Estramustine is used to treat metastatic or progressive prostate cancer.

Estramustine may also be used for purposes not listed in this medication guide.

You should not use estramustine if you have a blood clot, swelling of a vein caused by a blood clot, or if you have ever had an allergic reaction to estradiol or nitrogen mustard.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Take estramustine on an empty stomach, at least 1 hour before or 2 hours after a meal.

Take estramustine with water, not with milk or other dairy products.

Estramustine doses are based on weight (especially in children and teenagers). Your dose needs may change if you gain or lose weight.

It may take up to 90 days before you receive the full benefit of taking estramustine. Your doctor will determine how long to treat you.

You may need frequent blood tests. Your blood pressure will also need to be checked often.

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using estramustine.

Store in the refrigerator, do not freeze.

Usual Adult Dose for Prostate Cancer:

14 mg/kg/day orally in 3 or 4 divided doses

Duration of Therapy: Continue therapy as long as there is a favorable patient response; some patients have been maintained on therapy for more than 3 years.

Comments:
-Patients should receive this drug for 30 to 90 days before the treating physician determines the possible benefits of continued therapy.
-Most patients have been treated at 10 to 16 mg/kg/day.

Use: Palliative treatment of patients with metastatic and/or progressive carcinoma of the prostate.

You should not use estramustine if you are allergic to estradiol or to nitrogen mustard.

You may not be able to use this medicine if you have a blood clot or swelling of a vein caused by a blood clot.

Tell your doctor if you have ever had:

• a blood clot, stroke, or heart attack;

• diabetes;

• high blood pressure (hypertension);

• heart disease or coronary artery disease (atherosclerosis);

• congestive heart failure;

• migraine headaches;

• epilepsy or other seizure disorder;

• low or high levels of calcium in your blood;

• liver disease;

• kidney disease; or

• a bone disorder such as osteoporosis or Paget's disease.

If a man fathers a baby while using estramustine, the baby may have birth defects. Use condoms to prevent pregnancy during your treatment. Ask your doctor how long you should continue using condoms after you stop taking estramustine.

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store estramustine capsules in the refrigerator.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unless your doctor tells you otherwise, continue your normal diet.

Do not take estramustine with milk, milk products, calcium supplements, or calcium-rich foods such as ice cream, yogurt, broccoli, and others.

Avoid using antacids or vitamin/mineral supplements that contain calcium. Calcium can make it harder for your body to absorb estramustine.

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Estramustine may cause serious side effects. Stop using estramustine and call your doctor at once if you have:

• heart problems--shortness of breath (even with mild exertion), swelling, rapid weight gain, chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;

• signs of a stroke--sudden numbness or weakness (especially on one side of the body), severe headache, slurred speech, balance problems;

• signs of a blood clot in the lung--chest pain, sudden cough, wheezing, rapid breathing, coughing up blood; or

• signs of a blood clot deep in the body--swelling, warmth, or redness in an arm or leg.

Common side effects of estramustine may include:

• breast swelling or tenderness;

• impotence;

• nausea, diarrhea, upset stomach;

• swelling, trouble breathing;

• leg cramps; or

• abnormal liver function tests.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Other drugs may affect estramustine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to estramustine.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.