What are the proper usage and potential side effects of Oxandrolone (anabolic steroid) for treating severe weight loss or anemia?

Oxandrolone Usage and Side Effects for Severe Weight Loss and Anemia

Oxandrolone is FDA-approved as adjunctive therapy to promote weight gain after weight loss following extensive surgery, chronic infections, or severe trauma, and for patients who fail to gain or maintain normal weight without definite pathophysiologic reasons. 1

Proper Usage

Dosage and Administration

• Adult dosage ranges from 2.5 mg to 20 mg daily, given in 2-4 divided doses, with treatment courses typically lasting 2-4 weeks that can be repeated intermittently as needed 1
• Pediatric dosage is ≤0.1 mg per kilogram body weight daily 1
• Geriatric dosage recommendation is 5 mg twice daily 1
• Therapy should be intermittent rather than continuous 1
• Oxandrolone serves as adjunctive therapy and is not a replacement for conventional treatment 1

FDA-Approved Indications

• Promotion of weight gain after weight loss due to extensive surgery, chronic infections, or severe trauma 1
• Treatment for patients who fail to gain or maintain normal weight without clear pathophysiologic reasons 1
• Offsetting protein catabolism associated with prolonged corticosteroid administration 1
• Relief of bone pain accompanying osteoporosis 1

Potential Side Effects

Common Side Effects

• Weight gain (therapeutic effect) 2
• Androgenic side effects: acne, hirsutism, hair loss, vocal changes, and changes in libido and sexual potency 3
• Transient elevations in liver enzymes 2
• Reduction in high-density lipoprotein (HDL) cholesterol levels 2

Serious Side Effects in Women

• Virilization effects: clitoral enlargement, menstrual irregularities, and deepening of voice 3, 4
• Hirsutism and male-pattern baldness 4
• Altered libido 4

Serious Side Effects in Men

• Erectile tissue stimulation 3
• Gynecomastia 3

Hepatic Side Effects

• Unlike other 17α-alkylated anabolic steroids, oxandrolone appears to have less severe hepatotoxic effects 2
• However, monitoring of liver function is still necessary during treatment 2

Special Considerations

Benefits in Severe Weight Loss Conditions

• Significantly decreases weight loss and net nitrogen loss in burn patients 5
• Improves donor site wound healing in burn patients 5
• Regained lean body mass is maintained even 6 months after discontinuation of the drug 6
• Protects against multiorgan failure and modulates systemic inflammatory response during burn injury 7

Monitoring During Treatment

• Regular monitoring of liver function tests is recommended 2
• Lipid profile should be monitored due to potential reductions in HDL cholesterol 2
• For women, monitoring for signs of virilization is essential 4

Contraindications

• Pregnancy or women who may become pregnant 4
• History of liver disease 2
• Prostate cancer in men 3

Use in Cancer Patients

• While sometimes used in cancer cachexia, current evidence is insufficient to recommend androgenic steroids to increase muscle mass in cancer patients 4
• May show a trend toward smaller loss of body weight in non-small cell lung cancer patients undergoing chemotherapy, but results are limited 4

Overdose Information

• No specific symptoms associated with overdosage have been reported 1
• Sodium and water retention may occur 1
• No specific antidote is known, but gastric lavage may be used if overdose is suspected 1

Remember that oxandrolone should be used for the shortest time possible with careful monitoring for side effects, particularly in women who are more susceptible to virilization effects 4. The benefits in severe weight loss conditions must be weighed against the potential for adverse effects.