bicalutamide
Bicalutamide (Casodex) is a hormonal therapy known as an androgen receptor inhibitor or antiandrogen. It treats prostate cancer by blocking testosterone in the body. While it's FDA-approved to treat metastatic prostate cancer, it's also one of the recommended options (off-label) for early-stage prostate cancer as well. Bicalutamide (Casodex) is taken by mouth once a day. Usually, people also need to take another medication called luteinizing hormone-releasing hormone (LHRH) agonist during treatment. Some of the more common side effects of bicalutamide (Casodex) include hot flashes, pain, and weakness.
What is Bicalutamide (Casodex)?
What is Bicalutamide (Casodex) used for?
Metastatic prostate cancer
How Bicalutamide (Casodex) works
Most prostate cancer cells need testosterone to grow and spread. Testosterone is a type of male sex hormone called an androgen.
Bicalutamide (Casodex) is an androgen receptor inhibitor (antiandrogen), a type of hormone therapy that works by blocking testosterone from binding to prostate cancer cells. Without testosterone, cancer cells won’t have the "fuel" they need to spread.
Drug Facts
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What are the side effects of Bicalutamide (Casodex)?
Common Side Effects
- Hot flashes (53%)
- Whole body pain (35%)
- Back pain (25%)
- Weakness (22%)
- Constipation (22%)
- Pelvic (area below your belly and above your legs) pain (21%)
- Infection (18%)
- Nausea (15%)
- Swelling in arms or legs (13%)
- Difficulty breathing (13%)
- Urinating a lot at night (12%)
- Blood in the urine (12%)
- Diarrhea (12%)
- Stomach pain (11%)
- Dizziness (10%)
Other Side Effects
- Rash
- Bone pain
- Cough
- Pain while urinating and other symptoms of a urinary tract infection
- Breast enlargement or tenderness
- Feeling of “pins and needles”
- Weight loss
- Heartburn
- Chest pain
- Headache
- Flu-like symptoms
Serious Side Effects
- Severe liver problems: yellowing of the skin or eyes (jaundice), dark urine, right upper stomach pain, nausea, vomiting, tiredness, loss of appetite, chills, fever
- Serious bleeds: bleeding or bruising that doesn’t stop or go away, large amount of bleeding, blood in the urine, throwing up blood, bloody or black and tarry stools
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Bloating or swelling of the face, arms, hands, lower legs, or feet
blood in the urine
blurred vision
body aches or pain
chills
congestion
cough producing mucus
difficult or labored breathing
dizziness
dryness or soreness of the throat
headache
hoarseness
lower back or side pain
nervousness
painful or difficult urination
pounding in the ears
rapid weight gain
slow or fast heartbeat
sweating
tender, swollen glands in the neck
tightness in the chest
tingling of the hands or feet
trouble with swallowing
unusual weight gain or loss
voice changes
Less common
Abnormal growth filled with fluid or semisolid material
ankle, knee, or great toe joint pain
arm, back, or jaw pain
bleeding from the rectum or bloody stools
blindness
bloody nose
burning feeling while urinating
burning, tingling, numbness, or pain in the hands, arms, feet, or legs
change in bowel habits
chest pain, discomfort, tightness or heaviness
confusion
decrease in frequency of urination
decrease in urine volume
decreased vision
difficulty in passing urine (dribbling)
difficulty with swallowing or eating
dilated neck veins
fainting
irregular breathing or heartbeat
joint stiffness or swelling
lightheadedness
loss of appetite
lump or swelling in the abdomen or stomach
no blood pressure or pulse
noisy breathing
pain or discomfort in the arms, jaw, back, or neck
painful blisters on the trunk of the body
persistent, non-healing sore
rapid, shallow breathing
reddish patch or irritated area
sensation of pins and needles
shiny bump
stabbing pain
stomach discomfort
stopping of the heart
sunken eyes
thirst
tumor
unconsciousness
unexplained weight loss
unusual tiredness or weakness
vomiting
white, yellow, or waxy scar-like area
wrinkled skin
yellow skin or eyes
Incidence not known
Bleeding gums
coughing up blood
hives or welts, itching, skin rash
increased menstrual flow or vaginal bleeding
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
paralysis
prolonged bleeding from cuts
red or black, tarry stools
red or dark brown urine
redness of the skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Belching
breast pain
decreased interest in sexual intercourse
difficulty with moving
hair loss or thinning of the hair
inability to have or keep an erection
indigestion
leg cramps
loss in sexual ability, desire, drive, or performance
loss of strength or energy
muscle ache, cramp, pain, or weakness
pain in the pelvis
pain or tenderness around the eyes and cheekbones
passing of gas
sleepiness or unusual drowsiness
stomach pain or fullness
stuffy or runny nose
swelling of the breasts or breast soreness in both females and males
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Bicalutamide (Casodex)
Pros
Taken once daily, so more convenient
One of the recommended options for metastatic prostate cancer
Available as a generic medication
Cons
Can cause hot flashes, which can be unpleasant
Can cause liver problems
Can raise your risk for bleeds if you're taking a blood thinner called warfarin (Coumadin)
Pharmacist tips for Bicalutamide (Casodex)
Bicalutamide (Casodex) can be taken with or without food. It doesn’t matter what time of the day you take it, as long as you take it around the same time each day.
