Medical Oncologist
Medicines
Medicines, foods and supplements to avoid on exemestane
Most everyday medicines and foods are fine with exemestane, but a few things can work against it. This page explains why products containing oestrogen should be avoided, which tuberculosis and epilepsy medicines and herbal remedies can lower exemestane levels, what is usually safe, and how to check anything new before you take it.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
On this page
- What should you avoid while taking exemestane?
- Four groups to check before you take them
- Common products and what is generally advised
- The vocabulary, in plain language
- Where the evidence is thin
- Eating and drinking while on exemestane
- Starting a new medicine or seeing another doctor
- Myths about exemestane and interactions
- Common questions about exemestane interactions
The short answer
What should you avoid while taking exemestane?
Exemestane works by keeping oestrogen levels very low, so the most important things to avoid are anything that adds oestrogen back into your body. That means hormone replacement therapy, the combined contraceptive pill and other hormonal contraceptives, and in most cases vaginal oestrogen creams, tablets or rings, unless your oncologist has specifically agreed. Tibolone, a menopause medicine, and DHEA supplements should also be avoided. The second group to watch is medicines that speed up how the liver breaks down exemestane. Rifampicin for tuberculosis, carbamazepine, phenytoin and phenobarbital for epilepsy, and the herbal remedy St John's wort can lower exemestane levels, so your doctor may change your dose or suggest another option. Many herbal menopause products and high-dose plant oestrogen supplements, such as concentrated soy isoflavones or red clover tablets, are best avoided because their effect on hormone-sensitive cancer is uncertain. On the other hand, most everyday medicines are fine. Paracetamol, calcium, vitamin D, most blood pressure and diabetes tablets, antibiotics and vaccines can usually be taken as normal. Ordinary foods, including soy foods, dal, milk and tea in normal amounts, do not need to be avoided. Exemestane is best taken after a meal. Alcohol is worth keeping low. The simplest rule is to tell every doctor, dentist and pharmacist that you take exemestane, and to check before starting anything new.
Avoid added oestrogen
HRT, hormonal contraception and most vaginal oestrogen work against exemestane.
Some medicines lower its level
Certain tuberculosis and epilepsy medicines and St John's wort can reduce how much exemestane stays in your blood.
Normal food is fine
There is no special diet, but take the tablet after a meal and keep alcohol low.
This page gives general information only. Always check new medicines with your pharmacist or oncology team.What to watch
Four groups to check before you take them
Most problems come from a small number of products.
Oestrogen-containing medicines
HRT, combined pills, hormone patches and tibolone add back the hormone exemestane is trying to lower.
Liver enzyme boosters
Rifampicin, carbamazepine, phenytoin, phenobarbital and St John's wort can make exemestane leave the body faster.
Your doctor may adjust the dose if you truly need one of these.Herbal and hormone supplements
DHEA, concentrated soy or red clover capsules, dong quai and mixed menopause remedies have uncertain effects and unclear ingredients.
Other hormone treatments
Exemestane is not usually taken at the same time as tamoxifen or another aromatase inhibitor.
Usually safe to continue
- Calcium and vitamin D supplements
- Bone-strengthening medicines your team prescribes
- Ovarian suppression injections, when planned
Quick check
Common products and what is generally advised
Product
General advice
Paracetamol or ibuprofen for aches
Usually fine at normal doses; check ibuprofen if you have kidney, stomach or heart problems
Antidepressants for mood or hot flushes
Generally fine; unlike tamoxifen, exemestane is not weakened by paroxetine or fluoxetine
Soy foods, tofu and soy milk
Normal food amounts are considered safe; avoid concentrated soy supplements
Ayurvedic or herbal tonics
Check first, as ingredients and hormone effects are often unknown
Flu and other vaccines
Usually fine; exemestane does not weaken the immune system
Words you may hear
The vocabulary, in plain language
- Interaction
- When one medicine, food or supplement changes how another works or how strong it is.
- Enzyme inducer
- A medicine that speeds up the liver's breakdown of other medicines, lowering their levels.
- Phytoestrogen
- A plant substance with weak oestrogen-like activity, found in soy, flaxseed and some herbs.
- HRT
- Hormone replacement therapy, which tops up oestrogen to ease menopause symptoms.
- Tibolone
- A menopause medicine with hormone effects that is not used after breast cancer.
- DHEA
- A hormone supplement the body can turn into oestrogen and male hormones.
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Being straight with you
Where the evidence is thin
Interaction advice is firm for some products and cautious guesswork for others.
Herbal products are rarely studied
Most traditional remedies have never been tested alongside exemestane. Avoiding them is advice based on caution, not proof of harm.
