Liver toxicity

  • Tamoxifen, Abiraterone, Fulvestrant may elevate transaminases.

    • Monitor LFT baseline + q 3 mo.

    • Hold if AST/ALT > 5× ULN or bilirubin > 3× ULN.

    • Re-challenge at 50 % dose once normalized.

Endocrine cross-effects

  • AI → ↓ estrogen → ↑ LDL, hot flushes.

  • Abiraterone → ↑ mineralocorticoids → HTN, hypokalemia.

  • Long ADT → ↑ insulin resistance + ↑ fat mass + ↓ Hb → check Hb annually.

  • Consider intermittent ADT to limit metabolic drift.

Rare events

Agent Rare effect Action
Tamoxifen Endometrial carcinoma Report post-menopausal bleeding; pelvic US q year if symptomatic
SERD Injection-site necrosis (rare) Rotate gluteal sites
GnRH antagonist Injection reaction Ice pack ± NSAID pre-dose
Abiraterone Adrenal insufficiency if prednisone stopped Re-start prednisone, monitor cortisol
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