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DRUG INFORMATION ROUNDS

Oxandrolone in Pediatric Patients with Severe Thermal Burn Injury

at time of writing, Critical Care Specialty Resident, University of Michigan Hospitals and Health Centers; Adjunct Clinical Instructor, Department of Clinical, Social, and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI; now, Clinical Pharmacist Specialist, Department of Pharmacy, Sinai-Grace Hospital, Detroit, MI

Imad F Btaiche, PharmD BCNSP

Clinical Associate Professor, Department of Clinical, Social, and Administrative Sciences, College of Pharmacy, University of Michigan; Clinical Pharmacist, University of Michigan Hospitals and Health Centers

Reprints: Dr. Btaiche, Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, UHB2D301, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, fax 734/936-7027, imadb{at}umich.edu

OBJECTIVE: To review the role of oxandrolone in pediatric patients with severe thermal burn injury.

DATA SOURCES: MEDLINE (1950–April 2008) and Science Citation Index (1900–April 2008) searches were performed using the key terms oxandrolone, burn, and children.

STUDY SELECTION AND DATA EXTRACTION: All English-language articles that evaluated the efficacy and safety of oxandrolone in pediatric patients with severe thermal burn injury were included in this review.

DATA SYNTHESIS: Oxandrolone stimulates protein synthesis by binding to androgen receptors. The efficacy and safety of adjunct oxandrolone therapy in pediatric patients (18 y old) with severe thermal burn injury (total body surface area burn >20%) were evaluated in 8 clinical studies. Oral oxandrolone 0.1 mg/kg twice daily increased protein synthesis, lean body mass accretion, and muscle strength; improved serum visceral protein concentrations; promoted weight gain; and increased bone mineral content. During the postburn rehabilitation period, oxandrolone 0.1 mg/kg/day improved muscle strength, especially when combined with exercise. Based on clinical studies, oxandrolone 0.1 mg/kg twice daily is safe when given for up to 12 months. However, mild increases in serum liver transaminase concentrations and reversible sexual changes were observed during therapy. Although data on the efficacy and safety of oxandrolone in severely burned children are supported by prospective, randomized, controlled studies, limitations of available data are that they originated from a single study center and that wound healing measurement is lacking in children with severe thermal burns.

CONCLUSIONS: The benefits of adjunct oxandrolone therapy in severely burned pediatric patients have been demonstrated in the acute postburn injury and long-term postburn rehabilitation periods. Close monitoring of liver function, sexual development, and growth pattern is recommended during oxandrolone treatment.

Key Words: burns, children, oxandrolone

Published Online, August 5, 2008. www.theannals.com, DOI 10.1345/aph.1L162