Nilutamide

INTRODUCTION

Indications

Management of metastatic prostate cancer (with surgical castration).

Action

Blocks the effects of androgen (testosterone) at the cellular level. Therapeutic Effects: Decreased spread of prostate cancer.

Adverse Reactions/Side Effects

CNS: dizziness. EENT: impaired adaptation to darkness, abnormal vision. Resp: interstitial pneumonitis. CV: hypertension. GI: HEPATOTOXICITY, constipation, hepatitis, increased liver enzymes, nausea. Derm: hot flashes, hair loss, sweating.

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.

• Monitor signs of interstitial pneumonitis, including dyspnea, dry cough, shortness of breath, fever, and rales. Report these signs to the physician.

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

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

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.

• Because of possible pulmonary or blood pressure problems, 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).

Patient/Client-Related Instruction

• Advise patient about the likelihood of vision problems, including the impaired ability to adapt to darkness. Patients should use caution when entering a dark room, and implement better lighting conditions whenever possible.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged hot flashes, skin reactions (hair loss, increased sweating), or GI problems (nausea, constipation).

Pharmacokinetics

Absorption: Rapidly and completely absorbed following oral administration.

Distribution: Unknown.

Metabolism and Excretion: Extensively metabolized by the liver; 2 metabolites have antiandrogenic activity; <2% excreted unchanged in urine.

Half-life: 41–49 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Severe hepatic impairment; Severe respiratory insufficiency.

Use Cautiously in:...