This medication is used to treat some types of prostate cancer. In the body, estramustine breaks down into estrogens (estrone, estradiol) and a type of cancer drug (estromustine). This medication is thought to work by increasing estrogens, which interfere with prostate cancer, and by slowing/stopping the growth of cancer cells.

Take this medication by mouth on an empty stomach (1 hour before or 2 hours after a meal) as directed by your doctor, usually 3 to 4 times a day.

Take this medication with a full glass of water (8 ounces or 240 milliliters) unless your doctor directs you otherwise.

Take this medication regularly in order to get the most benefit from it. Remember to take it at the same times each day as directed. The dosage is based on your medical condition, weight, and response to treatment.

Take this medication 3 hours before or after taking any products containing magnesium, aluminum, or calcium. Some examples include quinapril, vitamins/minerals, and antacids. Dairy products (such as milk, yogurt), calcium-enriched juice, sucralfate, bismuth subsalicylate, iron, and zinc are also included. These products bind with estramustine, preventing its full absorption.

Do not increase your dose or take this medication more often than prescribed. Your condition will not improve any faster, and the risk of serious side effects may be increased.

Since this drug can be absorbed through the skin and lungs, women who are pregnant or who may become pregnant should not handle this medication or breathe the dust from the capsules.

Nausea, vomiting, loss of appetite, flushing, dry skin, headache, leg cramps, decreased sexual interest/ability, and male breast tenderness/enlargement may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor right away if you have any serious side effects, including:

• mental/mood changes (such as depression)
• swelling of hands/feet
• worsening of seizures
• increased thirst/urination
• nausea/vomiting that doesn't stop
• easy bruising/bleeding
• stomach/abdominal pain
• dark urine
• yellowing eyes/skin

This medication may rarely cause serious problems such as heart attack, stroke, and blood clots. Get medical help right away if you experience any of the following symptoms:

• chest/jaw/left arm pain
• sudden/severe headaches
• weakness on one side of the body
• confusion
• trouble speaking
• sudden vision changes
• pain/swelling/warmth in the groin/calf
• shortness of breath/rapid breathing
• sudden dizziness/fainting
• unusual sweating

This medication can lower the body's ability to fight an infection. Tell your doctor promptly if you develop any signs of an infection such as sore throat that doesn't go away, fever, or chills.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Before taking estramustine, tell your doctor or pharmacist if you are allergic to it; or to estradiol or other estrogens; or to nitrogen mustard (such as mechlorethamine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• blood clots (such as in the legs, eyes, lungs)
• bone disease (such as bone metastases, high calcium levels)
• high cholesterol or triglyceride (blood fat) levels
• depression
• diabetes
• severe headaches (such as migraine)
• heart disease (such as angina, heart attack, heart failure)
• high blood pressure
• kidney disease
• liver disease
• seizure
• long periods of sitting or lying down (for example, due to being bedridden)
• stroke
• thyroid problems

Do not smoke cigarettes or use tobacco. Estrogens combined with smoking further increase your risk for stroke, blood clots, high blood pressure, and heart attacks.

If you will be having surgery or will be confined to a chair or bed for a long time (such as on a long plane flight), notify your doctor beforehand. Special precautions may need to be taken in these circumstances while you are taking this drug because of the increased risk for blood clots.

If you have diabetes, estramustine may affect your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor.

If you are nearsighted or wear contact lenses, you may develop vision problems or trouble wearing your contact lenses. Contact your eye doctor if these problems occur.

This medication may cause blotchy, dark areas on your face and skin (melasma). Sunlight may worsen this effect. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors.

This medication may affect the production of sperm. Use a reliable form of birth control while on this medication. Consult your doctor.

This medication is not usually used in women. It is unlikely to be used during pregnancy or breastfeeding. Consult your doctor if you have any questions about this medication.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug are:

• aromatase inhibitors (such as anastrozole, exemestane)
• corticosteroids (such as prednisolone)
• ospemifene
• tamoxifen
• troleandomycin
• tranexamic acid
• medication for low thyroid (hypothyroidism)

Certain drugs can affect the estrogen levels in your system. Drugs that may cause this effect include: azole antifungals (such as itraconazole, ketoconazole), many antibiotics (such as cephalosporins, macrolides, penicillins, tetracyclines, sulfas), aprepitant, bexarotene, bosentan, dapsone, griseofulvin, certain HIV protease inhibitors (such as nelfinavir), modafinil, nevirapine, rifamycins (such as rifampin), ritonavir, many seizure medications (such as barbiturates, carbamazepine, phenytoin, primidone, topiramate), St John's wort.

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call 1-800-222-1222. Canada residents can call 1-844-764-7669.

Do not share this medication with others.

Lab tests (such as blood pressure, liver function, calcium levels) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store in the refrigerator away from light and moisture. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.