Altraz (anastrozole) is a potent, non-steroidal aromatase inhibitor indicated for the adjuvant treatment of postmenopausal women with hormone receptor-positive early breast cancer. It is also approved for the first-line treatment of advanced or metastatic breast cancer in this patient population and for the treatment of advanced breast cancer in postmenopausal women with disease progression following tamoxifen therapy. By selectively inhibiting the aromatase enzyme, Altraz significantly reduces estrogen production, depriving hormone-sensitive tumor cells of their primary growth stimulus. This targeted mechanism offers a crucial therapeutic strategy for managing estrogen-dependent malignancies.

Features

• Active Ingredient: Anastrozole 1 mg
• Pharmacological Class: Non-steroidal aromatase inhibitor
• Administration: Oral tablet
• Bioavailability: Well-absorbed with approximately 83–85% availability
• Half-life: Approximately 50 hours in postmenopausal women
• Metabolism: Primarily hepatic via N-dealkylation, hydroxylation, and glucuronidation
• Excretion: Mainly hepatic (85%), with renal excretion accounting for approximately 11%
• Protein Binding: 40%
• Time to Peak Plasma Concentration: Approximately 2 hours under fasting conditions

Benefits

• Significant Reduction in Estrogen Levels: Suppresses plasma estrogen levels by up to 85% in postmenopausal women, creating an unfavorable environment for hormone-dependent tumor growth
• Improved Disease-Free Survival: Demonstrated superiority over tamoxifen in multiple clinical trials for hormone receptor-positive early breast cancer adjuvant treatment
• Favorable Safety Profile: Lacks the estrogen agonist effects associated with tamoxifen, thereby reducing risk of endometrial cancer and thromboembolic events
• Convenient Dosing Regimen: Once-daily oral administration supports treatment adherence and quality of life
• Well-Characterized Pharmacokinetics: Predictable absorption and elimination patterns facilitate consistent therapeutic effect
• Established Clinical Efficacy: Supported by extensive clinical evidence including the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial with 10-year follow-up data

Common use

Altraz is primarily prescribed for the management of hormone receptor-positive breast cancer in postmenopausal women. In the adjuvant setting, treatment typically continues for 5–10 years based on individual risk assessment and tolerance. For advanced or metastatic disease, therapy continues until disease progression or unacceptable toxicity occurs. The medication may be used as monotherapy or sequenced following other endocrine therapies such as tamoxifen. Clinical decisions regarding treatment duration and sequencing should be based on comprehensive risk-benefit assessment, considering factors including tumor characteristics, comorbidities, and patient preference.

Dosage and direction

The recommended dosage of Altraz is one 1 mg tablet taken orally once daily, with or without food. Tablets should be swallowed whole with water; they should not be crushed or chewed. For adjuvant treatment of early breast cancer, therapy should continue for the prescribed duration unless disease recurrence or unacceptable toxicity occurs. In patients with advanced breast cancer, treatment typically continues until tumor progression is documented. No dosage adjustment is necessary for elderly patients or those with mild to moderate hepatic impairment. For patients with severe hepatic impairment or creatinine clearance <20 mL/min, careful monitoring is recommended though formal dosage adjustments have not been established.

Precautions

Patients should undergo comprehensive assessment of menopausal status before initiating therapy, as Altraz is not indicated for premenopausal women. Regular monitoring of bone mineral density is recommended due to the accelerated bone loss associated with estrogen suppression. Assessment of lipid profiles may be considered, particularly in patients with pre-existing dyslipidemia. Patients should be advised about potential effects on cholesterol levels and cardiovascular risk. Caution is advised in patients with pre-existing ischemic heart disease, as aromatase inhibitors may potentially increase cardiovascular risk. Regular hepatic function monitoring is recommended, particularly during the first few months of therapy. Patients should be informed about potential effects on cognitive function and mood changes.

Contraindications

Altraz is contraindicated in patients with known hypersensitivity to anastrozole or any component of the formulation. It is contraindicated in premenopausal women, pregnant women, and nursing mothers due to potential fetal harm and interference with estrogen synthesis. The medication should not be used in patients with severely impaired hepatic function (Child-Pugh Class C) unless potential benefits outweigh risks. Concomitant use with estrogen-containing therapies is contraindicated as these agents would counteract the therapeutic effect of anastrozole.

Possible side effect

The most frequently reported adverse reactions (occurring in >10% of patients) include hot flashes, asthenia, arthritis, pain, arthralgia, hypertension, depression, nausea and vomiting, rash, osteoporosis, fractures, back pain, insomnia, headache, and peripheral edema. Less common but clinically significant adverse effects may include vaginal dryness, vaginal bleeding, hair thinning, hypercholesterolemia, carpal tunnel syndrome, and elevated liver enzymes. Rare but serious adverse events include ischemic cardiovascular events, thromboembolism, and interstitial lung disease. Most adverse reactions are mild to moderate in severity and often diminish with continued therapy.

Drug interaction

Altraz is primarily metabolized by CYP3A4 and CYP3A5, with potential interactions with strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) which may increase anastrozole concentrations. Concomitant use with tamoxifen should be avoided as co-administration may reduce anastrozole plasma concentrations by approximately 27%. Estrogen-containing therapies may counteract the pharmacological effect of anastrozole and should not be co-administered. Although formal interaction studies are limited, caution is advised with medications that affect liver enzymes. No clinically significant interactions have been observed with warfarin, cimetidine, or other commonly co-prescribed medications.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed dose. The long half-life of anastrozole (approximately 50 hours) provides some buffer against temporary fluctuations in plasma concentrations, though consistent daily administration is important for maintaining optimal estrogen suppression.

Overdose

Limited data exist regarding acute overdose with anastrozole. Single doses up to 60 mg have been administered without serious adverse effects. In case of suspected overdose, supportive care is recommended with attention to potential estrogen suppression effects. Gastric lavage may be considered if ingestion occurred within a short time frame. No specific antidote exists, and dialysis is unlikely to be effective due to high protein binding. Management should focus on symptomatic treatment and monitoring for potential effects including hot flashes, nausea, or dizziness.

Storage

Store Altraz tablets at room temperature (20–25°C or 68–77°F) with excursions permitted between 15–30°C (59–86°F). Keep the medication in its original container with the lid tightly closed to protect from moisture and light. Do not store in bathroom areas where humidity levels may fluctuate. Keep out of reach of children and pets. Properly dispose of any expired or unused medication according to local regulations, typically through medication take-back programs.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made exclusively by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for complete information regarding indications, dosage, administration, and monitoring requirements. Patients should not alter their treatment regimen without medical supervision. While every effort has been made to ensure accuracy, medical knowledge evolves continuously, and healthcare providers should reference the most current prescribing information.

Reviews

Clinical studies consistently demonstrate Altraz’s efficacy in the adjuvant treatment of hormone receptor-positive early breast cancer. The ATAC trial, involving over 9,000 postmenopausal women, showed significant improvement in disease-free survival compared to tamoxifen at both 5 and 10-year follow-ups. Subsequent trials including BIG 1-98 and TEAM have further supported these findings. Real-world evidence confirms the clinical trial results, with particular appreciation for the reduced risk of endometrial complications compared to tamoxifen. Some patients report challenges with arthralgia and bone health management, though these are generally manageable with appropriate supportive care. The consistent efficacy profile and generally manageable side effect spectrum have established Altraz as a cornerstone of endocrine therapy for postmenopausal breast cancer patients.