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Xtandi

enzalutamide

Used for Prostate Cancer

Xtandi (enzalutamide) is an oral medication used to treat certain types of prostate cancer. It’s a form of hormonal therapy called an antiandrogen that works to block testosterone in your body. Xtandi (enzalutamide) is one of the recommended options for prostate cancer and is taken once a day. But it should be used in combination with another hormonal medication that targets gonadotropin-releasing hormone (GnRH), unless you’ve had surgery to remove both testicles (bilateral orchiectomy).

Reviewed by:

Jenny Zhang, PharmD, BCOP

Connie Zheng, PharmD

Last reviewed on August 2, 2022

Basics Side effects Pros & cons Pharmacist tips FAQs Warnings Dosage Alternatives Latest news Images Prices Medicare

What is Xtandi (enzalutamide)?

What is Xtandi (enzalutamide) used for?

Advanced or metastatic prostate cancer

How Xtandi (enzalutamide) works

Most prostate cancer cells need testosterone to grow and spread. Testosterone is a type of male sex hormone called an androgen.

Xtandi (enzalutamide) 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 grow or spread.

Are you looking for information on Erleada (apalutamide), Nubeqa (darolutamide) instead?

Drug Facts

Common BrandsXtandi

Drug ClassAnticancer

Controlled Substance ClassificationNot a controlled medication

Generic StatusNo lower-cost generic available

AvailabilityPrescription only

What are the side effects of Xtandi (enzalutamide)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Weakness or fatigue (up to 51%)
Back pain (up to 29%)
Hot flashes (up to 27%)
Constipation (up to 23%)
Diarrhea (up to 22%)
Joint pain (up to 21%)
Feeling less hungry (up to 19%)
High blood pressure (up to 14%)

Other Side Effects

Swelling in the arms or legs (peripheral edema)
Pain, weakness, or stiffness in the muscles or bones
Headache
Dizziness
Nausea
Problems with memory or focus
Lung infections
Falls
Bone fractures
Blood in the urine

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.

Seizures
New confusion, seizures, or sudden changes in mood or behavior: severe headaches, visual changes, difficulty staying awake, dizziness, trouble speaking
Heart problems: chest pain, racing heartbeat, shortness of breath, arm or shoulder pain, swelling of your legs or feet, sudden weight gain, sweating, fatigue, dizziness, nausea or vomiting

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
Loss of balance or coordination
Seizures
Sudden and severe headache, confusion, change in vision, seizures, which may be signs of posterior reversible encephalopathy syndrome (PRES)

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

Back pain
Constipation
Diarrhea
Hot flashes
Increase in blood pressure
Loss of appetite
Unusual weakness or fatigue

Pros and cons of Xtandi (enzalutamide)

Pros

Oral pill, taken once daily

Recommended option for certain types of prostate cancer

Can treat prostate cancer that is no longer responding to other hormonal therapies

Cons

Available as brand only, so can be expensive

Can interact with other medications

Can raise your risk for seizures

Pharmacist tips for Xtandi (enzalutamide)

Xtandi (enzalutamide) 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.

Swallow Xtandi (enzalutamide) capsules or tablets whole. Don’t open or dissolve the capsules. Don’t cut, crush, or chew the tablets.

Xtandi (enzalutamide) isn't meant to be taken alone to treat prostate cancer. Typically, you should be taking it at the same time as a medication that targets GnRH (e.g. Lupron Depot (leuprolide) or Firmagon (degarelix)), unless you’ve had surgery to remove both testicles. Check with your provider if you aren’t receiving a GnRH-targeting medication. Don’t stop taking these medications without talking to your healthcare provider first.

Certain medications, such as clarithromycin and rifampin (Rifadin), can interact with Xtandi (enzalutamide), which can change the levels of Xtandi (enzalutamide) in your body. This can affect how well Xtandi (enzalutamide) works to treat prostate cancer or raise your risk of side effects. Tell your provider and pharmacist about all the medications you take, including supplements and over-the-counter medications. Before starting any new medications, make sure your provider knows you're taking Xtandi (enzalutamide).

Be careful while driving, operating heavy machinery, or doing any activities that require a lot of focus and attention until you know how Xtandi (enzalutamide) affects you. Xtandi (enzalutamide) can cause seizures and sudden loss of consciousness. If you experience a seizure while taking this medication, stop taking it and contact your provider.

If your partner is able to become pregnant, use appropriate birth control measures, such as condoms, while you’re taking Xtandi (enzalutamide) and for 3 months after your last dose. It’s possible for Xtandi (enzalutamide) to cause birth defects or pregnancy loss 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.

Frequently asked questions about Xtandi (enzalutamide)

What types of prostate cancer is Xtandi (enzalutamide) used for?

