Table of Common Drugs and Generic Names
- Androgens
- danazol (Danocrine)
- fluoxymesterone (Androxyl)
- testosterone (Androderm, Depo-testosterone, Striant, Androgel, Fortesta)
- methyltestosterone (Testred, Virilon)
- Anabolic Steroids
- oxandrolone (Oxandrin)
- oxymetholone (Anadrol-50)
- Penile Erectile Dysfunction Drugs
- alprostadil (Caverject, Muse)
- sildenafil (Viagra, Revatio)
- tadalafil (Cialis, Adcirca)
- vardenafil (Levitra, Staxyn)
Androgens
Androgens are the male sex hormones: testosterone (produced in the testes) and the androgens produced in the adrenal glands. Testosterone (Duratest, Testoderm) is the primary natural androgen and the classic agent in use today, given for certain breast cancers and for hypogonadism (undeveloped testis). All testosterones are class III controlled substances.
Therapeutic Action
Androgens drive growth and development of the male sex organs and maintain secondary male sex characteristics. They increase retention of nitrogen, sodium, potassium, and phosphorus while decreasing urinary excretion of calcium, increase protein anabolism and decrease protein catabolism, and increase red blood cell production.
Indications
Danazol treats endometriosis, fibrocystic breast disease, and hereditary angioedema. It works by inhibiting the hypothalamic-pituitary-adrenal (HPA) axis and gonadotropin-releasing hormone (GnRH), which drops follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
Pharmacokinetics
Here are the characteristic interactions of androgens and the body in terms of absorption, distribution, metabolism, and excretion:
| Route | Onset | Peak | Duration |
|---|---|---|---|
| Buccal | Slow | 10-12 h | N/A |
| IM | Slow | 1-3 d | N/A |
| IM cypionate | Slow | 2-4 wk | N/A |
| IM enanthate | Slow | 2-4 wk | N/A |
| Dermal | Rapid | 24 h | N/A |
| Half-life (T1/2) | Metabolism | Excretion |
|---|---|---|
| 10-100 min | Liver | Kidney (urine) and intestines (feces) |
Contraindications and Cautions
Do not use with allergy to androgens or other drug ingredients. Avoid in pregnancy and lactation (potential adverse effects on the neonate; it is unclear whether androgens enter breast milk), and in men with prostate or breast cancer, which the testosterone effect aggravates. Use caution in liver dysfunction and CV disease, both of which the hormone effects can worsen. Topical testosterone carries a Black Box Warning for virilization in children who contact the drug through the man's clothes or skin. Danazol carries a Black Box Warning for thromboembolic events, fetal abnormalities, hepatitis, and intracranial hypertension.
Adverse Effects
Androgenic effects include acne, edema, hirsutism (increased hair distribution), deepening of the voice, oily skin and hair, weight gain, decreased breast size, and testicular atrophy. Antiestrogen effects include flushing, sweating, vaginitis, nervousness, and emotional lability. Common effects are headache (possibly tied to fluid and electrolyte changes), dizziness, sleep disorders, fatigue, rash, and altered serum electrolytes. The life-threatening effect on record is hepatocellular cancer.
Interactions
Drug-laboratory interactions include decreased thyroid function and increased creatinine and creatinine clearance (results not tied to disease states). These effects can persist up to 2 weeks after therapy is stopped.
Nursing Considerations
Nursing Assessment
Assess for the cautions and contraindications above (drug allergy, hepatic dysfunction, CV disease, breast or prostate cancer in men) before starting. Perform a full physical (skin, mental status, abdominal exam) for baseline data and to track effectiveness and adverse effects. Arrange long-bone radiographs in children to assess testosterone effects on growth.
Nursing Diagnoses
- Disturbed body image related to androgenic effects
- Sexual dysfunction related to androgenic effects
Implementation with Rationale
Monitor response closely when starting so the dose can be titrated. Remove the old dermal system before applying a new one to clean, dry, intact skin for accurate dosing and lower toxicity risk. Check liver function periodically on long-term therapy and stop the drug at any sign of hepatic dysfunction. Teach the patient how to avoid adverse effects, the warning signs, and the need for regular evaluation, especially blood pressure. Provide safety measures (adequate lighting, raised side rails) to prevent injury.
