What are the guidelines for using Oxandrolone (anabolic steroid) in patients requiring weight gain or treatment for conditions like Turner syndrome or anemia?

Guidelines for Oxandrolone Use in Weight Gain and Specific Conditions

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

FDA-Approved Indications

• Oxandrolone is approved to promote weight gain after weight loss following extensive surgery, chronic infections, or severe trauma 1
• It can be used for patients who fail to gain or maintain normal weight without definite pathophysiologic reasons 1
• It helps offset protein catabolism associated with prolonged corticosteroid administration 1
• It provides relief of bone pain frequently accompanying osteoporosis 1

Dosing Guidelines

Adults

• Daily adult dosage ranges from 2.5 mg to 20 mg given in 2 to 4 divided doses 1
• The desired response may be achieved with as little as 2.5 mg or as much as 20 mg daily 1
• A typical course of therapy lasts 2 to 4 weeks and may be repeated intermittently as indicated 1

Children

• For children, the total daily dosage is ≤0.1 mg per kilogram body weight or ≤0.045 mg per pound of body weight 1
• Treatment may be repeated intermittently as indicated 1

Geriatric Patients

• Recommended dose for geriatric patients is 5 mg twice daily 1

Use in Specific Conditions

Turner Syndrome

• Oxandrolone at a dosage of 0.03-0.05 mg/kg/day can be considered as adjunctive therapy to growth hormone (GH) in girls with Turner syndrome who are severely short for age or have modest growth rate despite good compliance with GH 2
• Starting age for oxandrolone in Turner syndrome is recommended at 8-10 years onward 2
• Addition of oxandrolone to GH therapy leads to an increase in adult height, on average 2.3-4.6 cm 2
• Lower doses (0.03 mg/kg/day) show better benefit-to-risk ratio than conventional doses (0.06 mg/kg/day) in Turner syndrome 3

Critical Illness and Recovery

• Oxandrolone has shown benefits in severe burns, including reduced weight loss, increased lean mass, improved donor-site healing, and reduced length of hospital stay 4
• It may be considered as part of a multimodal intervention for post-ICU recovery, particularly for patients with persistent testosterone deficiency 4

Cancer-Related Weight Loss

• There are insufficient consistent clinical data to recommend currently approved androgenic steroids like oxandrolone to increase muscle mass in cancer patients 4
• In a randomized trial of patients with non-small cell lung cancer undergoing chemotherapy, anabolic steroids showed only a trend toward smaller loss of body weight 4

Adverse Effects and Monitoring

• Common side effects in women include virilization (clitoromegaly), hirsutism, hoarseness or deepening of voice, weight gain, menstrual irregularities, and breast hypotrophy 4
• Most adverse effects are dose-related and can be minimized by titrating the dose to the lowest effective level 4
• In Turner syndrome, the most relevant safety concerns are virilization and a transient delay of breast development 2
• Monitor for signs of virilization, breast development, and possibly blood lipids during treatment 2
• Therapy with oxandrolone is adjunctive and not a replacement for conventional therapy 1

Special Considerations

• Female patients taking oxandrolone can still ovulate and must be informed that conception is possible 4
• Women in their reproductive years should use additional contraceptive methods while undergoing treatment 4
• Oxandrolone should be avoided in some patients due to side effects 4
• Spironolactone (100-200 mg/day) could be used for controlling hirsutism in patients undergoing treatment with anabolic androgenic steroids 4

Duration of Treatment

• Therapy should be intermittent rather than continuous 1
• The duration of therapy will depend on the patient's response and possible appearance of adverse reactions 1

Oxandrolone represents a valuable adjunctive therapy for specific conditions requiring weight gain, but its use should be carefully monitored due to potential side effects, particularly in female patients.