Flutamide

INTRODUCTION

Indications

Treatment of prostate carcinoma in conjunction with luteinizing hormone–releasing hormone (LHRH) analogues such as leuprolide.

Action

Antagonizes the effects of androgen (testosterone) at the cellular level. Therapeutic Effects: Decreased growth of prostate carcinoma, an androgen-sensitive tumor.

Adverse Reactions/Side Effects

Side effects primarily caused by LHRH antagonist CNS: anxiety, confusion, drowsiness, mental depression, nervousness. CV: edema, hypertension. GI: HEPATOTOXICITY, diarrhea, nausea, vomiting. GU: erectile dysfunction, loss of libido. Derm: photosensitivity, rash. Endo: gynecomastia. Misc: hot flashes.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician immediately.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report a sustained increase in blood pressure (hypertension) to the physician.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Be alert for anxiety, confusion, nervousness, drowsiness, or other alterations in mental status. Notify physician if these side effects become problematic (See Appendix D).

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

• Use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (respiratory symptoms, blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

Patient/Client-Related Instruction

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged skin rash, hot flashes, breast enlargement (gynecomastia), sexual dysfunction (decreased libido, erectile dysfunction), or GI problems (diarrhea, nausea, vomiting).

Pharmacokinetics

Absorption: Well absorbed after oral administration.

Distribution: Unknown.

Metabolism and Excretion: Mostly metabolized by the liver. Some conversion to another antiandrogenic compound (2-hydroxyflutamide).

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Severe hepatic impairment.

Use Cautiously in: Severe cardiovascular disease.