Evaluation
Track response (onset of puberty, maintenance of male sexual characteristics, palliation of breast cancer), watch for adverse effects (androgenic effects, hypoestrogen effects, serum electrolyte imbalance, headache), confirm the patient can name the drug, its indication, and the adverse effects to watch for, and monitor compliance.
Anabolic Steroids
Anabolic steroids are testosterone analogues built to deliver the tissue-building effect of testosterone with less androgenic effect.
Therapeutic Action
They promote body tissue-building, reverse catabolic (tissue-destroying) processes, and increase hemoglobin and red blood cell mass.
Indications
Used for anemias, certain cancers, and angioedema; to promote weight gain and tissue repair in debilitated patients; and for protein anabolism in patients on long-term corticosteroid therapy. They are also used illegally to enhance athletic performance by increasing muscle mass, hematocrit, strength, and endurance.
Pharmacokinetics
Here are the characteristic interactions of anabolic steroids and the body in terms of absorption, distribution, metabolism, and excretion:
| Route | Onset | Peak | Duration |
|---|---|---|---|
| PO | Slow | N/A | N/A |
| Half-life (T1/2) | Metabolism | Excretion |
|---|---|---|
| 9 h | Liver | Kidney (urine) |
Contraindications and Cautions
Do not use with allergy to androgens or other drug ingredients. Avoid in pregnancy and lactation (potential masculinization of the neonate) and in males with prostate or breast cancer, which these drugs exacerbate. Use caution in liver dysfunction, since the drug is metabolized in the liver and is known to cause hepatic toxicity, and in coronary disease, where the liver effect can raise cholesterol.
Adverse Effects
In prepubertal males, virilization (phallic enlargement, hirsutism, increased skin pigmentation). In postpubertal males, inhibition of testicular function, gynecomastia, testicular atrophy, priapism (painful continuous erection of the penis), baldness, and changed libido. In women, hirsutism, hoarseness, deepening of the voice, clitoral enlargement, baldness, and menstrual irregularities.
Interactions
Watch for interaction with oral anticoagulants, a potentially decreased need for antidiabetic agents, and altered lipid metabolism that blunts the effect of lipid-lowering agents.
Nursing Considerations
Nursing Assessment
Assess for the cautions and contraindications above (drug allergy, pregnancy and lactation, CV disease). Perform a full physical (skin, mental status, abdominal exam) for baseline data and to track effectiveness and adverse effects. Arrange long-bone radiographs in children to assess testosterone effects on growth.
Nursing Diagnoses
- Disturbed body image related to systemic effects
- Acute pain related to GI or CNS effects
Implementation with Rationale
Give with food if GI effects are severe. Monitor endocrine and hepatic function and serum electrolytes before and periodically during therapy so the dose can be adjusted and severe adverse effects avoided. Teach the patient how to avoid adverse effects, the warning signs, and the need for regular evaluation, especially blood pressure.
Evaluation
Track response (rising hematocrit, protein anabolism), watch for adverse effects (androgenic effects, serum electrolyte disturbances, epiphyseal closure, hepatic dysfunction), confirm the patient can name the drug, its indication, and the adverse effects to watch for, and monitor compliance.
Drugs For Treating Penile Erectile Dysfunction
Penile erectile dysfunction is a condition in which the corpus cavernosum does not fill with blood to allow erection. Approved drugs are the prostaglandin alprostadil and the phosphodiesterase type 5 (PDE5) receptor inhibitor sildenafil.
Therapeutic Action
Alprostadil acts locally to relax vascular smooth muscle and let the corpus cavernosum fill, producing erection. PDE5 receptor inhibitors raise nitrous oxide levels in the corpus cavernosum; nitrous oxide activates cyclic guanosine monophosphate (cGMP), which relaxes smooth muscle and increases blood flow.
Indications
Treatment of penile erectile dysfunction.
