Xtandi is a brand-name prescription drug that's used to treat prostate cancer in adult men. It's used to treat prostate cancer that no longer improves with typical medications or surgical treatments that work by lowering testosterone levels.

Xtandi is approved for use in adult men whose prostate cancer either:

  • has spread to other parts of their body (called metastatic cancer) or
  • hasn't spread to other parts of their body (called nonmetastatic cancer)

People taking Xtandi should either:

  • already have had an orchiectomy (surgery to remove their testicles) or
  • be taking a drug that works with Xtandi to lower their testosterone levels

Xtandi contains the drug enzalutamide. It belongs to a class of drugs called androgen receptor inhibitors. These drugs block the action of androgens (male hormones, such as testosterone) from helping prostate cancer to grow and spread.

Xtandi comes as capsules that are taken by mouth once each day. It's available in one strength: 40 mg.

Effectiveness

In clinical studies, Xtandi was given to 1,401 men with prostate cancer that no longer improved with medication or surgery that works by lowering testosterone levels. Their cancer hadn't spread to other parts of their body. Men taking Xtandi had a 71% lower risk of their cancer spreading to other parts of their body than did men who took a placebo (treatment with no active drug).

Xtandi was also studied in 1,717 men with prostate cancer that had spread to other parts of their body. Their cancer hadn't improved with surgery or medication that works by lowering testosterone levels. Men taking Xtandi had an 83% lower risk of their cancer getting worse than did men who were taking a placebo.

Xtandi is available only as a brand-name medication. It's not currently available in generic form.

Xtandi contains the active drug enzalutamide.

Xtandi can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Xtandi. These lists do not include all possible side effects.

For more information on the possible side effects of Xtandi, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

More common side effects

The more common side effects of Xtandi can include:

  • fatigue (lack of energy)
  • feeling weak
  • reduced appetite
  • hot flashes
  • joint pain
  • dizziness
  • high blood pressure
  • headaches
  • weight loss

Most of these side effects may go away within a few days or a couple of weeks. If they're more severe or don't go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Xtandi aren't common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you're having a medical emergency.

Serious side effects and their symptoms can include the following:

  • Trouble urinating. Symptoms can include:
    • frequently passing small amounts of urine
    • blood in your urine
  • Posterior reversible encephalopathy syndrome (PRES), which causes swelling in your brain. Symptoms can include:

Other serious side effects, which are discussed below in "Side effect details," include:

  • seizures
  • ischemic heart disease (heart disease caused by lack of blood flow to your heart muscle)
  • falls that may lead to bone fractures
  • severe allergic reaction

Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here's some detail on several of the side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Xtandi. Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

There have been some reports of swelling in people taking Xtandi. In clinical studies, 0.5% of these people had swelling of their face. Only 0.1% of the people had swelling of their tongue or lips.

Call your doctor right away if you have a severe allergic reaction to Xtandi. Call 911 if your symptoms feel life-threatening or if you think you're having a medical emergency.

Fatigue

You may have fatigue (lack of energy) while you're taking Xtandi. In clinical studies, up to 51% of people taking the drug felt fatigued or tired. Of those taking a placebo (treatment with no active drug), 44% had the same result.

If you feel fatigued during Xtandi treatment, talk with your doctor. They can recommend ways to help improve your energy levels.

Seizures

Seizures have occurred in people taking Xtandi. In clinical studies, 0.4% of people taking the drug had a seizure.

One clinical study was specifically designed to look at seizures in people taking Xtandi who were at higher risk of seizures for various reasons. In this study, 2.2% of people taking Xtandi had a seizure during treatment.

Symptoms of seizures may include:

  • sudden loss of consciousness
  • convulsions
  • rapid eye movements
  • drooling

It's not known if taking a seizure medication while you're using Xtandi will help prevent seizures. If you do have a seizure while you're taking Xtandi, call you doctor right away. Your doctor will prescribe a medication other than Xtandi for you.

If you're concerned about your risk of having a seizure while using Xtandi, talk with your doctor. They can discuss with you the risks and benefits of using this drug.

Falls and fractures

You may have an increased risk of falls and bone fractures when you're taking Xtandi. In clinical studies, falls occurred in 10% people taking the drug. Of people who took a placebo (treatment with no active drug), 4% had the same result. Fractures caused by falls occurred in 2% of people taking Xtandi during studies. In those taking the placebo, less than 1% had bone fractures.

The falls that occurred during studies weren't caused by loss of consciousness or seizures. Your doctor will discuss your risk of falls and fractures with you before you start taking Xtandi.

