Male Reproductive System Drugs -Anabolic Steroid Drugs

Name of the Anabolic Steroid Drugs

1. Oxandrolone
2. Oxymetholone

Mechanism of action:

Promotes tissue-building processes and reverses catabolic or tissue-depleting processes by promoting protein anabolism.

Indications:

Catabolic and Wasting Disorders

Adjunct to conventional therapy to promote weight gain in individuals who experience weight loss following extensive surgery, chronic infections (e.g., HIV-associated wasting syndrome; designated an orphan drug by FDA for this use), or severe trauma (e.g., burns, spinal cord injury).

Corticosteroid-induced Protein Catabolism

Adjunct to conventional therapy to offset protein catabolism (e.g., muscle wasting, muscle pain or weakness, delayed wound healing, atrophy of protein matrix of bone) associated with long-term corticosteroid therapy.

Osteoporosis

Labelled for the symptomatic treatment of bone pain accompanying osteoporosis.

Contraindications and Cautions:

• Known or suspected prostate or breast CA in males
• Females: breast cancer with hypercalcemia
• Pregnancy
• Nephrosis or the nephrotic phase of nephritis
• Hypercalcemia

Use with caution in patients with cardiovascular disease or risk factors for cardiovascular disease.

Metabolism and Half- Life:

Metabolized in kidney. Half-life: 10-13 hr

The oral bioavailability of oxandrolone is 97%. Its plasma protein binding is 94 to 97%.

About 28% of an oral dose of oxandrolone is eliminated unchanged in the urine and 3% is excreted in the feces.

Drug Interactions:

• Corticosteroids: increased risk of edema and severe acne
• Hepatotoxic drugs: increased risk of hepatotoxicity
• Insulin, oral antidiabetic drugs: possibly hypoglycemia
• NSAIDs, oral anticoagulants, salicylates: increased anticoagulant effects
• Sodium-containing drugs: increased risk of edema
• Somatrem, somatropin: possibly accelerated epiphyseal closure
• Warfarin: increased warfarin half-life and risk of bleeding
• High-sodium foods: increased risk of edema

Side- Effects:

• CNS: Depression, excitement, insomnia
• CV: Decreased serum HDL level, edema, hyperlipidemia, hypertension
• ENDO: Feminization in postpubertal males (epididymitis, gynecomastia, impotence, oligospermia, priapism, testicular atrophy); glucose intolerance; virilism in females (acne, clitoral enlargement, decreased breast size, deepened voice, diaphoresis, emotional lability, flushing, hirsutism, hoarseness, libido changes, male-pattern baldness, menstrual irregularities, nervousness, oily skin or hair, vaginal bleeding, vaginitis, weight gain), virilism in prepubertal males (acne, decreased ejaculatory volume, penis enlargement, prepubertal closure of epiphyseal plates, unnatural growth of body and facial hair)
• GI: Diarrhea, elevated liver function test results, hepatocellular carcinoma, nausea, vomiting
• GU: Benign prostatic hyperplasia, prostate cancer, urinary frequency, urine retention (elderly men)
• HEME: Iron deficiency anemia, leukemia, prolonged bleeding time
• SKIN: Jaundice
• Other: Fluid retention, hypercalcemia (females), physical and psychological dependence, sodium retention

Nursing Considerations

• Use oxandrolone cautiously in patients with heart disease because drug has hypercholesterolemic effects.
• Provide adequate calories and protein, as ordered, to maintain a positive nitrogen balance during oxandrolone therapy.
• Anticipate an increased risk of fluid and sodium retention in patients with cardiac, hepatic, or renal dysfunction.
• Weigh patient daily to detect fluid retention. If patient has fluid retention, expect a sodium-restricted diet or diuretics.
• Be aware that oxandrolone may suppress spermatogenesis in males and cause permanent virilization in females.
• Monitor blood glucose level frequently in patient with diabetes mellitus.
• If patient takes an oral anticoagulant, check INR or PT as ordered.

