Role of Anabolic Steroids in Burn Patients
Oxandrolone is strongly recommended for burn patients with severe burns (>20% total body surface area) to improve muscle protein metabolism, accelerate wound healing, and reduce hospital length of stay. 1
Mechanism and Benefits
Anabolic steroids, particularly oxandrolone, provide significant benefits in burn patients by:
- Increasing protein synthesis efficiency 2
- Reducing net weight loss and nitrogen loss 3
- Accelerating donor site healing 1
- Maintaining lean body mass 1
- Improving wound healing time 3
- Modulating systemic inflammatory response 4
- Protecting against multiorgan failure 4
Dosing Recommendations
- Adults: 2.5-20 mg daily in 2-4 divided doses 5
- Typical effective dose in burn patients: 10 mg twice daily 6
- Children: ≤0.1 mg per kilogram body weight daily 5, 2
- Geriatric patients: 5 mg twice daily 5
Duration of Treatment
- Therapy should be intermittent 5
- A course of 2-4 weeks is usually adequate and may be repeated as indicated 5
- Treatment typically begins in the recovery phase after burns (when hypermetabolic state resolves) 6
Clinical Evidence
Meta-analysis data shows oxandrolone provides significant benefits in severe burns, including:
- Reduced weight loss
- Increased lean body mass
- Improved donor-site healing
- Reduced length of hospital stay
- No increase in infection, hyperglycemia, or liver dysfunction 1
In comparative studies with human growth hormone (HGH), oxandrolone demonstrated:
- Similar benefits in decreasing weight and nitrogen loss
- Similar improvements in wound healing
- Fewer side effects (no hyperglycemia or accentuated hypermetabolism) 3
Nutritional Considerations
Oxandrolone should be used in conjunction with appropriate nutritional support:
- Protein requirements: 1.5-2 g/kg/day for burn patients 1
- Energy requirements: Best determined by serial indirect calorimetry 1
- Early enteral nutrition (within 24 hours) is recommended 1
Monitoring Parameters
- Liver function tests periodically 5
- Hemoglobin and hematocrit for polycythemia 5
- Lipid levels 5
- Bone age in children (every 6 months) 5
- Signs of virilization in women 5
Precautions and Contraindications
- Monitor for cholestatic hepatitis and jaundice 5
- Use with caution in patients with cardiac, renal, or hepatic disease due to risk of edema 5
- May accelerate bone maturation in children without compensatory gain in linear growth 5
- Significant drug interaction with warfarin (may increase INR/PT) 5
- Not recommended for patients with prostate cancer or breast cancer 5
Special Considerations
- Oxandrolone is a common standard of care in burn centers worldwide 1
- No significant side effects were noted in burn studies 3, 6
- Testosterone deficiency is common in critically ill patients, including burn patients 1
Oxandrolone represents an important adjunctive therapy in the comprehensive management of severe burn patients, with substantial evidence supporting its use to improve clinical outcomes and quality of life.