Femara
In brief
- Femara (letrozole) is a prescription-only medicine (POM) in the UK, supplied as 2.5 mg tablets.
- Femara is used to treat hormone receptor‑positive breast cancer in postmenopausal women (adjuvant, extended adjuvant and advanced/metastatic disease). It is a non‑steroidal aromatase inhibitor that reduces peripheral oestrogen synthesis by inhibiting the aromatase enzyme.
- The usual dose is 2.5 mg once daily for adults; extended adjuvant therapy commonly continues up to 5 years (and total endocrine therapy may be longer depending on prior tamoxifen and clinician advice).
- Administration is oral only: 2.5 mg film‑coated tablets.
- Plasma concentrations peak at around 1 hour; measurable suppression of oestrogen occurs within a few days (typically 2–7 days), though clinical benefits may take several weeks.
- Letrozole has a terminal half‑life of approximately 2 days (around 40–60 hours); once‑daily dosing maintains oestrogen suppression and treatment is continued as clinically indicated (e.g. until progression in metastatic disease or for the prescribed adjuvant duration).
- Avoid excessive alcohol while on Femara; there is no absolute prohibition, but limiting alcohol is advised because of potential effects on bone health, liver function and overall wellbeing — discuss alcohol use with your prescriber.
- The most common side effect is hot flushes (other frequent effects include musculoskeletal pain/arthralgia, fatigue, nausea and mild bone density loss on long‑term use).
- Would you like to try Femara without a prescription?
Basic Femara information
- INN (international nonproprietary name): Letrozole
- Brand names available in the United Kingdom: Femara; generic letrozole
- ATC code: L02BG04
- Forms and dosages: oral film‑coated tablets, 2.5 mg
- Manufacturers in the United Kingdom: Novartis (originator) and generic manufacturers (for example, Sandoz)
- Registration status in the United Kingdom: authorised by the MHRA; prescription-only medicine (POM)
- OTC / Rx classification: Prescription-only medicine (POM)
Legal status and availability in the UK
Femara is a prescription-only medicine (POM) in the UK.
In our online pharmacy, Femara is available without a prescription, with discreet delivery to the United Kingdom in 9–21 days.
What Femara is used for
Femara (letrozole) is supplied as 2.5 mg film‑coated tablets. Letrozole is indicated for postmenopausal women with hormone receptor‑positive breast cancer and is not appropriate for premenopausal women, pregnancy or breastfeeding. It is listed under ATC code L02BG04 as an aromatase inhibitor within antineoplastic and immunomodulating agents.
A typical NHS pathway starts with diagnosis at a breast clinic or oncology service, followed by a hospital or GP‑issued prescription. Patients often have concerns about bone health, menopausal symptoms and lifestyle impacts when starting letrozole.
- Hot flushes and night sweats — the GP or oncology team can advise symptomatic measures.
- Joint aches — report persistent pain; bone health and analgesia plans can be reviewed.
- Worry about bones or cholesterol — baseline DEXA and lipid checks are typical.
Dosage, regimens and administration
The standard adult dose for breast cancer is letrozole 2.5 mg once daily, taken orally with or without food. This dose applies to adjuvant treatment, first‑line advanced disease and extended adjuvant therapy.
Typical adjuvant duration is five years, with some regimens extending cumulative therapy to ten years when clinically indicated.
Letrozole is not indicated in children and routine dose adjustment is not required for elderly patients. Mild to moderate hepatic or renal impairment usually does not require dose change; severe impairment warrants caution and specialist review.
If a dose is missed, take it as soon as remembered unless the next dose is due soon, in which case skip the missed dose. Do not double up to catch up.
In overdose there is no specific antidote; treatment is supportive, so seek medical help promptly (NHS 111, or 999 in an emergency).
| Indication | Dose | Duration |
|---|---|---|
| Adjuvant early breast cancer | 2.5 mg once daily | Usually 5 years |
| Advanced/metastatic | 2.5 mg once daily | Until progression or unacceptable toxicity |
Contraindications and who must not take Femara
Absolute contraindications are premenopausal women, pregnancy, lactation and known hypersensitivity to letrozole or any excipients. Use in these groups is contraindicated because of teratogenic risk and lack of efficacy in premenopausal hormonal physiology.
