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Exemestane side effects: what 21,296 FDA adverse event reports show

Exemestane · 1,162 reaction terms · 104,455 drug–reaction co-reports · data 2026-09-14
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Drug class

Aromatase Inhibitor

FDA label (Established Pharmacologic Class) · compare the class

Who reports

21,296 reports · 77% serious · 2,512 with death outcome · 99% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Exemestane tablets are an aromatase inhibitor indicated for: adjuvant treatment of postmenopausal women with estrogen-receptor positive early breast cancer who have received two to three years of tamoxifen and are switched to exemestane tablets for completion of a total of five consecutive years of adjuvant hormonal therapy ( 14.1 ).

FDA label, Indications and Usage

What it is

Exemestane Tablets, USP for oral administration contain 25 mg of exemestane, an irreversible, steroidal aromatase inactivator. Exemestane is chemically described as 6-methylenandrosta-1,4-diene-3,17-dione.

FDA label, Description section

Boxed warning

None in the current label

How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled (related wording) 7Likely indication confounding 1Lab value / disease marker 5Not in label — unassessed 27
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only (and, for the 300 most-reported drugs, adjusted for age band), and flags pairs whose reports are unusually skewed by sex or come mostly from consumers. Each row also shows the PRR against the other drugs of the same FDA class, which removes most confounding by the condition being treated, and a calibrated p-value: on validation, known non-causes average an ROR of about 2, so significance is judged against that empirical null (✓ = p < 0.05 after calibration). 1,122 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Pik3ca-activated mutation83337.1
262.7–432.6ROR 338.4 · calibrated p 6e-12 ✓
236.8 EB05 197.1 · IC025 +6.3
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.7 (0.6–0.9)
Not in label — unassessedserious n=82no trial data cached
Amaurosis fugax229268.8
232.3–311.0ROR 271.7 · calibrated p 3e-11 ✓
207.1 EB05 185.5 · IC025 +7.0
3/3 methods agree
vs other Aromatase Inhibitors: PRR 1.0 (0.9–1.2)
Not in label — unassessedserious n=229 · 93% clinicianno trial data cached
Pleural neoplasm24167.6
108.7–258.4ROR 167.8 · calibrated p 8e-9 ✓
128.7 EB05 91.0 · IC025 +4.5
3/3 methods agree
vs other Aromatase Inhibitors: PRR 2.1 (1.3–3.4)
Not in label — unassessedserious n=24 · 100% clinicianno trial data cached
Bone sequestrum19138.7
85.8–224.2ROR 138.8 · calibrated p 5e-8 ✓
108.5 EB05 73.4 · IC025 +4.1
3/3 methods agree
vs other Aromatase Inhibitors: only this drug
Not in label — unassessedserious n=19no trial data cached
Carbohydrate antigen 27.29 increased18133.4
81.5–218.3ROR 133.5 · calibrated p 7e-8 ✓
104.7 EB05 70.0 · IC025 +4.0
3/3 methods agree
vs other Aromatase Inhibitors: PRR 1.1 (0.6–1.8)
Lab value / disease markerserious n=15no trial data cached
Oestrogen receptor positive breast cancer14122.4
