NILUTAMIDE

NILUTAMIDE
(ni-lu'ta-mide)
Nilandron
Classifications: antineoplastic agent; antiandrogen;
Therapeutic: antineoplastic
; antiandrogen
Prototype: Flutamide
Pregnancy Category: C

Availability

150 mg tablets

Action

Nonsteroidal with antiandrogen activity. Blocks the effects of testosterone at the androgen receptor sites, thus preventing the normal androgenic response.

Therapeutic Effect

Effective in blocking testosterone in treatment of metastatic prostate carcinoma.

Uses

Use with surgical castration for metastatic prostate cancer.

Contraindications

Severe hepatic impairment; severe respiratory insufficiency; hypersensitivity to nilutamide; pregnancy (category C), lactation.

Cautious Use

Asian patients relative to causing interstitial pneumonitis; alcoholics. Safety and effectiveness in children are not established.

Route & Dosage

Metastatic Prostate Cancer
Adult: PO 300 mg q.d. x 30 d, then 150 mg q.d.

Administration

Oral
  • Give first dose on the day of or day after surgical castration.
  • Store below 15°–30° C (59°–86° F) and protect from light.

Adverse Effects (≥1%)

Body as a Whole: Hot flushes, impotence, decreased libido, malaise, edema, weight loss, arthritis. CNS: Nervousness, paresthesias. CV: Angina, heart failure, syncope. GI: Diarrhea, GI hemorrhage, melena, dry mouth. Respiratory: Cough, interstitial lung disease, rhinitis. Skin: Pruritus. Other: Alcohol intolerance. Special Senses: Cataracts, photophobia.

Interactions

Drug: Carbamazepine, rifampin, phenytoin may decrease level; fluconazole, gemfibrozil, omeprazole may increase levels. Herbal: St. John's wort may decrease levels.

Pharmacokinetics

Absorption: Rapidly from GI tract. Metabolism: In the liver (CYP2C19). Elimination: In urine. Half-Life: 38–50 h.

Nursing Implications

Assessment & Drug Effects

  • Obtain baseline chest x-ray before treatment and periodically thereafter.
  • Closely monitor for S&S of pneumonitis; at the first sign of adverse pulmonary effects, withhold drug and notify physician. Abnormal ABGs may indicate need to discontinue drug.
  • Lab tests: Monitor liver function before beginning treatment and at 3-mo intervals; if serum transaminases increase >2–3 times upper limit of normal, discontinue treatment.
  • Monitor patients taking phenytoin, theophylline, or warfarin closely for toxic levels of these drugs.

Patient & Family Education

  • Report following S&S of adverse effects on lungs to physician immediately: Development of chest pain, dyspnea, and cough with fever.
  • Report S&S of liver injury to physician: Jaundice, dark urine, fatigue, or signs of GI distress including nausea, vomiting, abdominal pain.
  • Use caution when moving from lighted to dark areas because the drug may slow visual adaptation to darkness. Tinted glasses may partially alleviate the problem.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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