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Overview: Natesto is used to treat low testosterone levels in men caused by certain conditions. It is a nasal gel that is applied inside the nose. Common side effects include nasal symptoms (such as runny nose, nosebleeds, or nose discomfort), headache, and changes in certain lab test results. Serious side effects may include blood clots, liver damage, and an increased risk of prostate cancer.

Uses

What is Natesto used for?

Natesto (testosterone) is commonly used to treat low testosterone levels in men caused by certain conditions, such as hypogonadism.

Natesto may also be used for other conditions as determined by your health care provider.

How does Natesto work (mechanism of action)?

Natesto contains testosterone, a sex hormone that is made naturally in the body. It is a type of testosterone replacement therapy or TRT. Natesto works by adding more testosterone to a person’s body to help them achieve normal levels.

How is Natesto supplied (dosage forms)?

Brands and other names

  • Natesto

Dosage forms and strengths

  • 5.5 mg/actuation metered-dose pump nasal gel

See also: Testosterone and Testosterone topical

How should I store Natesto?

Natesto should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. 

Side Effects

What are the most common side effects of Natesto?

The most common side effects of Natesto are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Increase in prostate-specific antigen (PSA) levels
  • Headache
  • Nasal reactions, including runny nose, nosebleeds, scabbing, and discomfort (see below)
  • Infection in the nose or throat, sore throat, or common cold symptoms
  • Inflammation in the airways in the lungs (bronchitis)
  • Sinus infection

There may be other side effects of Natesto that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of Natesto?

While less common, the most serious side effects of Natesto are described below, along with what to do if they happen.

Severe Allergic Reactions. Natesto may cause allergic reactions, which can be serious. Stop using Natesto and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Nasal Reactions. Natesto can cause nasal side effects, including runny nose or congestion, nosebleeds, scabbing, dryness, and discomfort. These side effects are usually mild but can sometimes be severe. Tell your health care provider if you have any nasal side effects while using Natesto.

Prostate Cancer. Natesto may increase your risk of prostate cancer. Keep all appointments with your health care provider so they can monitor you while you are using Natesto.

Increased Red Blood Cell Levels. Natesto may increase the levels of red blood cells, also called erythrocytosis or polycythemia. This can increase hemoglobin levels in your blood. In severe cases, it may increase your risk for blood clots. Tell your health care provider right away if you have any of the following symptoms of erythrocytosis or polycythemia.

  • Blurred vision
  • Headaches
  • Confusion 
  • Itching 
  • Weakness or tiredness

Blood Clots. Natesto may increase the risk of blood clots in your veins and could cause a venous thromboembolism, including a blood clot in the lungs (pulmonary embolism) or deep vein thrombosis (DVT). Stop using Natesto and get emergency help if you have any of the following signs of blood clots. 

  • Chest pain or pressure
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, jaw, throat, or arm
  • Sweating, upset stomach, vomiting, or dizziness
  • Sudden weakness on one side of your body
  • Sudden and severe headache
  • Slurred speech or trouble understanding speech
  • Pain, swelling, or tenderness in your arm or leg
  • Vision loss
  • Bulging eyes 
  • Double vision

Risk of Misuse. Misusing Natesto can lead to serious side effects, such as heart problems or mental health problems. Misuse means using a medicine in a way other than how it was prescribed or using too much. Use Natesto exactly as prescribed. Call your health care provider right away or go to the nearest emergency room if you have any of the following serious symptoms.

  • Chest pain or pressure or trouble breathing
  • Depression
  • Extreme energy and behavior (mania)
  • Having a hard time knowing what is real and what is imaginary (delusions)
  • Feeling paranoid or aggressive

Decreased Sperm Count. Natesto may lower your sperm count. Talk to your health care provider if this is a concern for you.

Liver Damage. Liver damage, also called hepatotoxicity, can happen when using testosterone-containing medicines, such as Natesto. Call your health care provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Fluid Retention (Edema). Natesto can cause fluid retention, also called edema. Fluid retention can cause serious issues in people with certain conditions, such as heart failure or kidney problems. Call your health care provider right away if you have any of the following symptoms. 

  • Chest pain
  • Irregular heartbeat
  • Shortness of breath
  • Stretched or shiny skin
  • Swollen body parts, such as the belly or ankles

Enlarged Breasts. Natesto may cause enlarged breasts in men (gynecomastia) that could be painful. Tell your health care provider if you have this symptom or if it is a concern for you.

