(floo oks i MES te rone)
Replacement therapy in the treatment of delayed male puberty; male hypogonadism (primary or hypogonadotropic); inoperable metastatic female breast cancer
Males with carcinoma of the breast or the prostate (known or suspected); women who are or may become pregnant
Hypogonadism (Males): Oral: 5-20 mg daily
Delayed puberty (Males): Oral: 2.5-20 mg daily for 4-6 months
Inoperable breast carcinoma (Females): Oral: 10-40 mg daily in divided doses for ≥3 months
Refer to adult dosing.
No dosage adjustment provided in manufacturers labeling; use with caution.
No dosage adjustment provided in manufacturers labeling; use with caution.
Males: May be administered in single or divided doses. Females: Administer in divided doses.
Hazardous agent; use appropriate precautions for handling and disposal (NIOSH 2014 [group 2]).
Store between 15 ‚ °C to 30 ‚ °C (59 ‚ °F to 86 ‚ °F); protect from light.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Androxy: 10 mg [scored; contains fd&c blue #1 aluminum lake, fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]
Ajmaline: Androgens may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased. Monitor therapy
Blood Glucose Lowering Agents: Androgens may enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy
C1 inhibitors: Androgens may enhance the thrombogenic effect of C1 inhibitors. Monitor therapy
Corticosteroids (Systemic): May enhance the fluid-retaining effect of Androgens. Monitor therapy
CycloSPORINE (Systemic): Androgens may enhance the hepatotoxic effect of CycloSPORINE (Systemic). Androgens may increase the serum concentration of CycloSPORINE (Systemic). Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Androgens may enhance the anticoagulant effect of Vitamin K Antagonists. Consider therapy modification
Periodic liver function tests, lipid panel, hemoglobin, and hematocrit (prior to therapy, at 3-6 months, then annually); radiologic examination of wrist and hand every 6 months (when using in prepubertal children). Withhold initial treatment with hematocrit >50% (discontinue therapy if hematocrit exceeds 54% [Bhasin, 2010]), hyperviscosity, untreated obstructive sleep apnea, or uncontrolled severe heart failure. Monitor urine and serum calcium and signs of virilization in women treated for breast cancer. Serum glucose (may be decreased by testosterone; monitor patients with diabetes). Evaluate males for response to treatment and adverse events 3-6 months after initiation and then annually.
Decreased levels of thyroxine-binding globulin; decreased total T4 serum levels; increased resin uptake of T3 and T4
Frequency not defined.
Cardiovascular: Edema
Central nervous system: Anxiety, depression, headache, paresthesia
Dermatologic: Acne vulgaris, androgenetic alopecia
Endocrine & metabolic: Change in libido (decreased libido or increased libido), electrolyte disturbance (calcium, chloride, inorganic phosphate, potassium, and sodium retention), fluid retention, gynecomastia (males), hirsutism, hypercholesterolemia, menstrual disease (females; including amenorrhea)
Gastrointestinal: Gastrointestinal irritation, nausea, vomiting
Genitourinary: Benign prostatic hypertrophy (males), oligospermia (males; at higher doses), priapism (males), testicular atrophy (males), virilization (females; including clitoromegaly, deepening of the voice in females)
Hematologic & oncologic: Clotting factors suppression, polycythemia, prostate carcinoma (males)
Hepatic: Abnormal hepatic function tests, cholestatic jaundice, hepatic insufficiency
Hypersensitivity: Anaphylactoid reaction (non-immunologic anaphylaxis), hypersensitivity reaction
<1% (Limited to important or life-threatening): Hepatic coma, hepatocellular neoplasm, hepatotoxicity (idiosyncratic; Chalasani 2014), peliosis hepatitis
Concerns related to adverse effects:
- Dyslipidemia: Anabolic steroids may alter serum lipid profile; use caution in patients with history of myocardial infarction or coronary artery disease.
- Gynecomastia: May cause gynecomastia.
- Hepatic effects: Prolonged use of high doses of oral androgens has been associated with serious hepatic effects (eg, peliosis hepatis, hepatic neoplasms, cholestatic hepatitis, jaundice). Discontinue use in patients with cholestatic hepatitis with jaundice or abnormal liver function tests.
Disease-related concerns:
- Carbohydrate intolerance: May have adverse effects on glucose tolerance; use caution in patients with diabetes.
- Edematous conditions: Use with caution in patients with conditions influenced by edema (eg, cardiovascular disease, migraine, seizure disorder, renal impairment); may cause fluid retention.
- Hepatic impairment: Use with caution in patients with hepatic impairment.
- Hypercalcemia: Use with caution in patients with breast cancer or immobilization; may cause hypercalcemia by stimulating osteolysis. Discontinue use if hypercalcemia occurs; may indicate bony metastasis.
Special populations:
- Elderly: Elderly patients may be at greater risk for prostatic hyperplasia and prostate cancer; use with caution.
- Pediatric: May accelerate bone maturation without producing compensatory gain in linear growth in children. In prepubertal children, perform radiographic examination of the hand and wrist every 6 months to determine the rate of bone maturation and to assess the effect of treatment on the epiphyseal centers.
- Women: During treatment for metastatic breast cancer, women should be monitored for signs of virilization (eg, deepening of voice, hirsutism, acne, clitoromegaly, menstrual irregularities); discontinue use with evidence of mild virilization to prevent irreversible symptoms.
Special handling:
- Hazardous agent: Use appropriate precautions for handling and disposal (NIOSH 2014 [group 2])
X
Use is contraindicated in women who are or may become pregnant. May cause androgenic effects to the female fetus; clitoral hypertrophy, labial fusion, urogenital sinus defect, vaginal atresia, and ambiguous genitalia have been reported.
Synthetic derivative of testosterone; responsible for the normal growth and development of male sex hormones, male sex organs, and maintenance of secondary sex characteristics; large doses suppress endogenous testosterone release
Rapid
Hepatic; enterohepatic recirculation
Urine (90%); feces (6%)
10 hours (range: 10-100 minutes)
98%
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience enlarged breasts (males), decreased libido, anxiety, or headache. Have patient report immediately to prescriber signs of high calcium (weakness, confusion, feeling tired, headache, nausea and vomiting, constipation, or bone pain), signs of liver problems (dark urine, feeling tired, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin or eyes), signs of virilization (in females a deep voice, facial hair, pimples, or period changes), shortness of breath, excessive weight gain, swelling of arms or legs, skin discoloration, bruising, bleeding, depression, burning or numbness feeling, or penile pain (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.