Fluoxymesterone; a new oral androgen

Fluoxymesterone-induced gynaecomastia in a patient with childhood aplastic anaemia

Gynaecomastia is a benign condition characterised by enlargement of the male breast. Drug-induced gynaecomastia merits deep consideration as it may account for as many as 25% of all cases of gynaecomastia in adults. Although the mechanism is not fully clear, some mechanisms include oestrogen-like activities, stimulation of testicular production of oestrogens, inhibition of testosterone synthesis or blockade of androgen action. Anabolic steroids, in particular when used during the pubertal stage, may cause significant irreversible gynaecomastia. We report a case of 28-year-old Filipino man with persistent gynaecomastia from fluoxymesterone used for aplastic anaemia during his prepubertal stage. Hormonal work ups for gynaecomastia all turned out normal, thus isolating the drug as the cause. The patient was unable to undergo breast reconstruction surgery due to haematological contraindications, but eventually referred to psychiatry for counselling. This case will highlight the paradoxical effect of androgenic steroid used during childhood on male breast proliferation during puberty.

A screening study of drug-drug interactions in cerivastatin users: an adverse effect of clopidogrel

An analysis of a case-control study of rhabdomyolysis was conducted to screen for previously unrecognized cytochrome P450 enzyme (CYP) 2C8 inhibitors that may cause other clinically important drug-drug interactions. Medication use in cases of rhabdomyolysis using cerivastatin (n = 72) was compared with that in controls using atorvastatin (n = 287) for the period 1998-2001. The use of clopidogrel was strongly associated with rhabdomyolysis (odds ratio (OR) 29.6; 95% confidence interval (CI), 6.1-143). In a replication effort that used the US Food and Drug Administration (FDA) Adverse Event Reporting System (AERS), it was found that clopidogrel was used more commonly in patients with rhabdomyolysis receiving cerivastatin (17%) than in those receiving atorvastatin (0%, OR infinity; 95% CI = 5.2-infinity). Several medications were tested in vitro for their potential to cause drug-drug interactions. Clopidogrel, rosiglitazone, and montelukast were the most potent inhibitors of cerivastatin metabolism. Clopidogrel and its metabolites also inhibited cerivastatin metabolism in human hepatocytes. These epidemiological and in vitro findings suggest that clopidogrel may cause clinically important, dose-dependent drug-drug interactions with other medications metabolized by CYP2C8.

Improving elders' continence state

A 6-month study was conducted to assess the effects that noninvasive self-managed interventions on 12 remediable risk factors had on elder's urinary continence status. Each remediable risk factor was linked with a criterion meeting normal and if not normal, one or more interventions. Continence history assessments were conducted monthly on 31 elders (M age = 67.65 years). After the first assessment, elders were identified as continent, incontinent or at risk for loss of continence. At the end of the 6 months, 9 of the 11 incontinent elders moved to the at-risk group and the other 2 remained incontinent, and 12 of the 20 at-risk elders became continent. Both the elders who were initially at risk and those who were incontinent had a statistically significant reduction in the number of remediable risk factors reported at the end of the study period. The assessments and interventions are useful.