Changes in Lipid (Fat) Levels. Natesto can cause changes in the lipid (fat) levels in your blood, including cholesterol. Keep all appointments with your health care provider to have your blood checked. 

Sleep Apnea. Natesto may increase your risk of sleep apnea, which is a condition where breathing stops and starts again while sleeping. You may be at a higher risk of sleep apnea if you have obesity or lung problems, such as asthma or chronic obstructive pulmonary disease (COPD). Tell your health care provider if you or your bed partner notices that you have symptoms such as snoring, sleepiness during the day, restless sleeping, or waking up suddenly after gasping or choking.

Increased Blood Pressure (Hypertension). Natesto may increase your blood pressure or make it worse if you have a history of high blood pressure. This may increase your risk of a heart attack or stroke over time. Call your health care provider if your blood pressure increases while using this medicine.

If you measure your blood pressure and the top number (systolic) is 180 or higher or the bottom number (diastolic) is 120 or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for and tell your health care provider right away if you have any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea or vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heartbeats

Warnings & Precautions

Who should not use Natesto?

Allergies to Ingredients. People who are allergic to any of the following should not use Natesto.

  • Natesto
  • Testosterone
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in Natesto.

Certain Types of Cancer. Natesto should not be used if you have or might have breast or prostate cancer.

Pregnancy. Do not use Natesto if you are pregnant or may become pregnant. If you become pregnant, contact your health care provider right away. See the Pregnancy section for more details.

Breastfeeding. Do not use Natesto if you are breastfeeding. You must either stop breastfeeding or stop Natesto. See the Breastfeeding section for more details.

What should I know about Natesto before using it?

Do not use Natesto unless it has been prescribed to you by a health care provider. Use it as prescribed.

Do not share Natesto with other people, even if they have the same condition as you. It may harm them.

Keep Natesto out of the reach of children. Natesto is a controlled substance because it can be misused or lead to dependence. Store Natesto in a safe place to protect it from theft. It is illegal to sell or give away this medicine.

This medicine is applied into your nose using a special pump. Read and follow the instructions for Natesto and make sure that you or a caregiver understand how to properly prepare, use, and throw it away. If you have any questions, talk to your health care provider.

Blow your nose before using Natesto. After using it, do not blow your nose or sniff for one hour.

If you get any Natesto on your hands, wash them with warm water and soap.

Ask your pharmacist or another health care provider before using any other products in your nose, such as over-the-counter (OTC) nasal sprays. Some nasal sprays should not be used with Natesto.

People who are 65 and older can be at greater risk of some side effects from Natesto. Talk to your health care provider about your risks if you are in this age group.

Keep all appointments with your health care provider, including for blood tests, blood pressure checks, and other tests, before starting and while you are using Natesto. This will help your health care provider make sure it is safe for you to use Natesto. 

What should I tell my health care provider before using Natesto?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if Natesto is right for you.

In particular, make sure that you discuss any of the following.

Benign Prostatic Hyperplasia (BPH). Tell your health care provider if you have an enlarged prostate or BPH. Natesto can worsen symptoms of BPH or may increase the risk of prostate cancer. Tell your health care provider if you have any worsening prostate symptoms, such as having a hard time peeing or a weak flow, more frequent peeing, or an urgent need to pee. 

Other Current and Past Health Conditions. Tell your health care provider if you have any of the following.

Other Medicines and Supplements. Natesto may interact with other medicines and supplements. Before using Natesto, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. People who can become pregnant are not usually prescribed Natesto. Natesto may cause harm to a fetus.

Breastfeeding. People who can breastfeed are not usually prescribed Natesto. Natesto may cause harm to a breastfed baby.

How can I get more information about Natesto?

For more information about Natesto, you can visit the drugmaker’s website at www.natesto.com or call them at 833-698-3786.

Interactions

Does Natesto interact with foods or drinks?

There are no known interactions between Natesto and foods or drinks.

It is unknown if drinking alcohol will affect Natesto.

Does Natesto interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using Natesto.

  • Insulin, which is a medicine used for diabetes
  • A blood thinner, such as warfarin, which is a medicine used to treat or prevent blood clots
  • A corticosteroid, such as dexamethasone, methylprednisolone, or prednisone, which is a medicine for certain inflammatory conditions
  • Any other medicine applied in your nose

This may not be a complete list of medicines that can interact with Natesto. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much Natesto?

If you or someone else has used too much Natesto, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of Natesto?

If you miss a dose, use it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only use the next dose. Do not use double or extra doses.