Patient teaching

• Advise patient to consume a diet high in protein and calories to achieve maximum therapeutic effect of oxandrolone.
• Urge patient to weigh himself daily during therapy and to report swelling or unexplained weight gain at once.
• Explain that drug may alter libido.
• Inform woman that drug may cause permanent physical changes, such as clitoral enlargement, deepened voice, and hair growth.
• Advise female patient of childbearing age that she must use contraception during oxandrolone therapy and should notify prescriber immediately about suspected or known pregnancy.
• Instruct diabetic patient to monitor blood glucose level frequently.
• If patient takes warfarin, advise bleeding precautions (such as an electric shaver and soft toothbrush). Tell patient to notify prescriber immediately if bleeding occurs.

Mechanism of Action:

Anabolic steroid: promotes body tissue building, increases production of erythropoietin in patients with anemia resulting from bone marrow failure or from deficient red cell production

Indications:

Anemia Due to Deficient Red Cell Production

Off Label Uses: Fanconi anemia

Contraindications and Cautions:

• Males: known or suspected prostate or breast CA
• Females: breast cancer with hypercalcemia; pregnancy
• Nephrosis or nephrotic phase of nephritis
• Hypersensitivity
• Severe hepatic dysfunction

Caution in cardiac disease, DM, hepatic disease, renal, elderly, pediatric patients, women, oedematous condition

Metabolism and Half- Life :

Metabolized in the liver

 The elimination half-life of oxymetholone is unknown.^[4] oxymetholone and its metabolites are eliminated in the urine.

Drug Interactions:

• Corticosteroids: increased risk of edema and severe acne
• Hepatotoxic drugs: increased risk of hepatotoxicity
• Insulin, oral antidiabetic drugs: possibly hypoglycemia
• NSAIDs, oral anticoagulants, salicylates: increased anticoagulant effects
• Sodium-containing drugs: increased risk of edema
• Somatrem, somatropin: possibly accelerated epiphyseal maturation
• High-sodium foods: increased risk of edema

Side- Effects:

• CNS: Depression, excitement, insomnia
• CV: Decreased serum HDL level, edema, hyperlipidemia, hypertension
• ENDO: Feminization in postpubertal males (epididymitis, gynecomastia, impotence, oligospermia, priapism, testicular atrophy), glucose intolerance, virilism in females (acne, clitoral enlargement, decreased breast size, deepened voice, diaphoresis, emotional lability, flushing, hirsutism, hoarseness, libido changes, male-pattern baldness, menstrual irregularities, nervousness, oily hair or skin, vaginal bleeding, vaginitis, weight gain), virilism in prepubertal males (acne, decreased ejaculatory volume, penis enlargement, prepubertal closure of epiphyseal plates, unnatural growth of body and facial hair)
• GI: Diarrhea, elevated liver function test results, hepatocellular carcinoma, nausea, vomiting
• GU: Benign prostatic hyperplasia, prostate cancer, urinary frequency, urine retention (elderly men)
• HEME: Iron deficiency anemia, leukemia, prolonged bleeding time
• SKIN: Jaundice
• Other: Fluid retention, hypercalcemia (females), physical and psychological dependence, sodium retention

Nursing Considerations

• Be aware that oxymetholone shouldn’t be used in patients with a history of hypercalcemia because drug may exacerbate this condition or in patients with prostate problems because drug may promote benign or cancerous tumor growth.
• Anticipate increased risk of fluid and sodium retention in patients with cardiac, hepatic, or renal dysfunction. Monitor for signs and symptoms of fluid retention. Expect to place patient with fluid retention on sodium restricted diet or diuretics, as prescribed.
• Monitor daily weight.
• Be aware that oxymetholone may suppress spermatogenesis in males and cause permanent virilization in females.

Patient teaching

• Advise patient to consume a diet high in protein and calories to achieve maximum therapeutic effect of oxymetholone.
• Instruct patient to check his weight daily during oxymetholone therapy and to notify prescriber immediately about swelling or unexplained weight gain.
• Inform patient that drug may alter libido.
• Advise diabetic patient to monitor blood glucose levels frequently because drug may increase hypoglycaemic effect of antidiabetic drugs.
• Inform female patient that drug may cause permanent physical changes, such as clitoral enlargement, deepened voice, and unnatural hair growth.
• Advise female patient of childbearing age to use contraception during therapy and to notify prescriber immediately about suspected or known pregnancy.

REFERENCES

1. Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
2. McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
3. April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
4. Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
5. Nursebro.com, Search – Nursebro

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