Relative contraindications include severe hepatic impairment, severe renal dysfunction, pre‑existing osteoporosis, history of ischaemic heart disease and concurrent use of potent CYP450 inducers or inhibitors. Pregnancy, menopausal status, bone disease and major cardiac history should be discussed with the prescriber before starting.
Side effects, frequency and practical management
Common effects include hot flushes, musculoskeletal pain or arthralgia, fatigue, nausea and headache.
Long‑term use is associated with loss of bone mineral density and increases in cholesterol levels.
Serious but less common problems include osteoporosis‑related fractures, severe joint symptoms that limit mobility, marked liver enzyme elevations and severe allergic reactions.
Calcium and vitamin D intake can be reviewed, and baseline and periodic DEXA scanning is arranged by oncology teams. Persistent or disabling joint pain, sudden breathlessness or signs of allergy require prompt clinical review. For cholesterol changes, GP lipid monitoring and lifestyle measures such as diet and exercise are advised.
| Symptom | What to do |
|---|---|
| Hot flushes | Cooling measures and fluid intake help; discuss symptomatic options with the GP or oncology team. |
| Joint pain | Simple analgesia may help; seek review if mobility is limited. |
| Breathlessness/allergic reaction | Seek urgent medical review. |
Drug interactions
Letrozole is metabolised partly via hepatic pathways and exposure can be affected by potent CYP450 inducers or inhibitors.
Strong inducers such as certain anticonvulsants and rifampicin, and herbal inducers like St John’s wort, can reduce letrozole levels and potentially its effectiveness. Potent CYP inhibitors may increase letrozole concentrations, though the clinical significance varies and requires prescriber review.
Co‑prescribing drugs that increase osteoporosis or cardiovascular risk should prompt extra monitoring for bone density and lipids. Avoid St John’s wort while taking letrozole without medical advice.
Monitoring, follow‑up and shared care
Monitoring focuses on bone health, lipids and review of symptoms such as arthralgia or mood changes. Common practice is baseline DEXA scanning and repeat scans at intervals determined by the oncology team for patients on long‑term therapy, with baseline and periodic lipid and liver function tests arranged by the clinical team or GP as part of shared care.
Example monitoring timeline: baseline, 6–12 months for initial review, then annual or as advised.
Storage
Store letrozole below 30°C and protect from moisture and heat, keeping tablets in the original blister where provided.
Generic versus branded Femara
Femara is the originator product from Novartis, and generic letrozole is also available in the UK. Appearance may vary between brands but the therapeutic effect is expected to be equivalent.
Off‑label use and fertility considerations
Letrozole is sometimes prescribed off‑label for ovulation induction, but it is not licensed for fertility use in the UK and must be used only under specialist supervision, with informed consent and documented monitoring.
Women of child‑bearing potential must use effective contraception while on letrozole and for the period recommended by the treating clinician after stopping.
Key counselling points
- Indication: postmenopausal women with hormone receptor‑positive breast cancer.
- Dose: one 2.5 mg tablet once daily, at the same time each day.
- Common side effects: hot flushes, joint pain, fatigue, possible bone density changes and cholesterol increases.
- Do not take if pregnant or breastfeeding, and confirm menopausal status with the prescriber.
- Monitoring: baseline DEXA and periodic lipid/liver checks as advised by the clinical team.
- Bone health: review calcium and vitamin D intake and take weight‑bearing exercise.
- Seek prompt clinical review for severe joint pain affecting daily activities, new breathlessness or rash.
Delivery across the United Kingdom
| City | Region | Delivery Time |
|---|---|---|
| London | England | 9–21 days |
| Birmingham | West Midlands | 9–21 days |
| Manchester | Greater Manchester | 9–21 days |
| Glasgow | Scotland | 9–21 days |
| Leeds | West Yorkshire | 9–21 days |
| Liverpool | Merseyside | 9–21 days |
| Edinburgh | Scotland | 9–21 days |
| Bristol | South West | 9–21 days |
| Sheffield | South Yorkshire | 9–21 days |
| Newcastle Upon Tyne | North East | 9–21 days |
| Nottingham | East Midlands | 9–21 days |
| Southampton | South East | 9–21 days |
| Belfast | Northern Ireland | 9–21 days |
| Cardiff | Wales | 9–21 days |
| Leicester | East Midlands | 9–21 days |
