Medical Editor: John P. Cunha, DO, FACOEP
Aveed (testosterone undecanoate) Injection is a form of the male hormone, testosterone, used for testosterone replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone. Common side effects of Aveed include acne, injection site pain or other reactions, PSA (prostate-specific antigen) increase, increased estradiol level, low testosterone levels, fatigue, feeling tired, irritability, increased red blood cell count, difficulty sleeping (insomnia), mood swings, aggression, difficulty ejaculating, and weight gain.
The recommended dose of Aveed is 3 mL (750 mg) injected intramuscularly, followed by 3 mL (750 mg) injected after 4 weeks, then 3 mL (750 mg) injected every 10 weeks thereafter. Aveed may interact with insulin, anticoagulants, and corticosteroids. Tell your doctor all medications and supplements you use. Aveed is not recommended for use in women, therefore it is unlikely to be used during pregnancy or while breastfeeding. Withdrawal symptoms may occur if you stop taking this medication.
Our Aveed (testosterone undecanoate) Injection Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Clinical Trial Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
Aveed was evaluated in an 84-week clinical study using a dose regimen of 750 mg (3 mL) at initiation, at 4 weeks, and every 10 weeks thereafter in 153 hypogonadal men. The most commonly reported adverse reactions (>2%) were: acne (5.2%), injection site pain (4.6%), prostate specific antigen increased (4.6%), hypogonadism (2.6%) and estradiol increased (2.6%).
Table 1 presents adverse reactions reported by ≥1% of patients in the 84-week clinical study.
Table 1: Adverse Reactions Reported in at Least 1% of
Patients in the 84-Week Clinical Study of Aveed
|MedDRA Preferred Term||Number of patients (%)|
|Aveed 750 mg (N=153)|
|Injection site pain||7 (4.6%)|
|Prostatic specific antigen increased*||7 (4.6%)|
|Estradiol increased||4 (2.6%)|
|Hemoglobin increased||3 (2%)|
|Mood swings||3 (2%)|
|Ejaculation disorder||2 (1.3%)|
|Injection site erythema||2 (1.3%)|
|Hematocrit increased||2 (1.3%)|
|Prostate Cancer||2 (1.3%)|
|Prostate induration||2 (1.3%)|
|Weight increased||2 (1.3%)|
|*Prostate-specific antigen increased defined as a serum PSA concentration >4 ng/mL.|
In the 84-week clinical trial, 7 patients (4.6%) discontinued treatment because of adverse reactions. Adverse reactions leading to discontinuation included: hematocrit increased, estradiol increased, prostatic specific antigen increased, prostate cancer, mood swings, prostatic dysplasia, acne, and deep vein thrombosis.
During the 84-week clinical trial, the average serum PSA increased from 1.0 ± 0.8 ng/mL at baseline to 1.5 ± 1.3 ng/mL at the end of study. Fourteen (14) patients (10.9%) in whom the baseline PSA was < 4 ng/mL had a post-baseline serum PSA of > 4 ng/mL during the 84-week treatment period.
A total of 725 hypogonadal men received intramuscular testosterone undecanoate in a total of 7 controlled clinical trials. In these clinical trials, the dose and dose frequency of intramuscular testosterone undecanoate varied from 750 mg to 1000 mg, and from every 9 weeks to every 14 weeks. Several of these clinical trials incorporated additional doses upon initiation of therapy (eg, loading doses). In addition to those adverse reactions noted in Table 1, the following adverse events were reported by at least 3% of patients in these trials, irrespective of the investigator's assessment of relationship to study medication: sinusitis, prostatitis, arthralgia, nasopharyngitis, upper respiratory tract infection, bronchitis, back pain, hypertension, diarrhea and headache.
Pulmonary Oil Microembolism (POME) And Anaphylaxis In Controlled Clinical Studies
Adverse events attributable to pulmonary oil microembolism and anaphylaxis were reported in a small number of patients in controlled clinical trials. In the 84-week clinical trial of Aveed, 1 patient experienced a mild coughing fit lasting 10 minutes after his third injection, which was retrospectively attributed to POME. In another clinical trial of intramuscular testosterone undecanoate (1000 mg), a hypogonadal male patient experienced the urge to cough and respiratory distress at 1 minute after his tenth injection, which was also retrospectively attributed to POME.
During a review that involved adjudication of all cases meeting specific criteria, 9 POME events in 8 patients and 2 events of anaphylaxis among 3,556 patients treated with intramuscular testosterone undecanoate in 18 clinical trials were judged to have occurred.
The following adverse reactions have been identified during post-approval use of Aveed. Because the reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Pulmonary Oil Microembolism (POME) And Anaphylaxis
Serious pulmonary oil microembolism (POME) reactions, involving cough, urge to cough, dyspnea, hyperhidrosis, throat tightening, chest pain, dizziness, and syncope, have been reported to occur during or immediately after the injection of intramuscular testosterone undecanoate 1000 mg (4 mL) in post-approval use outside the United States. The majority of these events lasted a few minutes and resolved with supportive measures; however, some lasted up to several hours and some required emergency care and/or hospitalization.
In addition to serious POME reactions, episodes of anaphylaxis, including life-threatening reactions, have also been reported to occur following the injection of intramuscular testosterone undecanoate in post-approval use outside of the United States.
Both serious POME reactions and anaphylaxis have been reported to occur after any injection of testosterone undecanoate during the course of therapy, including after the first dose.
The following treatment emergent adverse events or adverse reactions have been identified during post-marketing clinical trials and during post-approval use of intramuscular testosterone undecanoate. In most cases, the dose being used was 1000 mg.
Ear and Labyrinth Disorders: sudden hearing loss, tinnitus
Gastrointestinal Disorders: abdominal pain upper, diarrhea, vomiting
General Disorders and Administrative Site Conditions: chest pain, edema peripheral, injection site discomfort, injection site hematoma, injection site irritation, injection site pain, injection site reaction, malaise, paresthesia, procedural pain
Infections and Infestations: injection site abscess, prostate infection
Investigations: alanine aminotransferase increased, aspartate aminotransferase increased, blood bilirubin increased, blood glucose increased, blood pressure increased, blood prolactin increased, blood testosterone decreased, blood testosterone increased, blood triglycerides increased, gamma-glutamyltransferase increased, hematocrit increased, intraocular pressure increased, liver function test abnormal, prostate examination abnormal, prostatic specific antigen increased, transaminases increased
Reproductive System and Breast Disorders: azoospermia, benign prostatic hyperplasia, breast induration, breast pain, erectile dysfunction, gynecomastia, libido decreased, libido increased, prostate induration, prostatitis, spermatocele, testicular pain
Read the entire FDA prescribing information for Aveed (Testosterone Undecanoate Injection)