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OXANDROLONE

use in ICU

SAAD SBAA

Pr. M. Faroudy

INTRO

  • Oxandrolone is an anabolic androgenic steroid (AAS) used to promote weight gain in various situations .

TODAY'S SCHEDULE

1. HISTORY

2. DEFINITIONS

TODAY'S SCHEDULE

3. INDICATIONS

4. SIDE EFFECTS

5. CLINICAL CASE

HISTORY

TIMELINE

First described

1960

1962

1989

Reintroduced

1992

taken off the market

1995

came back as an orphan drug

2019

present day

DEFINITIONS

DEFINITIONS

Anabolic Androgenic Steroids

AAS

  • AAS are synthetically produced variants of the naturally occurring male sex hormone testosterone.
  • They are "anabolic" and increase protein within cells, especially in skeletal muscle,
  • and "androgenic" refers to increased male sexual characteristics.

What is DHT?

DHT

5α-reductase

Dihydrotestosterone

Testosterone

AAR

ANABOLIC ANDROGENIC RATIO

  • Compounds with a high androgenic : anabolic ratio are the drug of choice in androgen-replacement therapy (e.g., treating hypogonadism in males).

  • Compounds with a low androgenic : anabolic ratio are preferred for anemia and osteoporosis, and to reverse protein loss following trauma, surgery, or prolonged immobilization.

EXAMPLES :

testosterone

(AAR = 1:1)

oxandrolone

(AAR = 630:24)

Mechanism of action

AAS

Extracellular

fluid

Plasma

membrane

Intracellular

receptor

Cytoplasm

DNA

Nucleus

Protein

synthesis

+

Blocks Cortisol effect on LBM

INDICATIONS

  • Burns
  • Surgery
  • Trauma
  • Chronic infection

Indications

This medication is used to offset Protein Catabolism and help patients regain weight lost due to various conditions.

  • Long term use of Corticosteroids.
  • Relieve bone pain due to Osteoporosis.
  • Development of girls with Turner Sd.
  • AIDS-associated wasting myopathy.
  • Hypercalcemia
  • Pregnancy

Contraindications

  • Prostate cancer
  • Breast cancer

Side Effects

SIDE EFFECTS

Side effects are linked to the androgenic nature of the drug.

Hormonal

At high doses, patients may experience symptoms of masculinization such as acne, increased hair growth, voice changes, increased sexual desire,...

Uniquely amongst AAS that are active by mouth, Oxandrolone seem to have little risk of liver toxicity.

Liver

Oxandrolone does not generally cause gynecomastia, as it does not aromatize into estrogenic metabolites.

Gyno

CLINICAL CASE

CLINICAL SITUATION

Situation

CLINICAL SITUATION

  • X, a 59-year-old man, is admitted to the ICU for management following a 31% full thickness burn.
  • A week into the admission, he begins to lose significant lean body mass (LBM).
  • This symptom is thought to be a hypermetabolic response resulting from his burn.
  • What is your attitude?

Answer

  • Oral oxandrolone : 10 mg twice daily is recommended to prevent loss of LBM resulting from his burn.
  • Treatment should be continued throughout his inpatient admission and rehabilitation.
  • Liver function and blood lipids should be monitored periodically while on oxandrolone.
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