Fulvestrant (Faslodex®) is a hormonal therapy drug used to treat breast cancer that has spread to other parts of the body. This is called advanced cancer. It can be given alone or with other types of treatment. It is best to read this information with our general information about hormonal therapies and secondary breast cancer. It is sometimes given to treat breast cancer in men.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
Hormones are chemicals that our bodies make. Hormones act as messengers and help control how cells and organs work. Hormonal therapies are drugs that change the way hormones are made or how they work in the body.
Many breast cancers need the hormone oestrogen to grow. This is called oestrogen-receptor positive (ER positive) breast cancer. These cancers have receptors (proteins) on the cancer cells that allow oestrogen to attach to the cell.
Fulvestrant blocks the receptors and stops oestrogen reaching the cancer cells. This slows down or stops the cancer cells from growing. Fulvestrant also reduces the number of receptors on the breast cancer cells.
Fulvestrant is given as an injection into a muscle (intramuscular).
You are given fulvestrant as 2 injections, one in each buttock. The injections are given one after the other. Each one takes 1 to 2 minutes.
The first 3 doses are given 2 weeks apart, after that you have the injections once a month. You can have the injections at the hospital or at your GP surgery. Your GP or practice nurse will give you the injection. If you are not able to visit the surgery, a district nurse may give you the injections at home.
If you sometimes delay the injections by 1 or 2 days, this should not affect how well the treatment works. But it is important to make sure you have your injections every month as prescribed.
Tell your doctor or nurse if you are taking any medicines to thin your blood, as this may increase bruising.
Your nurse or doctor will talk to you about your treatment plan. You usually have fulvestrant for as long as it is effective in controlling the cancer.
You may have some pain, swelling, redness or a darker colour around the area that was injected. Let your doctor know if this happens. Painkillers may help.
We explain the most common side effects of this treatment here. We also include some less common side effects.
You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Some people have an allergic reaction while having this treatment. Signs of a reaction can include:
- feeling hot or flushed
- a skin rash
- feeling dizzy
- a headache
- feeling breathless.
If you feel unwell or have any of these signs, tell a doctor or nurse straight away. Do not take any more of this treatment until you have spoken to them.
Hot flushes and sweats
Hot flushes are a common side effect of this treatment. During a flush, your neck and face may feel warm and look red. Flushes may last from a few seconds up to 10 minutes. You may have sweats and then feel cold and clammy. Some people feel anxious or irritable during a hot flush.
There are things you can do to try to reduce flushes:
- Wear clothes made from natural fabrics, such as cotton.
- Wear layers of clothes that you can remove if you feel hot.
- Use cotton bed sheets and have layers of bedding that you can remove if you feel hot.
- Keep room temperatures cool or use a fan.
- Have cold drinks rather than hot ones. Try to avoid drinks with caffeine in them.
You may have fewer hot flushes and sweats as your body adjusts to hormonal treatment. Or your doctor can prescribe drugs to help. Flushes and sweats usually stop a few months after treatment finishes, but some people continue to have them.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
You may feel sick, but this is usually mild. If you feel sick, tell your doctor or nurse. They can give you anti-sickness drugs to help.
Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.
Muscle or joint pain
You may get pain in your muscles or joints. If this happens, tell your doctor so they can give you painkillers. Being physically active may help with the pain and keep your joints flexible. Keeping to a healthy weight may help too. Tell your doctor or nurse if the pain does not get better.
Effects on the liver
This treatment may affect how your liver works. This is usually mild. You will have blood tests to check how well your liver is working.
This treatment may affect your skin. It may cause a rash, which might be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.
Always tell your doctor or nurse about any changes to your skin. They can give you advice and may prescribe creams or medicines to help. Skin changes usually improve when treatment finishes.
Fulvestrant can make you more likely to get a urine infection. Let your doctor know if you have pain or discomfort when you pass urine, if you need to go more often or if your urine is cloudy or smelly. Your doctor may prescribe antibiotics.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.
You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
Vaginal bleeding or dryness
This treatment can cause vaginal changes. You may have bleeding when you start this treatment, or if you change to it from another treatment. If bleeding continues for more than a few days, tell your doctor or nurse.
You can use non-hormonal creams, gels or lubricants to help with vaginal dryness and any discomfort during sex. You can buy these from a chemist, or your doctor can prescribe them. We have more information about cancer and sex.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red or purple spots on the skin that may look like a rash.
Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.
This treatment contains alcohol. If this is a problem for you, tell your doctor, nurse or pharmacist. Your blood alcohol level may be above the legal limit after you have the treatment. It is best not to drive or operate machinery for a few hours after having this treatment, even if you feel okay.