Can I Drink Alcohol If I’m Taking Prostate Cancer Medications Like Casodex?

Prostate cancer is one of the most common types of cancer for people assigned male at birth in the U.S. It’s estimated that about 1 in every 8 people assigned male at birth will develop prostate cancer at some point during their lifetime. Thankfully, this form of cancer is very treatable, if caught early.

One group of medications used to treat prostate cancer is anti-androgen medications, also called androgen receptor antagonists. A well-known medication in this class is bicalutamide (Casodex). These medications help stop androgen hormones like testosterone from attaching to and feeding cancer cells. Depending on how advanced your cancer is, you may have to take an anti-androgen medication for a few years.

A common question people have for their healthcare providers and pharmacists when first starting any medication is whether they can safely enjoy alcoholic beverages while taking it. But before filling your glass with wine, there are some things you should be aware of when combining alcohol and anti-androgen medications.

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In this article, we’ll cover the potential risks and side effects of mixing alcohol with medications like bicalutamide.

How does alcohol affect people with prostate cancer?

There are several factors that can raise your risk of developing prostate cancer, including family history, age, and genetics. Whether alcohol use affects this risk has not been well-studied.

If you currently have prostate cancer, there is some research suggesting that drinking alcohol in moderation may be safe. One study found that drinking alcohol, particularly red wine, was linked to a lower rate of prostate cancer-related death compared to people who didn’t drink any alcohol at all. However, more studies are needed to confirm these findings.

What we can say is that drinking in moderation — no more than 2 drinks per day — is probably safe if you have prostate cancer. But it’s best to speak with your healthcare provider about alcohol use first if you have prostate cancer, so they can let you know if your risks are different. 

Can I take medications like bicalutamide with alcohol?

As mentioned above, bicalutamide is an anti-androgen medication. These medications work by blocking the effects that androgen hormones, like testosterone, have on prostate cancer cells. Since prostate cancer uses androgens to grow, blocking these hormones can sometimes be helpful in treating this type of cancer by slowing its growth.

The following are anti-androgen medications FDA-approved to treat prostate cancer:

• Bicalutamide

• Flutamide (Eulexin)

• Nilutamide (Nilandron)

• Apalutamide (Erleada)

• Darolutamide (Nubeqa)

• Enzalutamide (Xtandi)

While alcohol isn’t known to affect how anti-androgen medications work, it’s still not a good idea to combine the two. Alcohol can cause side effects that are similar to certain side effects of these medications, such as hot flashes or nausea. In some instances, alcohol can also raise your risk of serious liver-related problems. More on this below.

It’s important to note that anti-androgen medications are typically taken together with other prostate cancer medications that lower the amount of androgens the body produces. So alcohol’s effects on these other medications would also have to be considered.

Is having one or two drinks OK?

There is no level of alcohol that is deemed safe to combine with prostate cancer medications like bicalutamide. Everyone’s tolerance of both anti-androgen medications and alcohol is unique, and it can be hard to predict how much alcohol is OK to drink. It’s best to speak with your healthcare provider before drinking any alcohol with these medications.

Are certain people more at risk when combining alcohol and anti-androgen medications?

Alcohol can have different effects on everyone. These differences depend on multiple factors, including genetics, certain medications you take, and other health conditions you have. However, some people may have a higher risk of problems if they mix alcohol with medications like bicalutamide.

Older adults

Adults over age 65 tend to be more sensitive to alcohol’s effects. This is because the way our bodies digest alcohol changes as we get older. People over 65 are more likely to feel intoxicated sooner or more intensely than younger adults. Generally speaking, this puts them at a higher risk for alcohol-related drug interactions.

People with liver problems

The liver is the organ responsible for digesting alcohol in the body after you drink it. The liver is also responsible for breaking down (metabolizing) medications like bicalutamide. If your liver is not working well, your body may have a harder time metabolizing both of these substances. This puts you at a higher risk for liver damage when you combine the two.

How does alcohol interact with medications like bicalutamide?

As mentioned earlier, alcohol is not known to directly interact with anti-androgen medications. Instead, alcohol can make certain side effects worse. This can range from temporarily unpleasant to potentially dangerous effects. 

What are the typical side effects?

Many side effects caused by medications like bicalutamide are due to their ability to block testosterone throughout the body. Some of these are similar to the aftereffects of drinking alcohol.

Typical side effects of bicalutamide that could be worsened by alcohol can include: 

• Hot flashes

• Nausea

• Stomach pain

• Diarrhea

• Constipation

• Dizziness

• Weakness

• Headache

• Having to urinate more often

Are there any serious side effects or risks?

Anti-androgen medications can cause some more serious side effects. The risk that’s most concerning when mixing alcohol with these medications is the possibility of liver damage.

As discussed above, the liver is responsible for metabolizing both alcohol and medications like bicalutamide. Anti-androgen medications, especially flutamide and bicalutamide, can cause liver damage or liver failure. You will most likely have to have regular blood work done in order to monitor your liver health while taking these medications.

Because it puts extra stress on your liver, drinking alcohol can raise the risk of these serious side effects even further. Because of this, you should discuss alcohol use with your healthcare provider before drinking alcohol while taking anti-androgen medications.

When should I get medical attention?

Signs of liver damage can be hard to spot, especially when they’re mild, but you should never ignore them. Call 911 or seek immediate medical attention if you experience the following:

• Nausea and vomiting that don’t go away

• Severe right-sided stomach pain

• Dark urine

• Yellowing of the skin or eyes (jaundice)

• Unexplainable and severe tiredness

When can I start drinking after I’ve stopped taking anti-androgen medications?

It’s important to keep taking your anti-androgen medications until your healthcare provider has told you it’s OK to stop them. Stopping these medications too early could affect how your prostate cancer is being treated. Never stop your medications in order to have a drink.

If you’ve recently finished or will soon be finishing your complete course of anti-androgen medications, the answer to this question varies widely based on the medication you’ve been taking.

For example, with flutamide, you’d only have to wait about 2 days to ensure alcohol wouldn’t be mixing with the medication. Bicalutamide, on the other hand, can take up to 42 days to completely leave the body. So you’d have to wait several weeks to be sure there was no interaction.

To get more accurate information, you should speak with your healthcare provider about when it might be safe for you to drink alcohol after finishing your anti-androgen treatment.

Are there any prostate cancer medications that aren’t affected by alcohol?

Unfortunately, other prostate cancer medications have similar common side effects to anti-androgen medications. This means alcohol may interact with other medications in a similar way. Because each prostate cancer medication carries its own unique risks, it’s best to check with your healthcare provider before taking them while consuming alcohol.

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Written by:

Sonia Amin Thomas, PharmD, BCOP

Sonia Amin Thomas, PharmD, BCOP, has been practicing as a clinical pharmacist for 12 years and in oncology pharmacy for over 10 years. She practices both academic and clinical pharmacy and is board certified as an oncology pharmacist and integrative health coach.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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