Pregnancy, lactation, liver disease, history of jaundice or persistent pruritus during pregnancy, history of herpes during pregnancy, Dubin-Johnson syndrome, Rotor syndrome, pre-existing or existing liver tumor (not due to metastatic prostate cancer), wasting disease (except inoperable prostate cancer), severe chronic depression, previous or existing thromboembolic condition, severe diabetes mellitus with vascular changes, sickle cell anemia is contraindicated. Patients with prostate cancer who have a history of thromboembolism, sickle cell anemia, or severe diabetes mellitus with vascular changes must carefully weigh the pros and cons of each case before using this drug.
It should be used with caution in patients with occupations requiring a high degree of concentration (e.g., drivers, machine operators), as this drug can cause fatigue, loss of energy, and may also affect the ability to concentrate.
The libido-reducing effect of the drug can be attenuated under the influence of the anti-inhibitory effect of alcohol.
The drug should not be given before the end of puberty, since its adverse effects on physical growth, as well as on the axis of endocrine function, which is not yet unstable, cannot be ruled out.
During treatment, liver function, adrenal function, and red blood cell count should be checked regularly. Use with caution in diabetic patients, as the need for oral antidiabetic drugs or insulin may vary. As with other steroidal hormones, benign and malignant liver changes have been reported in individual cases. In rare cases, liver tumors can cause life-threatening intra-abdominal bleeding. Therefore, when abnormal epigastric discomfort occurs and does not disappear on its own in a short period of time, appropriate diagnosis and treatment should be carried out.
A thorough general and gynecologic examination (including breast and cervical cytology smears) should be performed before treatment is initiated. Women of childbearing potential must rule out pregnancy. If a small amount of irregular bleeding occurs within 3 weeks of taking the drug during combination therapy, the drug should not be stopped. However, if there is excessive bleeding, necessary tests should be done.
from Bayer,2021.05
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