testosterone (Rx)

Replacement

Adult: IM (enanthate or cypionate) 50-400 mg q2-4 wk; transdermal (Testoderm) 4-6 mg applied q24 hr; (Androderm, AndroGel) 5 mg applied q24 hr; once daily (gel); topical sol (Axiron) 60 mg (2 pump activations) each am; BUCCAL 1 buccal system (30 mg) to the gum region q12 hr before meals/pm Adult (male) and child: SUBCUT (pellets) 150-450 mg (2-6 pellets) inserted q3-6 mo Breast cancer

Adult: IM 50-100 mg 3 3/wk (propionate) or 200-400 mg q2-4 wk (cypionate or enanthate) Delayed male puberty Child >12 yr: IM up to 100 mg/mo for up to 6 mo

Enanthate: inj 200 mg/ml; cypionate: inj 100, 200 mg/ml; pellets 75 mg; transdermal 2, 4 mg/24 hr; gel 1%, 1.62%, 10 mg/actuation; buccal system 30 mg; topical solution 30 mg/actuation

Implementation - Administer diet with increased calories, protein; decreased sodium if edema occurs - Administer supportive product if anemia occurs - Give titrated dose; use lowest effective dose - Give IM inj deep into upper outer quadrant of gluteal muscle; route can be painful Transdermal route - Apply Testoderm to skin of scrotum, Androderm to skin of back, upper arms, thighs, abdomen; area must be clean and dry, free of hair Gel route - Products are not interchangeable, dosage and administration for AndroGel 1% differs from AndroGel 1.62% - Apply daily to clean dry area on shoulders, upper arms, or abdomen; women, children should not touch gel or treated skin Buccal system route - Do not chew or swallow buccal system - Rotate sites; place above incisor tooth on either side of mouth - Open packet; place rounded side of surface against gum and hold firmly in place with finger over lip for 30 sec; if product falls off, replace with new system; discard in trash can away from children or pets Topical solution - Using the provided applicator, apply the solution to clean, dry, intact skin of the axilla, preferably at the same time each morning. Do not apply to any other part of the body. Allow the solution to dry completely before dressing. If an antiperspirant or deodorant is used, apply at least 2 min before applying the solution. The pump must be primed before the first use by fully depressing the pump mechanism 3 times and discarding any solution that is released during the priming. To dispense the solution, position the nozzle over the applicator cup and carefully depress the pump once fully; the cup should be filled with no more than 1 pump actuation (30 mg). With the applicator upright, place it up into the axilla and wipe steadily down and up into the axilla. Do not use fingers or hand to rub the solution. If multiple applications are necessary for the required dose, alternate application between the left and right axilla. When repeat application to the same axilla is necessary, allow the solution to dry completely before the next application. After use, rinse the applicator under running water and pat dry with tissue. Wash hands with soap and water - Following application, allow the site to dry a few minutes before putting on clothing - Direct contact of the medicated skin with the skin of another person can result in the transfer of residual testosterone and absorption by the other person. To reduce accidental transfer, the patient should cover the application site(s) with clothing (e.g., a T-shirt) after the solution has dried. The application site should be washed with soap and water prior to any skin-to-skin contact regardless of the length of time since application. In the case of direct contact, the other person should wash the area of contact with soap and water as soon as possible - Patients should be advised that the topical solution is flammable; therefore, fire, flame, and smoking should be avoided during use - Advise patients to avoid swimming or washing the application site until 2 hr following application of solution