70.2–213.4ROR 122.5 · calibrated p 2e-7 ✓
95.1 EB05 60.2 · IC025 +3.6
3/3 methods agree
vs other Aromatase Inhibitors: only this drug
Likely indication confounding
term in indications; also in warnings
serious n=13no trial data cached
Pseudocirrhosis33110.1
76.8–157.7ROR 110.3 · calibrated p 1e-7 ✓
93.7 EB05 69.8 · IC025 +4.7
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.7 (0.5–1.0)
Not in label — unassessedserious n=33 · 100% clinicianno trial data cached
Metastases to chest wall34107.2
75.2–152.7ROR 107.3 · calibrated p 2e-7 ✓
91.8 EB05 68.7 · IC025 +4.8
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.8 (0.5–1.1)
Not in label — unassessedserious n=34no trial data cached
Carbohydrate antigen 15-3 increased74105.9
83.4–134.6ROR 106.3 · calibrated p 1e-7 ✓
93.4 EB05 76.8 · IC025 +5.5
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.4 (0.3–0.5)
Lab value / disease markerserious n=73no trial data cached
Metastases to thorax24102.6
67.4–156.3ROR 102.7 · calibrated p 3e-7 ✓
86.7 EB05 61.3 · IC025 +4.3
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.8 (0.5–1.3)
Not in label — unassessedserious n=24no trial data cached
Tumour marker decreased1588.8
52.3–150.6ROR 88.8 · calibrated p 1e-6 ✓
74.0 EB05 47.6 · IC025 +3.6
3/3 methods agree
vs other Aromatase Inhibitors: only this drug
Lab value / disease markerserious n=15no trial data cached
Metastases to pleura8688.6
71.1–110.5ROR 89.0 · calibrated p 4e-7 ✓
79.9 EB05 66.7 · IC025 +5.4
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.9 (0.7–1.1)
Not in label — unassessedserious n=86no trial data cached
Tumour marker abnormal2786.2
58.2–127.8ROR 86.3 · calibrated p 9e-7 ✓
75.2 EB05 54.3 · IC025 +4.4
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.9 (0.6–1.3)
Lab value / disease markerserious n=26no trial data cached
Breast cancer metastatic84784.4
78.8–90.4ROR 87.9 · calibrated p 3e-7 ✓
77.6 EB05 73.3 · IC025 +6.1
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.7 (0.7–0.8)
Not in label — unassessedserious PRR 54.9no trial data cached
Invasive lobular breast carcinoma4083.3
60.3–115.1ROR 83.5 · calibrated p 8e-7 ✓
74.2 EB05 56.8 · IC025 +4.8
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.9 (0.6–1.3)
Not in label — unassessedserious n=39no trial data cached
Anticipatory anxiety1974.4
46.7–118.6ROR 74.4 · calibrated p 3e-6 ✓
64.8 EB05 43.9 · IC025 +3.9
3/3 methods agree
vs other Aromatase Inhibitors: only this drug
Not in label — unassessedserious n=19no trial data cached
Metastases to the mediastinum2871.2
48.5–104.4ROR 71.2 · calibrated p 3e-6 ✓
63.6 EB05 46.2 · IC025 +4.3
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.6 (0.4–0.9)
Not in label — unassessedserious n=28 · 100% clinicianno trial data cached
Metastases to pelvis4168.4
49.8–93.8ROR 68.5 · calibrated p 3e-6 ✓
62.2 EB05 47.8 · IC025 +4.7
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.7 (0.5–1.0)
Not in label — unassessedserious n=41no trial data cached
Metastases to soft tissue1664.2
38.7–106.4ROR 64.2 · calibrated p 1e-5 ✓
56.4 EB05 36.8 · IC025 +3.6
3/3 methods agree
vs other Aromatase Inhibitors: only this drug
