Oxandrin as a Medication to Stimulate Growth?
Dear Dr. Warren: I would like to thank you for providing this forum on the 'net. But in order to save you time, I will get right to the point as I know you are very busy. I have a 7 year old son that weighs approximately 42 lbs. He is very slender and does not carry a lot of weight on his already small bone structure. In fact, Doctor, he almost seems to me to be terribly underweight and I worry that his slow growth and extremely slow weight gain will pose health/social problems in the future. A little background is probably in order at this point. He was a little over a month premature when born but fortunately completely developed and suffering no complications from it. However, he does seem to suffer from ADHD and has been on Ritalin (15 mg) daily for approximately a year now in order to improve his focus in School activities. Although he is extremely bright and his cognitive development seems above average, he does have difficulty with emotions and expressing himself verbally at times. But anyway, my question is if prescribing Oxandrin (Oxandrolone) a mild (alpha-alkylated-17) oral steroid to him would benefit his growth rate and maybe increase his appetite as well without serious long- term side effects. From my own research I understand Oxandrolone (formerly known as Anavar) is relatively safe anabolic agent/mildly androgenic and very low if any in hepato-toxicity. (I'm not sure but , possibly the Ritalin adversely affects his growth and appetite as well.). Any advice or information you can send me will be greatly appreciated. Someday, I hope to study medicine as well and become an immunologist specializing in Biomedical research. It's just tough with my current situation.....(full-time law- enforcement career, and 3-children to support and rear.). Once again thank you for your time and keep up the interesting website, it is no doubt, greatly appreciated by many parents that seek answers to their children's medical problems. Have a Merry Christmas and Happy New Year.
-DP
Dear DP: The PDR lists the following indications for Oxandrin:
Oxandrin is indicated as adjunctive therapy to promote weight gain after weight loss following extensive surgery, chronic infections, or severe trauma, and in some patients who without definite pathophysiologic reasons fail to gain or to maintain normal weight, to offset the protein catabolism associated with prolonged administration of corticosteroids, and for the relief of the bone pain frequently accompanying osteoporosis.
The following warning is listed in the PDR:
In children, androgen therapy may accelerate bone maturation without producing compensatory gain in linear growth. This adverse effect results in compromised adult height. The younger the child, the greater the risk of compromising final mature height. The effect on bone maturation should be monitored by assessing bone age of the left wrist and hand every 6 months.
The following comment on use in children appears in the PDR:
Anabolic agents may accelerate epiphyseal maturation more rapidly than linear growth in children and the effect may continue for 6 months after the drug has been stopped. Therefore, therapy should be monitored by x-ray studies at 6- month intervals in order to avoid the risk of compromising adult height. Androgenic anabolic steroid therapy should be used very cautiously in children and only by specialists who are aware of the effects on bone maturation.
The following adverse reactions are listed in the PDR:
Hepatic: Cholestatic jaundice with, rarely, hepatic necrosis and death. Hepatocellular neoplasms and peliosis hepatis with long-term therapy. Reversible changes in liver function tests also occur including increased bromsulfophthalein (BSP) retention, and increases in serum bilirubin, aspartate aminotransferase (AST, SGOT) and alkaline phosphatase.
Prepubertal: Phallic enlargement and increased frequency or persistence of erections.
Postpubertal: Inhibition of testicular function, testicular atrophy and oligospermia, impotence, chronic priapism, epididymitis, and bladder irritability.
CNS: Habituation, excitation, insomnia, depression, and changes in libido. Hematologic: Bleeding in patients on concomitant anticoagulant therapy.
Breast: Gynecomastia.
Skin: Acne (especially in females and prepubertal males).
Skeletal: Premature closure of epiphyses in children .
Fluid and electrolytes: Edema, retention of serum electrolytes (sodium, chloride, potassium, phosphate, calcium).
Metabolic/Endocrine: Decreased glucose tolerance, increased creatinine excretion, increased serum levels of creatinine phosphokinase (CPK). Inhibition of gonadotropin secretion.
There are considerable risks to using this medication and it is NOT indicated for use in small children to promote growth. Ritalin may certainly be affecting your son's appetite, therefore his growth should be monitored carefully by his doctor. Should his growth rate not be adequately maintained, his medication may need to be changed and he may require evaluation by an endocrinologist for poor growth.