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Flutamide is used in the management and treatment of androgen-dependent tumors like prostate cancer and conditions associated with hyperandrogenism like polycystic ovarian syndrome (PCOS). It is a prototypical drug of the anti-androgen class of medications. This activity succinctly reviews the indications, action, adverse effects and precautions, and contraindications for flutamide and related congeners as a valuable agent in treating prostate cancer, with a brief description of its use in the treatment in PCOS. Objectives: Review the mechanism of action of flutamide as an anti-androgen drug and discussing its role as a medical therapy in patients with prostate cancer and polycystic ovarian syndrome (PCOS). Summarize the current evidence regarding flutamide use, efficacy, and safety as a monotherapy and in combination therapy for its indicated purpose. Identify the other and newer congeners of this anti-androgen group, highlighting the relative advantages and shortcomings of the alternatives. Outline some interprofessional strategies that can increase the effectiveness of this drug and its congeners to improve patient outcomes and safety. Access free multiple choice questions on this topic.

There is a risk for severe hepatic injury leading to hepatic failure. There is a potential for aniline toxicity, which may cause methemoglobinemia or hemolytic anemia. The risk of cardiovascular disease may increase due to androgen deprivation.

Flutamide is indicated for the adult population only in the treatment of stage B2-C and stage D2 metastatic carcinoma of the prostate, hyperandrogenic features of PCOS, and few other indications, including idiopathic hirsutism. The drug may be prescribed by the urologist, oncologist, dermatologist, gynecologist, primary care physician, and nurse practitioner (as per the prevailing laws of the country's healthcare system). However, it is essential that all healthcare workers who prescribe flutamide be aware of the black box warning related to liver failure. Also, the prescribing physician and pharmacist must make sure that the patient is on no other concomitant hepatotoxic medication or a drug that may interfere with its metabolism leading to toxic elevation of serum levels. Thus, at every visit, the patient must be examined and the liver function evaluated. Nursing can also answer patient questions and provide counsel regarding administration and potential adverse effects. It is advised to discontinue therapy if jaundice develops or if alanine aminotransferase increased to two times the upper limit of normal.[7] Lastly, the treating health personnel should be cognizant of the management principles in case of hepatotoxicity and be aware of similar and newer congeners like bicalutamide, which have better pharmacokinetics and safety profiles. This interprofessional team approach to flutamide therapy can result in improved therapeutic results while minimizing adverse events. [Level 5]