nandrolone decanoate
Deca-Durabolin

Available forms
Available by prescription only
Injection (in oil): 100 mg/ml, 200 mg/ml

Indications and dosages
 Anemia caused by renal insufficiency. Adults: 100 to 200 mg I.M. weekly in men; 50 to 100 mg I.M. weekly in women.
Children ages 2 to 13: 25 to 50 mg I.M. q 3 to 4 weeks.

Pharmacodynamics
Androgenic action: Nandrolone exerts inhibitory effects on hormone-responsive breast tumors and metastases.
Erythropoietic action: Nandrolone stimulates kidney production of erythropoietin, leading to increases in red blood cell mass and volume.
Anabolic action: Nandrolone may reverse corticosteroid-induced catabolism and promote tissue development in severely debilitated patients.

Pharmacokinetics
Absorption: Well absorbed.
Distribution: Slowly released from I.M. depot following injection and is hydrolyzed to free nandrolone by plasma esterase.
Metabolism: Metabolized in the liver.
Excretion: Both the unchanged drug and its metabolites are excreted in the urine. The elimination half-life of nandrolone is 6 to 8 days.

Contraindications and precautions
Contraindicated in pregnant women, breast-feeding women, patients hypersensitive to anabolic steroids, men with breast cancer or prostate cancer, patients with nephrosis, patients experiencing the nephrotic phase of nephritis, and women with breast cancer and hypercalcemia.
  Use cautiously in patients with renal, cardiac, or hepatic disease; diabetes; epilepsy; migraine; or other conditions that may be aggravated by fluid retention.

Interactions
Drug-drug. Sulfonylureas: Decreases blood glucose level. Dosage adjustment of antidiabetic or insulin may be needed.
Warfarin-type anticoagulants: Increases PT and INR. Monitor PT and INR.

Adverse reactions
CNS: excitation, insomnia, habituation, depression.
CV: edema.
GI: nausea, vomiting, diarrhea.
GU: bladder irritability, hypoestrogenic effects in women (flushing; diaphoresis; vaginitis, including itching, dryness, and burning; vaginal bleeding; nervousness; emotional lability; menstrual irregularities), renal impairment.
Hematologic: suppression of clotting factors.
Hepatic: reversible jaundice, peliosis hepatitis, liver cell tumors.
Metabolic: hypercalcemia.
Skin: pain and induration at injection site.
Other: excessive hormonal effects in men (prepubertal-premature epiphyseal closure, acne, priapism, growth of body and facial hair, phallic enlargement; postpubertal-testicular atrophy, oligospermia, decreased ejaculatory volume, impotence, gynecomastia, epididymitis), androgenic effects in women (acne, edema, weight gain, hirsutism, hoarseness, clitoral enlargement, decreased breast size, changes in libido, male-pattern baldness, oily skin or hair).

Effects on lab test results
• May increase creatinine, lipid, sodium, potassium, calcium, phosphate, cholesterol, and liver enzyme levels.
• May decrease thyroid function test result values.

Overdose and treatment
No information available.

Special considerations
• Administer nandrolone injections I.M. deep into the gluteal muscle.
• An adequate iron intake is needed for maximum response when patient is receiving nandrolone decanoate injections.
• Therapy should be intermittent, if possible.
• Monitor liver function test results, urine and serum calcium levels (in women with breast cancer), serum lipid and cholesterol levels, and CBC periodically.
• Prepubertal patients should have X-ray studies every 6 months to evaluate bone age.
• Duration of therapy depends on patient response and the occurrence of adverse reactions.
• Drug can cause abnormal results of fasting plasma glucose, glucose tolerance, and metyrapone tests; decreased 17-ketosteroid levels.
Breast-feeding patients
• It isn’t known if anabolic steroids appear in breast milk. Because of the risk of serious adverse reactions in breast-fed infants, a decision should be made to discontinue breast-feeding or drug.
Pediatric patients
• The adverse effects of giving androgens to young children aren’t fully understood, but the risk of serious disturbances (premature epiphyseal closure, masculinization of females, or precocious development in males) exists. Weigh the benefits and risks before starting therapy in young children.
Geriatric patients
• Assess elderly men for the development of prostatic hypertrophy and prostatic carcinoma.

Patient education
• Instruct diabetic patient to monitor glucose levels closely because glucose tolerance may be altered.
• Tell women to report menstrual irregularities, acne, deepening of voice, male-pattern baldness, or hirsutism.
• Tell patient to call if persistent GI upset, nausea, vomiting, changes in skin color, or ankle swelling occurs.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use