Aromatase Inhibitors: How to choose and manage side effects?

I’ve tried Letrozole and anastrozole brand name. The Letrozole destroyed the ulner nerves in both arms after 3 weeks of taking it. The anastrozole made my joints hurt and the brain fog was unbearable. I’m really skeptical now about trying the 3rd one!
Did you find one to work for you?

Switching manufacturers and then to brand name helped me. I know everyone is different! Which ones have you tried and what are you about to try?

I’m on the fence about trying a 3rd AI. First two weren’t tolerable. Please share good or bad experiences. Thank you!

Hot flashes and joint pain— in my case r knee and hands— were some of my worst symptoms. I’m taking Anastrozole from my local CVS distributed by Aurobindo Pharma USA ofEast Windsor, NJ.
I have a rare hot flash on occasion ( less than once a month) but that’s it.
I think it’s the new formulation; my doc says it can also be my body adjusted after the 6 months of living with the side effects and misery. whatever I’m just grateful.

Which one did you try? I have the brand name not a generic, but the hot flashes I hate and other little side effects like hip pain.

My diagnosis and treatment was similar to yours in April 2023. A year ago I started with Anastrozole. I lasted a week on it. Didn’t feel well and developed a rash. I was switched to Letrozole which I’ve been on for a year now, problem free. I’ve found taking it at night helps with the sleep issues I initially had. Few if any aches and pains, but I take a joint supplement and such to combat that. We moved recently, causing the small joints in my hands to flare up as well as my ankles due to all the packing and going up and down the stairs. It’s been a week and I’m slowly recovering. I was doubtful Letrozole would be any different from Anastrozole, but was pleasantly surprised to find I’m in the 50% who can tolerate it. I certainly understand your misgivings. In my case, I’m glad I gave it a shot!

Yes. Good you found a different mfg. It DOES make a difference. Get to know your pharmacist WELL
Mine was willing to look things up for me and allowed me to pick her brain. She looked into the half life theory I had, said shed research it for me and call me back. She did.

Yes, the side effects are terrible for many. These drugs are crippling. I switched to exemestane. It worked for awhile. However, i was in the 1% that affects the heart. I had a heart issue about 4 years ago. ER Q Cardio suspected i either had a blood clot or an arterial spasm. Asked about my exemestane.
Look into natural AIs. I was told by a certified nutritionalist that flaxseed HULLS were best.. not flaxseed meal, etc. Mushroom's are another.
I wish more oncologists would work WITH these specialists.
IMHO: the half life OF most AIs are 50 hours.Discuss with your dr if you can start a build up of every other day or 2 days on, 1 day off.
Research exemestane for bodybuilders. Their drs say no more than 3 months due to cardio issues. That might be for just men, but I doubt it.
I was on Letrozole. Couldnt tolerate it. Then to exemestane. Much better, but I think i was on it too long.
BUT MFGs do make a difference. I would look for an Israeli mfg. Seriously. I used TEVA but that was 10 years ago.
And if you need an extra dose of depression, search to purchase your drug in powder form. You will be stunned.

Anastrazole didn’t agree with me at all. I’m 61. Tried exemastane- joints and sleeping issues. Took a break and went back on it. So far so good. I am also doing acupuncture and am on a few supplements. I’m very pleased how I feel. Not back to the “old” me . But feeling very good. I walk and yoga and breathing yoga. Everything has helped. I’m good with the “new” normal.

I have been on Anastrazole for 5+ years now. ER+ breast cancer. 19 lymph nodes removed at age 68. The Anastrazole reduces my risk of recurrence of breast cancer by at least 50% my oncologist tells me. Now they are supporting continued use of AI meds if patient can tolerate and that is my plan. Other than being very difficult to lose weight (common with estrogen suppressant meds) I have had no other issues. I have worked with my pcp to take meds that are NOT hormone based ( the new wonder diet drugs are hormone based) and I Have lost 40 pounds since initial diagnosis. I want to lose another 20 pounds. The chemo And breast docs both agree that weight reduction and continued use of anastrazole will reduce my risk of recurrence. Pre versus post menopausal status may make a big difference so careful discussion with doctors is critical. JMHO!