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Anabolic Steroid — Burns Hypermetabolism Pregnancy: Contraindicated — androgenic effects on fetus

Oxandrolone

Brand names: Oxandrin, Anavar

Adult dose

Dose: 10–20 mg/day in divided doses
Route: Oral
Frequency: Twice daily
Max: 20 mg/day
Used for major burns (>30% TBSA) to attenuate hypermetabolic response and preserve lean body mass. Typically continued for up to 12 months post-burn. Accelerates wound healing and rehabilitation. Requires endocrine monitoring. Controlled drug (Class C, Schedule 4 Part 2 in UK).

Paediatric dose

Dose: 0.1 mg/day/kg
Route: Oral
Frequency: Twice daily
Max: 10 mg/day
Paediatric major burns: 0.1 mg/kg/day in two divided doses under specialist guidance. Monitor bone age and growth in children.

Dose adjustments

Renal

Use with caution in renal impairment — fluid retention risk.

Hepatic

Contraindicated in significant hepatic impairment — hepatotoxic. LFTs mandatory.

Paediatric weight-based calculator

Paediatric major burns: 0.1 mg/kg/day in two divided doses under specialist guidance. Monitor bone age and growth in children.

Clinical pearls

  • Galveston RCTs (Herndon et al.): oxandrolone significantly reduces length of hospital stay, preserves lean body mass, improves donor site healing, and reduces mortality in paediatric major burns
  • Combined with propranolol for maximal attenuation of hypermetabolic response
  • Controlled drug in UK — requires CD prescription; only available from specialist burns units

Contraindications

  • Prostate carcinoma
  • Breast carcinoma
  • Pregnancy
  • Severe hepatic impairment
  • Nephrotic syndrome
  • Hypercalcaemia

Side effects

  • Virilisation in females (voice deepening, hirsutism, clitoral enlargement)
  • Hepatotoxicity (cholestatic jaundice, peliosis hepatis)
  • Premature epiphyseal closure in children
  • Polycythaemia
  • Dyslipidaemia (reduced HDL)
  • Fluid retention

Interactions

  • Warfarin (significantly potentiates anticoagulant effect — reduce warfarin dose and monitor INR closely)
  • Insulin/antidiabetics (anabolic steroids improve glucose tolerance — reduce dose)
  • Ciclosporin (increased plasma levels)

Monitoring

  • LFTs every 3 months
  • INR if on warfarin
  • Haematocrit (polycythaemia)
  • Bone age (children — X-ray wrist every 6 months)
  • Lipid profile
  • Virilisation signs in females

Reference: BNFc; BNF 90; Herndon et al. Ann Surg (2009) — Oxandrolone in Burns; BBA Major Burns Management Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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