Pharmacokinetics
Here are the characteristic interactions of drugs affecting the male reproductive system and the body in terms of absorption, distribution, metabolism, and excretion:
| Route | Onset | Peak | Duration |
|---|---|---|---|
| Buccal | 15-30 min | 30-120 min | 4 h |
| Half-life (T1/2) | Metabolism | Excretion |
|---|---|---|
| 4 h | Liver | Kidney (urine) and intestines (feces) |
Contraindications and Cautions
Do not use with any anatomical obstruction or condition that predisposes to priapism, which these drugs can worsen, or with penile implants. Use caution in bleeding disorders, CV disease, optic neuropathy, and severe hepatic or renal disorders.
Adverse Effects
Local effects of alprostadil: pain at the injection site, infection, priapism, fibrosis, and rash. PDE5 inhibitor effects: headache, flushing, dyspepsia, urinary tract infection, diarrhea, and dizziness. The serious risks of PDE5 inhibitors are profound, potentially fatal hypotension when combined with nitrates, priapism, and sudden vision loss (non-arteritic anterior ischemic optic neuropathy) or sudden hearing loss (StatPearls). Hepatocellular cancer is a risk of the androgen and anabolic-steroid groups, not of the erectile dysfunction drugs.
Interactions
Organic nitrates and alpha-adrenergic blockers cause serious CV effects, including death; coadministration of a PDE5 inhibitor with any nitrate is contraindicated, and a nitrate should not be given until at least 24 hours after the last sildenafil or vardenafil dose (longer for tadalafil) (StatPearls). Ketoconazole, itraconazole, and erythromycin increase sildenafil levels.
Nursing Considerations
Nursing Assessment
Assess for the cautions and contraindications above (drug allergy, penile implants, bleeding disorders). Perform a full physical (skin, mental status, vital signs) for baseline data and to track effectiveness and adverse effects. Check bleeding time and liver function to monitor for hepatic effects.
Nursing Diagnoses
- Disturbed body image related to drug effects
- Sexual dysfunction related to drug effects
Implementation with Rationale
Assess the cause of dysfunction before starting to ensure appropriate use. Monitor patients with vascular disease for any sign of exacerbation so the drug can be stopped before severe effects occur. Monitor response closely when starting so the dose can be titrated. Teach the patient how to avoid adverse effects, the warning signs, and the need for regular evaluation, especially blood pressure.
Evaluation
Track response (improved erection), watch for adverse effects (dizziness, flushing, local inflammation or infection, fibrosis, diarrhea), confirm the patient can name the drug, its indication, and the adverse effects to watch for, and monitor compliance.
Frequently Asked Questions
Why can't PDE5 inhibitors like sildenafil be taken with nitrates? Both drugs lower blood pressure through the same pathway, so together they can cause profound, life-threatening hypotension. The combination is contraindicated; a nitrate should not be given for at least 24 hours after sildenafil or vardenafil, and longer after tadalafil (StatPearls). Screen every patient for nitrate use before starting.
Are testosterone products controlled substances? Yes. Testosterone and other anabolic-androgenic steroids are Schedule III controlled substances in the United States because of their abuse potential.
What is the most common lab change to watch for on testosterone therapy? A rising red blood cell count. Erythrocytosis (polycythemia) is the most commonly reported adverse effect of testosterone replacement, so the hematocrit is monitored during therapy (StatPearls).
Why monitor liver function with androgens and anabolic steroids? These drugs, especially oral 17-alkylated forms, are metabolized in the liver and can cause hepatic toxicity; the life-threatening effect on record is hepatocellular cancer. Check liver function periodically and stop the drug at any sign of dysfunction.
What does priapism mean and why does it matter? Priapism is a prolonged, painful erection that does not resolve. It can occur with alprostadil injections and with PDE5 inhibitors and is a medical emergency, because untreated priapism can permanently damage erectile tissue.
Can anabolic steroids be used safely to build muscle? Used illegally for athletic performance, they carry real harm: in men, testicular atrophy, gynecomastia, and infertility; in women, voice deepening, hirsutism, and menstrual changes; plus liver toxicity and altered lipids in either sex. Their approved uses are for specific medical conditions under monitoring, not performance enhancement.