual support. Palliative treatments can be curative (treating to cure), but not always.
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Risks and warnings for Emcyt (estramustine)
Emcyt (estramustine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Higher risk for blood clots
- Risk factors: Hormonal (estrogen) treatment | Blood flow problems
Estrogen treatment for prostate cancer, like Emcyt (estramustine), can raise your risk for developing blood clots. In rare cases, the clots can cause heart attacks, which can be deadly. Let your provider know if you have a history of blood clots, especially if they developed while you were on any previous estrogen therapy. Also, tell your provider if you have a history of stroke (or other blood clots in your brain) or problems with the blood vessels in your heart (coronary artery disease), as these can raise your risk of serious blood clots. Get medical help right away if you experience chest pain, shortness of breath, sweating, heartbeats that aren’t regular, dizziness, weakness, sudden confusion, difficulty walking, slurred speech, vision problems, or severe headache.
High blood sugar
- Risk factors: High blood sugar
Emcyt (estramustine) can make it more difficult for your body to control your blood sugar, which can result in high blood sugar. If you have diabetes, you and your provider should monitor your blood sugars more closely. Let your provider know if you become more thirsty or hungry, urinating more, or have headaches and blurry vision.
High blood pressure
Emcyt (estramustine) can raise your blood pressure. Your provider may have you monitor your blood pressure more regularly. Let your provider know if you experience irregular heartbeat, severe headaches, fatigue, or dizziness.
Fluid buildup in arms or legs (peripheral edema) or heart
- Risk factors: Edema | Heart failure
Emcyt (estramustine) can cause new or worsening swelling or fluid buildup in the arms of legs or heart failure. Some symptoms of heart failure include shortness of breath during rest or exercise, weight gain, swelling of the legs or ankles, fatigue, and poor appetite. Let your doctor know if you have other conditions, including seizures, migraines, or kidney problems, that can be made worse by the extra fluid in your body so they can help you monitor for symptoms.
Emcyt (estramustine) dosage
Capsule| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 140mg | 30 capsules | $488.88 | $16.30 |
Typical dosage for Emcyt (estramustine)
Your provider will calculate your dose based on your weight.
In general, the typical dose of Emcyt (estramustine) is 14 mg/kg taken by mouth daily, split into 3 or 4 smaller doses and taken throughout the day.
Interactions between Emcyt (estramustine) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Emcyt (estramustine) cost?
$488.88
Emcyt (estramustine) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Emcyt (estramustine) will not be safe for you to take.
- Allergy to estradiol or nitrogen mustard
- Blood clot problems
What are alternatives to Emcyt (estramustine)?
Prostate cancer that has spread to other parts of the body, in combination with a corticosteroid:
