It is unknown whether bicalutamide is excreted in breast milk, but many drugs are excreted in breast milk, and for this reason, bicalutamide treatment is similarly not recommended while breastfeeding.In individuals with severe, though not mild-to-moderate hepatic impairment, there is evidence that the elimination of bicalutamide is slowed, and hence, caution may be warranted in these patients as circulating levels of bicalutamide may be increased. In severe hepatic impairment, the elimination half-life of the active (R)-enantiomer of bicalutamide is increased by about 1.75-fold (76% increase; elimination half-life of 5.9 and 10.4 days for normal and impaired patients, respectively). The elimination half-life of bicalutamide is unchanged in renal impairment. Side effects
The side effect profile of bicalutamide is highly dependent on sex; that is, on whether the person is male or female. In men, due to androgen deprivation, a variety of side effects of varying severity may occur during bicalutamide treatment, with breast pain/tenderness and gynecomastia (breast development/enlargement) being the most common. Gynecomastia occurs in up to 80% of men treated with bicalutamide monotherapy, though is of only mild-to-moderate severity in more than 90% of affected men. In addition to breast changes, physical feminization and demasculinization in general, including reduced body hair growth, decreased muscle mass and strength, feminine changes in fat mass and distribution, reduced penile length, and decreased semen/ejaculate volume, may occur in men.
Prevention is by general hygiene measures.It is uncommon. It generally occurs in tropical and subtropical countries of Central and South America, the Caribbean, Europe, South East Asia, Australia and the Far East. The disease was first described by Alexandre Cerqueira from Brazil in 1891. No cases in animals have been reported. Causes
This infection is caused by the fungus formerly classified as Cladosporium werneckii, but more recently classified as Hortaea werneckii. The causative organism has also been described as Phaeoannellomyces werneckii. Tinea nigra is extremely superficial and can be removed from the skin by forceful scraping. It tends to appear in areas where eccrine sweat glands are highly concentrated. Infections generally start to appear on the skin around 2–7 weeks post inoculation. The ability of H. werneckii to tolerate high salt concentrations and acidic conditions allows it to flourish inside the stratum corneum. H. wernickii tends remain localized in one spot or region, and produces darkly-colored, brown macules on the skin due to the production of a melanin-like substance. Diagnosis
Diagnosis of tinea nigra is made based on microscopic examination of stratum corneum skin scrapings obtained by using a scalpel. The scrapings are mixed with potassium hydroxide (KOH). The KOH lyses the nonfungal debris. The skin scrapings are cultured on Sabourauds agar at 25°C and allowed to grow for about a week. H. werneckii can generally be distinguished due to its two-celled yeast form and the presence of septate hyphae with thick, darkly pigmented walls.