Not in label — unassessedserious n=16no trial data cached
Breast cancer recurrent17557.9
49.7–67.4ROR 58.3 · calibrated p 6e-6 ✓
54.4 EB05 47.9 · IC025 +5.3
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.6 (0.5–0.7)
Not in label — unassessedserious n=172no trial data cached
Tumour marker increased26256.7
50.1–64.2ROR 57.4 · calibrated p 6e-6 ✓
53.4 EB05 48.2 · IC025 +5.4
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.8 (0.7–0.9)
Lab value / disease markerserious n=236no trial data cached
Primary sequestrum4955.5
41.6–74.0ROR 55.6 · calibrated p 1e-5 ✓
51.6 EB05 40.5 · IC025 +4.6
3/3 methods agree
vs other Aromatase Inhibitors: PRR 1.6 (1.2–2.3)
Not in label — unassessedserious n=49no trial data cached
Oral cavity fistula2654.5
36.7–80.9ROR 54.6 · calibrated p 2e-5 ✓
49.9 EB05 35.8 · IC025 +4.1
3/3 methods agree
vs other Aromatase Inhibitors: only this drug
Not in label — unassessedserious n=26no trial data cached
Metastases to ovary1652.3
31.6–86.5ROR 52.3 · calibrated p 3e-5 ✓
47.1 EB05 30.7 · IC025 +3.5
3/3 methods agree
vs other Aromatase Inhibitors: PRR 4.3 (2.1–8.6)
Not in label — unassessedserious n=16no trial data cached
Bone marrow infiltration1950.9
32.1–80.8ROR 51.0 · calibrated p 3e-5 ✓
46.4 EB05 31.4 · IC025 +3.7
3/3 methods agree
vs other Aromatase Inhibitors: PRR 1.0 (0.6–1.7)
Not in label — unassessedserious n=19no trial data cached
Fibrous histiocytoma1543.3
25.8–72.7ROR 43.4 · calibrated p 9e-5 ✓
39.6 EB05 25.5 · IC025 +3.3
3/3 methods agree
vs other Aromatase Inhibitors: only this drug
Not in label — unassessedserious n=14no trial data cached
Metastases to lymph nodes27642.2
37.5–47.6ROR 42.8 · calibrated p 4e-5 ✓
40.4 EB05 36.6 · IC025 +5.0
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.8 (0.7–0.9)
Not in label — unassessedserious n=275no trial data cached
Lymphangiosis carcinomatosa4241.3
30.3–56.2ROR 41.4 · calibrated p 6e-5 ✓
39.0 EB05 30.1 · IC025 +4.3
3/3 methods agree
vs other Aromatase Inhibitors: PRR 1.4 (1.0–1.9)
Not in label — unassessedserious n=42 · 100% clinicianno trial data cached
Nail dystrophy2240.6
26.5–62.2ROR 40.6 · calibrated p 1e-4 ✓
37.8 EB05 26.3 · IC025 +3.7
3/3 methods agree
vs other Aromatase Inhibitors: PRR 3.4 (1.9–6.0)
Not in label — unassessedserious n=21no trial data cached
Osteosclerosis6038.9
30.1–50.3ROR 39.0 · calibrated p 8e-5 ✓
37.0 EB05 29.8 · IC025 +4.4
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.7 (0.5–0.9)
Not in label — unassessedserious n=60no trial data cached
Wound debridement1638.8
23.6–64.0ROR 38.9 · calibrated p 2e-4 ✓
35.9 EB05 23.4 · IC025 +3.3
3/3 methods agree
vs other Aromatase Inhibitors: only this drug
Not in label — unassessedserious n=17no trial data cached
Bone lesion13738.8
32.8–46.0ROR 39.1 · calibrated p 7e-5 ✓
37.2 EB05 32.3 · IC025 +4.8
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.7 (0.6–0.8)
Not in label — unassessedserious n=135no trial data cached
Atrophic vulvovaginitis2737.9
25.8–55.6ROR 37.9 · calibrated p 1e-4 ✓
35.7 EB05 25.7 · IC025 +3.8
3/3 methods agree
vs other Aromatase Inhibitors: PRR 1.2 (0.8–1.8)
Not in label — unassessedserious n=24no trial data cached

