Flutamide is a non-steroidal anti-androgenic
drug, commonly used in the treatment of advanced
prostate cancer,
acne and
hirsutism. This
drug may induce various degrees of liver injury, including
acute liver failure (ALF), with further need for
liver transplantation. Here, we present a report of 10 consecutive patients seen in a period of 14 years, with acute liver toxicity induced by
flutamide (in most cases severe hepatotoxicity): 3 men and 7 women, with a mean age of 75 and 29 years old, respectively. All men received
flutamide as treatment of advanced prostate
carcinoma and they developed hepatotoxicity without ALF, and three months after withdrawal of the
drug, they recovered completely. In contrast, in 7 young female with liver toxicity caused by
flutamide as treatment of various hyperandrogenic conditions (
acne and
hirsutism), ALF was observed in 5 patients, all of them requiring urgent
liver transplantation, with excellent outcome and survival in 4 of them. Based on the above, we believe that
flutamide treatment should be preferentially avoided in young female patients with benign pathologies, or if it is used, patients should be warned of its potential severe complications. Also, serial liver tests should be closely monitored and, in case of elevations, the
drug should be immediately withdrawn.