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Issues for surgery

Potential increased risk of wound complications if continued – see Further information.

Advice in the perioperative period

Elective and emergency surgery 

Continue.

Post-operative advice

Restart as soon as enteral intake resumed.

Monitor post-operative wound healing and discuss with patient’s oncology team if patient develops post-operative wound complications such as infection.

Interactions with common anaesthetic agents

None.

Interactions with other common medicines used in the perioperative period

None.

Further information

Discontinuation and effect on cancer

The risk of cancer recurrence from temporary cessation of exemestane is unknown. Any interruption should be discussed with the patient’s oncology team.

Wound healing

One study reported a potential association between perioperative aromatase inhibitor use and perioperative wound complications, but this is limited to one small retrospective study of patients undergoing breast reconstruction surgery.

References

1. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 23^rd October 2024]
   
   
2. Billon R, Bosc R, Belkacemi Y et al. Impact of adjuvant anti-estrogen therapies (tamoxifen and aromatase inhibitors) on perioperative outcomes of breast reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery, 2017; 70:1495-1504 doi: 10.1016/j.bjps.2017.05.046
   
   
3. Brayfield A, Cardart C (eds), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed on 20^th October 2024]
   
   
4. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 23^rd October 2024]
   
   
5. Pfeifer KJ, Selzer A, Mendez MD, et al. Thematic Review on Perioperative Medicine. Preoperative Management of Endocrine, Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Mayo Clin Proc. 2021;96(6):1655-1669 doi:10.1016/j.mayocp.2020.10.002
   
   
6. Summary of Product Characteristics. Exemestane 25mg film-coated tablets. Zentiva. Accessed via www.medicines.org.uk 22/10/2024 [date of revision of the text November 2022]