Xtandi (enzalutamide) is a recommended treatment option to treat prostate cancer that’s no longer responding to initial hormonal therapy or surgery to lower testosterone. It’s also used to treat metastatic prostate cancer, meaning cancer that has spread to other parts of the body.

Is Xtandi (enzalutamide) a kind of chemotherapy?

Xtandi (enzalutamide) isn't chemotherapy. Chemotherapy is a class of medication that targets and kills cancer cells in your body. Xtandi (enzalutamide) doesn’t kill cancer cells. Instead, it’s a form of hormonal therapy called an androgen receptor inhibitor or antiandrogen. It works by blocking the male sex hormone, testosterone, in your body. Most prostate cancer cells need testosterone to grow and spread. By blocking testosterone, Xtandi (enzalutamide) blocks the “fuel” cancer cells need to grow or spread.

How long do I need to take Xtandi (enzalutamide) for?

You should take Xtandi (enzalutamide) as instructed by your provider. How long you take Xtandi (enzalutamide) depends on several factors, including how well the medication is working to treat your cancer and how well your body tolerates the side effects. Don’t stop receiving Xtandi (enzalutamide) without first discussing with your provider.

How can I manage hot flashes from Xtandi (enzalutamide)?

Let your provider know if you experience hot flashes while taking Xtandi (enzalutamide) and they can suggest ways to help you manage this side effect both with and without medications. Medications that can ease your hot flashes include estrogens, progestin, antidepressants, and anticonvulsants. But these medications can cause additional side effects that you might find bothersome, including nausea, tiredness, or dizziness. If you want to avoid medications, you can try relaxation techniques, breathing exercises, behavioral therapy, and hypnosis, to cope with hot flashes. You can also try wearing loose-fitting clothing or using fans to keep you cool.

Is Xtandi (enzalutamide) better compared to other similar medications that treat prostate cancer?

Newer antiandrogens, like Xtandi (enzalutamide), might be a better option compared with older antiandrogens, such as flutamide (Eulexin) or bicalutamide (Casodex), if you have prostate cancer that’s no longer responding to initial hormone therapies. This is because they're able to block testosterone better than the older antiandrogens. Your provider will work with you to determine which prostate cancer medication is best for you. Different treatments typically have different dosing and slightly different side effects. Your provider will help you choose one depending on many factors, including the type and stage of your prostate cancer, how well your body handles the side effects, other medical conditions you might have, and cost. Talk with your provider if you've any questions about the benefits and risks for any of the treatment options.

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What are the risks and warnings for Xtandi (enzalutamide)?

Xtandi (enzalutamide) 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.

Seizures

Risk factors: Taking other medications that can raise the risk of seizures | Serious brain or head injury | Stroke | Alzheimer’s disease or other brain conditions | Past seizures

Though rare, Xtandi (enzalutamide) can cause seizures. Let your provider know if you've a history of seizures or conditions that raise your risk of seizures (e.g., head trauma, stroke, or are taking medications that can make you more likely to have a seizure). Let your loved ones and caregivers know of this risk so they can help you and also get medical help if you do have a seizure. Stop taking Xtandi (enzalutamide) and tell your provider right away if you think you've had a seizure while on treatment because most likely you’ll need to switch to a different medication to treat your prostate cancer. Some early symptoms of a seizure can include having a strange sense of taste or smell, anxiety, nausea, or a fluttering sensation.

Swelling and narrowing of the blood vessels in your brain

Rare cases of a brain condition called posterior reversible encephalopathy syndrome (PRES) have happened with people taking Xtandi (enzalutamide). If you have PRES, you’ll need to stop this medication. Get medical help right away if you experience symptoms of PRES, including sudden severe headaches, sudden confusion, sudden vision loss or other vision changes, behavioral changes, or seizures.

Heart problems

Risk factors: High blood pressure | Diabetes | High cholesterol

Xtandi (enzalutamide) can cause the blood vessels around your heart to narrow and make it difficult for enough blood or oxygen to reach your heart. Though rare, this can lead to serious problems, including heart attacks. If you have heart problems or have a higher risk for heart problems, your provider should monitor you more regularly while you’re taking Xtandi (enzalutamide). Let your provider know right away or seek medical help if you have chest pain, racing heartbeat, shortness of breath, arm or shoulder pain, sweating, or dizziness.

Falls and fractures

Xtandi (enzalutamide) can raise your risk of falls and bone fractures. Your provider will monitor you more closely if you are at higher risk for falls and fractures and might prescribe medication to help strengthen your bones. Tell your provider if you develop bone pain or experience more falls while taking this medication.

Possible harm to unborn baby

It’s possible for Xtandi (enzalutamide) to harm unborn babies.
If your partner is able to get pregnant, you should use birth control measures, such as condoms, while taking Xtandi (enzalutamide) and for 3 months after your last dose. Let your provider know right away if your partner becomes pregnant during this time.