Danocrine

[dan´o-krin] trademark for a preparation of danazol, an anterior pituitary suppressant used for treatment of endometriosis, fibrocystic disease of the breast, hereditary angioedema, and gynecomastia.

danazol

(da-na-zole) danazol,

Cyclomen

(trade name),

Danocrine

(trade name)

Classification

Therapeutic: hormones
Pharmacologic: androgens
Pregnancy Category: X

Indications

Treatment of moderate endometriosis that is unresponsive to conventional therapy.Palliative therapy of fibrocystic breast disease.Prophylaxis of hereditary angioedema.

Action

Inhibits pituitary output of gonadotropins, resulting in suppression of ovarian function. Has weak androgenic-anabolic activity.

Therapeutic effects

Atrophy of ectopic endometrial tissue in endometriosis.Decreased pain and nodularity in fibrocystic breast disease.Correction of biochemical abnormalities in hereditary angioedema.

Pharmacokinetics

Absorption: Absorbed from the GI tract.Distribution: Unknown.Metabolism and Excretion: Metabolized by the liver.Half-life: 4.5 hr.

Time/action profile (disease response)

ROUTE	ONSET	PEAK	DURATION
PO (endometriosis)	unknown	6–8 wk	60–90 days
PO (fibrocystic disease)	1 mo	2–6 mo	1 yr
PO (angioedema)	unknown	1–3 mo	unknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Male patients with breast or prostate cancer; Hypercalcemia; Severe hepatic, renal, or cardiac disease; Obstetric / Lactation: Pregnancy or lactation.Use Cautiously in: Previous history of liver disease; History of porphyria; Coronary artery disease; Prepubertal boys.

Adverse Reactions/Side Effects

Central nervous system

emotional lability (most frequent)

Ear, Eye, Nose, Throat

deepening of voice (most frequent)

Cardiovascular

edema (most frequent)

Gastrointestinal

hepatitis (cholestatic jaundice)

Genitourinary

amenorrhea
clitoral enlargement
testicular atrophy

Dermatologic

acne (most frequent)
hirsutism (most frequent)
oiliness (most frequent)

Endocrinologic

amenorrhea (most frequent)
anovulation (most frequent)
↓ breast size (women) (most frequent)
↓ libido

Metabolic

weight gain (most frequent)

Interactions

Drug-Drug interaction

May potentiate warfarin, oral hypoglycemic agents, insulins, or corticosteroids.May ↑ cyclosporine or carbamazepine levels and risk of toxicity.May ↑ the requirement for insulin in patients with diabetes.↑ risk of myopathy or rhabdomyolysis with HMG Co-A reductase inhibitors

Route/Dosage

Oral (Adults and Adolescents) Endometriosis—400 mg twice daily (for milder cases may initiate therapy with 100–200 mg twice daily). Fibrocystic breast disease—50–200 mg twice daily.Hereditary angioedema—200 mg 2–3 times daily. Attempt to ↓ dosage by 50% or less q 1–3 mo. If acute attack occurs, ↑ dose by up to 200 mg/day.

Availability

Capsules: 50 mg, 100 mg, 200 mg

Nursing implications

Nursing assessment

Endometriosis: Assess endometrial pain before and periodically throughout therapy.
Fibrocystic Breast Disease: Assess breast pain, tenderness, and nodules before and monthly throughout therapy. To rule out carcinoma, mammography or cyst biopsy is recommended before and during treatment if nodules persist or enlarge.
Hereditary Angioedema: Monitor for edematous attacks throughout therapy, especially during dosage adjustments.
Lab Test Considerations: Monitor liver function tests periodically throughout therapy.
- Semen volume and viscosity, sperm count, and motility determinations are recommended every 3–4 mo during treatment for hereditary angioedema, especially in adolescents.
- May alter results of glucose tolerance or thyroid function tests. May also cause ↑ serum glucose and low-density lipoprotein concentrations and ↓ high-density lipoprotein concentrations.

Potential Nursing Diagnoses

Sexual dysfunction (Side Effects)
Disturbed body image (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

In patients with endometriosis or fibrocystic breast disease, therapy should be started during menstruation or preceded by a pregnancy test. Advise patient to notify health care professional immediately if pregnancy is suspected.
Oral: Medication may be administered with meals to minimize GI irritation.

Patient/Family Teaching

Instruct patient to take medication exactly as directed. Take missed doses as soon as remembered, if not almost time for next dose; do not double doses.
- Advise patient to notify health care professional if masculinizing effects occur (abnormal growth of facial hair or other body hair, deepening of the voice).
- Advise patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
- Advise patient to use a nonhormonal form of contraception during therapy. Inform patient that amenorrhea is expected with higher doses. Instruct patient to notify health care professional if regular menstruation does not occur within 60–90 days after discontinuation of therapy or if pregnancy is suspected.
- Emphasize the importance of routine visits to health care professional to check progress during therapy.
Fibrocystic Breast Disease: Teach patient the correct technique for monthly breast self-exam. Instruct patient to report increase in size of nodules to health care professional promptly.

Evaluation/Desired Outcomes

Decrease in symptoms of endometriosis. Therapy for endometriosis usually requires 3–6 mo and may extend to 9 mo to decrease symptoms.
Relief of pain and tenderness in fibrocystic breast disease, which is usually relieved by the first month and eliminated in 2–3 mo. Elimination of nodularity usually requires 4–6 mo.
Resolution of signs and symptoms of hereditary angioedema. Initial response in hereditary angioedema may require 1–3 mo of therapy; efforts should be made to decrease dose at 1–3-mo intervals.

Danocrine

A brand name for DANAZOLE.