Vaginal oestrogen is debated
Very low-dose vaginal products release small amounts of oestrogen. Most teams avoid them with aromatase inhibitors, but some consider them for severe symptoms after discussion.
What this page cannot tell you
It cannot check your personal list of medicines. A pharmacist reviewing everything you take, including supplements, is the safest way to catch a problem.
Food and drink
Eating and drinking while on exemestane
You do not need a special diet, but a few habits support your treatment and your long-term health.
Take it after a meal
Exemestane is absorbed better after food. Taking it after the same meal each day also helps you remember.
Alcohol
Alcohol does not directly block exemestane, but it can raise breast cancer risk, worsen hot flushes and harm bone health. Keeping it low or avoiding it is sensible.
Bone-friendly eating
Exemestane can thin the bones. Milk, curd, paneer, ragi, green leafy vegetables and sesame provide calcium, and safe sunlight or supplements help with vitamin D. Limit fizzy drinks and very salty food.
Grapefruit
No important interaction with grapefruit is known, so there is no need to avoid it.
Staying safe
Starting a new medicine or seeing another doctor
Good communication prevents most interaction problems.
Keep an up-to-date list
Carry a list of every medicine, vitamin and herbal product you take, with doses. Show it at every appointment, including dental and eye visits.
Tuberculosis or epilepsy treatment
If you are prescribed rifampicin or an epilepsy medicine, make sure both doctors know about each other's treatment so the dose of exemestane can be reviewed.
Surgery and hospital stays
Exemestane can usually be continued around minor procedures. Tell the admitting team, and ask before stopping.
Commonly believed
Myths about exemestane and interactions
Natural remedies cannot interfere with cancer tablets.
Herbs can contain active substances, and St John's wort is known to lower exemestane levels.
I must stop eating soy and dal.
Everyday foods are fine. Only concentrated plant oestrogen supplements are best avoided.
Vaginal cream is local, so it does not count.
Oestrogen creams can be partly absorbed, so always check with your oncologist first.
Antidepressants will stop exemestane working.
That concern applies to some antidepressants with tamoxifen, not to exemestane.
Questions we are asked
Common questions about exemestane interactions
Can I take painkillers for joint pain on exemestane?
Paracetamol is usually fine at the normal dose. Anti-inflammatory painkillers such as ibuprofen can also help with joint aches, but they may not suit people with stomach ulcers, kidney problems, heart disease or those taking blood thinners. Ask your doctor or pharmacist before using them regularly.
Is it safe to take calcium and vitamin D with exemestane?
Yes. Calcium and vitamin D are often recommended during aromatase inhibitor treatment to protect the bones. There is no need to separate them from your exemestane dose. Take them as your team advises, and do not exceed the suggested amount without a blood test showing you need more.
Can I take thyroid tablets with exemestane?
Thyroxine is not known to interact with exemestane in any important way. Continue taking it as usual, on an empty stomach as your doctor advised, and take exemestane after a meal later. Keep up your usual thyroid blood tests, and mention both medicines at every review.
I take a homoeopathic or Ayurvedic remedy. Should I stop?
Show the product, or its label, to your oncologist or pharmacist. Some remedies contain herbs with hormone-like effects, heavy metals or unlisted medicines. Many teams advise avoiding such products during hormone therapy, because their safety alongside exemestane has not been studied.
Can I use a vaginal moisturiser or lubricant?
Yes. Non-hormonal vaginal moisturisers and water-based or silicone-based lubricants do not contain oestrogen and are safe to use with exemestane. They are the first choice for dryness and discomfort. Check the label to make sure a product does not contain hormones.
Does exemestane interact with diabetes or blood pressure tablets?
Most diabetes, blood pressure and cholesterol medicines can be taken normally with exemestane. Aromatase inhibitors can affect cholesterol, so your doctor may keep an eye on your levels. Continue your usual checks and let every doctor know about all your treatments.
Can I take antibiotics while on exemestane?
Most antibiotics are fine. The main exception is rifampicin and related medicines, used for tuberculosis and some other infections, which can lower exemestane levels. If you are prescribed one of these, make sure your oncologist knows so they can review your dose.
Is flaxseed or evening primrose oil safe?
Small amounts of flaxseed in food are generally considered fine. Evidence on high-dose flaxseed or evening primrose oil capsules during hormone therapy is limited. Evening primrose oil has not been shown to help hot flushes. Check with your team before taking regular supplements.
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Sources
- National Cancer Institute — Exemestane
- MedlinePlus — Exemestane
- Macmillan Cancer Support — Exemestane
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.