Flutamide: Anti-Androgen Prostate Cancer Hormone Treatment
Indications for Flutamide
Anti-androgen hormone treatment of prostate cancer with flutamide is a therapeutic option against prostate cancer in the following situations:
- Hormonal treatment of metastatic prostate cancer
- Adjuvant therapy of advanced prostate cancer after external beam radiation therapy (EBRT) or radical prostatectomy.
- Conservative treatment of locally advanced prostate cancer with lower urinary tract symptoms (LUTS)
- Reduction of prostate volume before brachytherapy of prostate cancer
Mechanism of Action of Flutamide
Flutamide is a nonsteroidal anti-androgen drug which binds without biological activity to the androgen receptor (competitive antagonism).
Pharmacokinetics of Flutamide
- Hepatic metabolism to active metabolites. Mostly renal elimination. Elimination half life: 6–8 h.
Side Effects of Flutamide
- Flutamide shows typical side effects of antiandrogens: gynecomastia, hot flushes, decreased libido, decreased erectile function. Sexual side effects are less pronounced than with LHRH treatment.
- Abdominal pain, diarrhea or nausea, rarely vomiting.
- Increased liver enzymes (7%) or jaundice. Fatal liver necrosis due to flutamid has been reported.
- Fluid retention, cardiac decompensation
- Anemia (frequently), rarely leukopenia, thrombocytopenia
- Allergic reactions
- Greenish discoloration of urine
Contraindications for Flutamide
Liver insufficiency. Increased liver enzymes during flutamide treatment warrant dose reduction and regular laboratory monitoring. Flutamide should be stopped in progressive elevation of liver transaminases without evidence of liver metastases. Further contraindications are allergy, flutamide has no indications in women and children.
Dosage of Flutamide
200 mg 1-1-1 p.o.
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Dr. med. Dirk Manski
man...@urologielehrbuch.de