Heart disease

Ischemic heart disease has occurred in some people taking Xtandi. With ischemic heart disease, a blockage forms in the arteries of your heart. The blockage stops blood from flowing to your heart muscle. In clinical studies, 2.7% of people taking Xtandi had ischemic heart disease. Of those who took a placebo (treatment with no active drug), 1.2% had the same result.

In serious cases, this condition has led to death. In clinical studies, 0.4% of people taking Xtandi who had ischemic heart disease died. Of those taking a placebo who had ischemic heart disease, 0.1% died.

Symptoms of ischemic heart disease can include:

  • chest pain
  • feeling tired
  • shortness of breath
  • heart palpitations (which feel like fluttering in your chest)
  • dizziness or lightheadedness

Your doctor will monitor you for heart problems during your treatment with Xtandi. If you have any symptoms of heart disease while you're taking Xtandi, call your doctor right away or go to an emergency room.

Weight loss

You may have weight loss when you're taking Xtandi. This occurs because Xtandi can reduce your appetite. In clinical studies, up to 12% of people taking Xtandi had weight loss. Of those taking a placebo (treatment with no active drug), up to 8.5% had weight loss.

If you're concerned about weight loss during Xtandi treatment, talk with your doctor. They can recommend diet tips that can help you maintain a healthy weight.

The Xtandi dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you're using Xtandi to treat
  • other drugs that you are taking
  • other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they'll adjust it over time to reach the amount that's right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Drug forms and strengths

Xtandi comes as capsules that are taken by mouth. It's available in one strength: 40 mg.

Dosage for castration-resistant prostate cancer

The typical dosage of Xtandi is 160 mg (four 40-mg capsules) taken by mouth once each day. It can be taken with or without food.

If you haven't had an orchiectomy (surgery to remove your testicles), you'll take Xtandi with another medication to lower your testosterone levels.

What if I miss a dose?

If you miss a dose of Xtandi, take it as soon as you remember. However, if the whole day has passed and you haven't taken the drug, just take your scheduled dose the next day.

Don't take more than one dose of Xtandi at a time. Doing so may increase your risk of side effects.

To help make sure that you don't miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Will I need to use this drug long term?

Xtandi is meant to be used as a long-term treatment. If you and your doctor determine that Xtandi is safe and effective for you, you'll likely take it long term.

Xtandi is approved to treat prostate cancer that's castration resistant. This type of cancer no longer improves with typical medications or surgical treatments that work to lower testosterone levels.

Other drugs are available that can treat this condition. Some may be better suited for you than others. If you're interested in finding an alternative to Xtandi, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that's approved to treat one condition is used to treat a different condition.

Examples of other drugs that may be used to treat castration-resistant prostate cancer include:

  • abiraterone (Zytiga)
  • radium-233 (Xofigo)
  • apalutamide (Erleada)
  • docetaxel (Docefrez, Taxotere)
  • sipuleucel-T (Provenge)
  • cabazitaxel (Jevtana)

You may wonder how Xtandi compares to other medications that are prescribed for similar uses. Here we look at how Xtandi and Zytiga are alike and different.

Uses

Both Xtandi and Zytiga are used to treat prostate cancer that no longer improves with typical medications or surgical treatments that work to lower testosterone levels.

Xtandi is approved for use in adult men whose prostate cancer either:

  • has spread to other parts of their body (metastatic cancer) or
  • hasn't spread to other parts of their body (nonmetastatic cancer)

Zytiga is used to treat prostate cancer that has spread to other parts of the body (metastatic cancer). It's used in combination with another drug, called prednisone.

People taking Xtandi or Zytiga should either:

  • already have had an orchiectomy (surgery to remove their testicles) or
  • be taking a drug that works with Xtandi or Zytiga to lower their testosterone levels

Drug forms and administration

Xtandi comes as capsules that are taken by mouth. It's available in one strength: 40 mg.

The typical dosage of Xtandi is 160 mg (four 40-mg capsules) taken by mouth once each day. It can be taken with or without food.

Zytiga comes as tablets that are taken by mouth. It's available in two strengths: 250 mg or 500 mg.

The typical dosage of Zytiga is 1,000 mg (four 250-mg tablets or two 500-mg tablets) taken by mouth once each day. It should be taken on an empty stomach (at least 1 hour before or 2 hours after a meal) with a glass of water.

Side effects and risks

Xtandi and Zytiga both contain drugs that belong to a class of drugs called androgen receptor inhibitors. Therefore, both medications can cause very similar side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Xtandi, with Zytiga, or with both drugs (when taken individually).

