(floo oks i MES te rone)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Androxy: 10 mg [DSC] [scored; contains fd&c blue #1 aluminum lake, fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]
Brand Names: U.S.
- Androxy [DSC]
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
Hepatic; enterohepatic recirculation
Urine (90%); feces (6%)
10 hours (range: 10-100 minutes)
Use: Labeled Indications
Breast cancer, metastatic (females): Salvage treatment of inoperable metastatic breast cancer in postmenopausal females
Delayed puberty (males): Replacement therapy in the treatment of delayed male puberty
Hypogonadism (males): Treatment of male hypogonadism (primary or hypogonadotropic)
Males with carcinoma of the breast or the prostate (known or suspected); women who are or may become pregnant
Breast cancer, metastatic (females): Oral: Manufacturer labeling: 10 to 40 mg daily in divided doses for ≥3 months
Delayed puberty (males): Oral: 2.5 to 20 mg daily for 4 to 6 months
Hypogonadism, primary or hypogonadotropic (males): Oral: 5 to 20 mg daily
Refer to adult dosing.
Dosing: Renal Impairment
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
Dosing: Hepatic Impairment
Hepatic impairment prior to therapy: There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
Hepatic impairment during therapy: Discontinue use if abnormal liver function tests or cholestatic hepatitis with jaundice occur.
Dosing: Adjustment for Toxicity
Edema: If therapy is discontinued due to edema, may reinitiate (if indicated) at a reduced dosage
Hypercalcemia during therapy for metastatic breast cancer (females): Discontinue use
Hypogonadism (males) (off-label): Hematocrit (HCT) >50%: Use is not recommended; if HCT >54% during therapy, discontinue until HCT falls to a safe level, assess for hypoxia and sleep apnea; if reinitiating therapy, reduce the dose (Bhasin 2010)
Males: May be administered in single or divided doses. Females: Administer in divided doses.
Store between 15°C to 30°C (59°F to 86°F); protect from light.
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
Decreased levels of thyroxine-binding globulin; decreased total T4 serum levels; increased resin uptake of T3 and T4
Frequency not defined.
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%, postmarketing, and/or case reports: 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.
• 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.
• Heart failure: Not recommended for androgen replacement in hypogonadal males with uncontrolled or poorly controlled heart failure (Bhasin 2010).
• 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.
• Renal impairment: Use with caution in renal impairment; not recommended for androgen replacement in hypogonadal males with severe lower urinary tract symptoms (eg, International Prostate Symptom Score [IPSS] >19) (Bhasin 2010).
• Sleep apnea: Not recommended for androgen replacement in hypogonadal males with untreated severe obstructive sleep apnea (Bhasin 2010).
• Elderly: Elderly males 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.
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
• Fertility: Large doses of exogenous androgens may suppress spermatogenesis; not recommended for androgen replacement in hypogonadal males desiring fertility (Bhasin 2010).
Periodic liver function tests, lipid panel, and serum glucose (diabetic patients); hemoglobin and hematocrit at baseline then periodically during therapy (alternatively in males receiving androgen replacement therapy, it has been recommended to monitor at baseline, at 3 to 6 months, and then annually [Bhasin 2010])
Urine and serum calcium and signs of virilization in females treated for breast cancer
Radiologic examination of wrist and hand every 6 months (prepubertal males); response to treatment and adverse events 3 to 6 months after initiation and then annually (males)
Signs/symptoms of edema, sleep apnea, and/or heart failure
Pregnancy Risk Factor
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.
• 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), acne, 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, depression, burning or numbness feeling, nausea, vomiting, or priapism (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.
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- Drug class: androgens and anabolic steroids