Antiandrogens, Nonsteroidal (Systemic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the nonsteroidal antiandrogens, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to any of the nonsteroidal antiandrogens. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Fertility - Nonsteroidal antiandrogens, and other treatments for prostate cancer that are used together with these medicines, may cause low sperm counts or otherwise decrease a man's ability to father a child. In some cases, these effects may be permanent. Men who wish to have children should discuss this with their doctors before starting treatment.

Pregnancy - Nonsteroidal antiandrogens are usually given to men. However, if one of these medicines is needed by a woman, it is very important that an effective method of avoiding pregnancy be used during treatment. Because these medicines block the effect of the male hormone, testosterone, they may interfere with the normal development of a male fetus.

Breast-feeding - Nonsteroidal antiandrogens are usually given to men, and it is not known whether any of these medicines passes into breast milk. However, nonsteroidal antiandrogens can cause serious side effects. Therefore, if a woman needs one of these medicines, she should not breast-feed during treatment.

Children - Studies with the nonsteroidal antiandrogens have been done only in adults, and there is no specific information comparing the use of these medicines in children with use in other age groups. There is a chance that a nonsteroidal antiandrogen could interfere with the development of boys. However, cancer of the prostate gland usually occurs in middle-aged or older men, so it is very unlikely that a child would need these medicines.

Older adults - Nonsteroidal antiandrogens have been tested in elderly people and have not been shown to cause different side effects or problems than they do in younger adults.

Race - A serious side effect of nilutamide that affects the lungs may be more likely to occur in Asian patients than in Caucasian patients.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking a nonsteroidal antiandrogen, it is especially important that your health care professional know if you are taking any of the following:

• Anticoagulants such as warfarin (e.g., Coumadin) - Bicalutamide,flutamide, or nilutamide may increase the effects of the anticoagulant. Your doctor may recommend having your blood tested more often so that the dose of anticoagulant can be changed if necessary

• Phenytoin (e.g., Dilantin) or
• Theophylline (e.g., Theo-Dur; Theolair) - Nilutamide may increase the blood levels of these medicines in your body, which can increase the risk of serious side effects

Also tell your doctor if you smoke tobacco. Tobacco smoking may increase the risk of a rare side effect of flutamide.

Other medical problems - The presence of other medical problems may affect the use of nonsteroidal antiandrogens. Make sure you tell your doctor if you have any other medical problems, especially:

• Certain blood deficiencies or disorders or
• Tobacco smoking - Increased risk of anemia, other blood disorders, and jaundice
• Liver disease - The chance of serious side effects may be increased
• Lung disease or other breathing problems - One side effect of nilutamide can make your condition worse; your doctor may want to select a different antiandrogen