Typically, you should be taking bicalutamide (Casodex) together with another medication called a LHRH agonist. Bicalutamide (Casodex) isn’t usually taken by itself to treat prostate cancer, so check with your provider if you don't have a prescription for a LHRH agonist. Don’t stop taking these medications without talking to your healthcare provider first.
Taking bicalutamide (Casodex) can cause you to be more sensitive to the sun and UV rays. Avoid direct exposure to the sun and tanning beds. If you’re going to be outside, be sure to wear sunscreen with at least SPF 15 and protective clothing like long sleeves, pants, hats, and sunglasses.
Don’t drive, operate heavy machinery, or do any activities that require a lot of focus and attention until you know how bicalutamide (Casodex) affects you. Bicalutamide (Casodex) can make you more sleepy.
Let your provider know if you’re taking a blood thinner called warfarin (Coumadin). Taking warfarin (Coumadin) with bicalutamide (Casodex) can raise your risk for bleeding, which can be very serious. You might have to get your labs checked more often to make sure your warfarin (Coumadin) dose is right for you.
If your partner is able to become pregnant, use condoms or other appropriate forms of birth control, while you’re taking bicalutamide (Casodex). Continue to do so for about 4 and a half months after your last dose. It’s possible for bicalutamide (Casodex) to cause birth defects in female partners of males who are taking this medication. Talk with your provider if you have questions about birth control options for you and your partner.
Ask your healthcare provider or pharmacist about the best way to handle and dispose of this anticancer medication. These medications can be very harmful to people who handle or come into contact with them, so you need to get rid of them safely.
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What are the risks and warnings for Bicalutamide (Casodex)?
Bicalutamide (Casodex) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Liver damage
Although rare, bicalutamide (Casodex) can cause serious liver damage. This usually happens within 3 to 4 months of starting treatment. Because of this risk, your provider will do blood work to monitor your liver before you start and during treatment with bicalutamide (Casodex). Let your provider know right away if you experience symptoms of liver problems, such as tiredness, loss of appetite, nausea or vomiting, dark urine, right-side stomach pain, or yellowing of the eyes or skin, because you might have to stop taking bicalutamide (Casodex).
Serious bleeding with warfarin (Coumadin)
Risk factors: Taking warfarin (Coumadin)
Bicalutamide (Casodex) can raise your risk for serious bleeds if you’re also taking the blood thinner warfarin (Coumadin).This can happen even if you were previously stable on your dose of warfarin (Coumadin). Serious bleeds can happen days to weeks after starting bicalutamide (Casodex). You might need to check your international normalized ratio (INR) more regularly to make sure your warfarin dose is right for you while you’re on bicalutamide (Casodex). Seek medical help right away if you have sudden weakness or numbness in your body, severe headache, confusion, dizziness, seizures, changes in vision, loss of balance, slurred speech, throwing up blood, or bloody or black and tarry stools. These can be signs of serious bleeds and need to be treated immediately.
Breast enlargement and tenderness
Risk factors: Taking high doses of bicalutamide (Casodex)
Bicalutamide (Casodex) can cause breast enlargement, tenderness, and pain if you take doses that are higher than what's typically recommended. Talk with your provider if you experience breast pain or tenderness.
High blood sugar
Risk factors: Diabetes | Taking LHRH agonists
When you take bicalutamide (Casodex) with LHRH agonists, your body might have a difficult time controlling your blood sugar, and this can result in high blood sugar. You and your provider should monitor your blood sugars more closely, especially if you have diabetes. If you’re taking medications to control your blood sugar, your dose might need to be adjusted depending on your blood sugar levels. Let your provider know if you become more thirsty or hungry, urinating more, or have headaches and blurry vision.
Bicalutamide (Casodex) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 50mg | 30 tablets | $22.08 | $0.74 |
Typical dosing for Bicalutamide (Casodex)
The typical dosing is 50 mg by mouth once a day.
It must be used in combination with another hormonal medication that targets luteinizing hormone-releasing hormone (LHRH).
Interactions between Bicalutamide (Casodex) and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acenocoumarol
- Domperidone
- Phenprocoumon
- Piperaquine
- Warfarin
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References
Best studies we foundAccord Healthcare Inc. (2024). Bicalutamide tablet [package insert]. DailyMed.
American Cancer Society. (2019). Chemotherapy safety.
American Cancer Society. (2023). Hormone therapy for prostate cancer.
Kumar, R. J., et al. (2005). Adverse events associated with hormonal therapy for prostate cancer. Reviews in Urology.
National Cancer Institute. (2021). Hot flashes and night sweats (PDQ®)–Patient version.
National Cancer Institute. (n.d.). Antiandrogen.
National Comprehensive Cancer Network. (2024). Advanced-stage prostate cancer.
National Comprehensive Cancer Network. (2024). Early-stage prostate cancer.
National Comprehensive Cancer Network. (2024). Survivorship care for cancer-related late and long-term effects.
Shipley, W. U., et al. (2017). Radiation with or without antiandrogen therapy in recurrent prostate cancer. The New England Journal of Medicine.
Turco, F., et al. (2023). How to improve the quality of life of patients with prostate cancer treated with hormone therapy? Research and Reports in Urology.
Ziółkowska, E., et al. (2012). The side effects of hormonal therapy at the patients with prostate cancer. Contemporary Oncology.
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