Trial evidence (ClinicalTrials.gov)

Trial cross-check not yet run for this drug (ClinicalTrials.gov pull covers the 800 most-reported drugs first).

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Fatigue (tiredness)2,2612.9
2.8–3.0ROR 3.1 · calibrated p 0.597
2.9 EB05 2.8 · IC025 +1.4
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.5 (0.5–0.5)
Labeled adverse reaction
exact term
serious PRR 3.1no trial data cached
Malignant neoplasm progression1,81817.9
17.1–18.7ROR 19.5 · calibrated p 0.002 ✓
17.6 EB05 16.9 · IC025 +4.1
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.7 (0.7–0.7)
Reporting / coding artifactserious PRR 13.3no trial data cached
Nausea1,7282.2
2.1–2.3ROR 2.3 · calibrated p 0.921
2.2 EB05 2.1 · IC025 +1.0
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.5 (0.5–0.5)
Labeled adverse reaction
exact term
serious PRR 2.5no trial data cached
Arthralgia (joint pain)1,7244.1
3.9–4.3ROR 4.4 · calibrated p 0.313
4.1 EB05 3.9 · IC025 +2.0
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.6 (0.6–0.6)
Labeled adverse reaction
exact term
serious PRR 4.0no trial data cached
Diarrhoea (diarrhea)1,7022.6
2.5–2.7ROR 2.7 · calibrated p 0.713
2.6 EB05 2.5 · IC025 +1.3
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.5 (0.5–0.6)
Labeled adverse reaction
exact term
serious PRR 2.9no trial data cached
Dyspnoea (shortness of breath)1,4052.4
2.3–2.6ROR 2.6 · calibrated p 0.791
2.4 EB05 2.3 · IC025 +1.2
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.7 (0.7–0.7)
Labeled adverse reaction
exact term
serious PRR 2.4no trial data cached
Pain1,1341.8
1.7–1.9ROR 1.9 · calibrated p 0.867
1.8 EB05 1.7 · IC025 +0.8
vs other Aromatase Inhibitors: PRR 0.6 (0.5–0.6)
Labeled adverse reaction
exact term
serious PRR 1.7no trial data cached
Asthenia (weakness)1,0902.9
2.7–3.0ROR 3.0 · calibrated p 0.640
2.9 EB05 2.7 · IC025 +1.4
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.5 (0.5–0.6)
Labeled adverse reaction
exact term
serious PRR 2.7no trial data cached
Headache1,0821.7
1.6–1.8ROR 1.7 · calibrated p 0.794
1.7 EB05 1.6 · IC025 +0.7
vs other Aromatase Inhibitors: PRR 0.6 (0.6–0.6)
Labeled adverse reaction
exact term
serious PRR 2.2no trial data cached
Malaise (feeling unwell)1,0782.4
2.3–2.6ROR 2.5 · calibrated p 0.816
2.4 EB05 2.3 · IC025 +1.2
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.7 (0.7–0.8)
Not in label — unassessedserious PRR 2.3no trial data cached
Cough1,0363.7
3.4–3.9ROR 3.8 · calibrated p 0.419
3.6 EB05 3.5 · IC025 +1.8
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.7 (0.7–0.8)
Labeled adverse reaction
exact term
serious PRR 4.4no trial data cached
Vomiting9972.1
2.0–2.2ROR 2.2 · calibrated p 0.977
2.1 EB05 2.0 · IC025 +1.0
vs other Aromatase Inhibitors: PRR 0.5 (0.5–0.6)
Labeled adverse reaction
exact term
serious PRR 2.1no trial data cached
Disease progression9768.2
7.7–8.7ROR 8.6 · calibrated p 0.054
8.1 EB05 7.7 · IC025 +2.9
3/3 methods agree
vs other Aromatase Inhibitors: PRR 0.8 (0.7–0.9)
Reporting / coding artifactserious PRR 5.2no trial data cached
Death9381.1
1.0–1.1ROR 1.1 · calibrated p 0.357
1.1 EB05 1.0 · IC025 -0.0
PRR-only: not supported by EBGM or IC
vs other Aromatase Inhibitors: PRR 0.6 (0.6–0.7)
Outcome field, not a reactionserious PRR 0.8no trial data cached

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Exemestane?

In FDA FAERS, the most frequently co-reported reaction terms for Exemestane are fatigue, nausea, arthralgia, diarrhoea, dyspnoea, pain. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Exemestane have an FDA boxed warning?

No. The FDA label retrieved for Exemestane has no boxed warning; see the label's Warnings and Precautions for the recognised risks.

Do FAERS signals prove that Exemestane causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-14. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.