Xtandi vs. Nilutamide for Prostate Cancer: Important Differences and Potential Risks.

Key takeaways

Xtandi (enzalutamide) and nilutamide (Nilandron) are both oral medications used to treat metastatic prostate cancer, but they have some differences. Both medications are taken by mouth once a day, but nilutamide is typically only taken for a few weeks after starting a LHRH agonist. Common side effects while on Xtandi are weakness and back pain, while those taking nilutamide commonly experience hot flashes, difficulty with night vision, and nausea. Xtandi can increase the risk of seizures and heart problems, whereas nilutamide has the risk of serious liver and lung problems. While Xtandi is only available as a brand-name medication, nilutamide is available as a lower-cost generic option.

Xtandi

(enzalutamide)

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Nilutamide

(Nilandron)

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Summary for Xtandi

Prescription only

Xtandi (enzalutamide) is a prescription cancer medication used to treat certain types of prostate cancer in adults. It works by blocking testosterone, a hormone that many prostate cancers need to grow. You usually take a tablet or capsule once a day by mouth, often along with other hormone treatments or after surgery to remove the testicles. Common side effects include weakness or fatigue, back pain, and hot flashes.

Indications for Xtandi

Prostate cancer that's castration-resistant
Metastatic prostate cancer that's hormone-sensitive
Non-metastatic prostate cancer that's hormone-sensitive, with a high risk of spreading

Pros and Cons for Xtandi

Pros

Pill that’s taken by mouth once a day
Can take with or without food
Recommended option for certain types of prostate cancer

Cons

Interacts with many medications
Can raise your risk for seizures and fractures
Requires regular blood tests and monitoring

Common Side Effects for Xtandi

Muscle and joint pain
Feeling more tired than usual
Hot flashes
Constipation
Reduced appetite
Diarrhea
High blood pressure
Bleeding problems
Falls
Bone fractures
Headache

Warnings for Xtandi

Seizures
Brain problem
Allergic reaction
Heart problems
Falls and fractures
Possible harm to unborn baby
Choking and trouble swallowing

Summary for Nilutamide

Prescription only

Nilutamide (Nilandron) is taken by mouth and used to treat metastatic prostate cancer, meaning cancer that has spread to other parts of the body. It’s a form of hormonal therapy called an androgen receptor inhibitor or antiandrogen, that works to block testosterone in your body. Nilutamide (Nilandron) is one of the recommended options for prostate cancer and is taken once a day. It can cause hot flashes and make it difficult for your eyes to adjust at night, which can be bothersome.

Indications for Nilutamide

Metastatic prostate cancer

Pros and Cons for Nilutamide

Pros

Oral pill
Taken once daily
One of the recommended options for metastatic prostate cancer
Available as a lower-cost generic medication

Cons

Can cause hot flashes, which can be unpleasant
Your eyes might start having problems adjusting to light
Can cause liver or breathing problems

Common Side Effects for Nilutamide

Side effects experienced by people who took nilutamide (Nilandron) after surgical castration:

Hot flashes (28%)
Difficulty of eyes adjusting to dark (13%)
Nausea (10%)
Pain or burning while urinating, needing to urinate more often, and other symptoms of a urinary tract infection (8%)

Side effects experienced by people who took nilutamide (Nilandron) with leuprolide (a LHRH agonist):