  • Can occur with Xtandi:
    • fatigue (lack of energy)
    • headaches
    • dizziness
    • reduced appetite
    • weight loss
  • Can occur with Zytiga:
  • Can occur with both Xtandi and Zytiga:

Serious side effects

These lists contain examples of serious side effects that can occur with Xtandi, with Zytiga, or with both drugs (when taken individually).

  • Can occur with Xtandi:
    • seizures
    • heart disease
    • falls that may lead to bone fractures
    • posterior reversible encephalopathy syndrome (PRES), which causes swelling in your brain
    • hypersensitivity or allergic reaction
  • Can occur with Zytiga:
    • problems with your heart rhythm
    • liver damage
    • high triglyceride level
    • fluid retention (swelling), which may lead to heart problems
    • low potassium level
    • problems with your adrenal glands
  • Can occur with both Xtandi and Zytiga:

Effectiveness

Xtandi and Zytiga are both used to treat prostate cancer that no longer improves with typical medications or surgical treatments that work to lower testosterone levels.

These drugs haven't been directly compared in clinical studies. But studies have found both Xtandi and Zytiga to be effective in treating certain forms of prostate cancer.

Costs

Xtandi and Zytiga are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

According to estimates on WellRx.com, Zytiga costs slightly more than Xtandi. The actual price you'll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

You may wonder how Xtandi compares to other medications that are prescribed for similar uses. Here we look at how Xtandi and Erleada are alike and different.

Uses

Both Xtandi and Erleada are used to treat prostate cancer that no longer improves with typical medications or surgical treatments that work to lower testosterone levels.

Xtandi is approved for use in adult men whose prostate cancer either:

  • has spread to other parts of their body (metastatic cancer) or
  • hasn't spread to other parts of their body (nonmetastatic cancer)

Erleada is approved to treat prostate cancer that hasn't spread from the prostate to other parts of the body (nonmetastatic cancer).

People taking either Xtandi or Erleada should either:

  • already have had an orchiectomy (surgery to remove their testicles) or
  • be taking a drug that works with Xtandi or Erleada to lower their testosterone levels

Drug forms and administration

Xtandi comes as capsules that are taken by mouth. It's available in one strength: 40 mg.

The typical dosage of Xtandi is 160 mg (four 40-mg capsules) taken by mouth once each day. It can be taken with or without food.

Erleada also comes as capsules that are taken by mouth. It's available in one strength: 60 mg.

The typical dosage of Erleada is 240 mg (four 60-mg capsules) taken by mouth once each day. It can be taken with or without food.

Side effects and risks

Xtandi and Erleada both contain drugs that belong to a class of drugs called androgen receptor inhibitors. Therefore, both medications can cause very similar side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Xtandi, with Erleada, or with both drugs (when taken individually).

  • Can occur with Xtandi:
    • headaches
    • dizziness
    • joint pain
    • fatigue (lack of energy)
  • Can occur with Erleada:
    • rash
    • nausea
    • high triglyceride level
    • high potassium level
  • Can occur with both Xtandi and Erleada:

Serious side effects

These lists contain examples of serious side effects that can occur with Xtandi, with Erleada, or with both drugs (when taken individually).

  • Can occur with Xtandi:
    • frequent urination
    • blood in your urine
    • heart disease
    • posterior reversible encephalopathy syndrome (PRES), which causes swelling in your brain
    • hypersensitivity or allergic reaction
  • Can occur with Erleada:
  • Can occur with both Xtandi and Erleada:

Effectiveness

Xtandi and Erleada are both used to treat prostate cancer that no longer improves with typical medications or surgical treatments that work to lower testosterone levels.

These drugs haven't been directly compared in clinical studies. But studies have found both Xtandi and Erleada to be effective in treating certain forms of prostate cancer.

Costs

Xtandi and Erleada are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

According to estimates on WellRx.com, Xtandi and Erleada generally cost about the same. The actual price you'll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

The Food and Drug Administration (FDA) approves prescription drugs such as Xtandi to treat certain conditions. Xtandi may also be used off-label for other conditions. Off-label use is when a drug that's approved to treat one condition is used to treat a different condition.

Xtandi is used to treat prostate cancer that no longer improves with typical medications or surgical treatments that work by lowering testosterone levels.

Xtandi is approved for use in adult men whose prostate cancer either:

  • has spread to other parts of their body (called metastatic cancer) or
  • hasn't spread to other parts of their body (called nonmetastatic cancer)

People taking Xtandi should either:

  • already have had an orchiectomy (surgery to remove their testicles) or
  • be taking a drug that works with Xtandi to lower their testosterone levels

Xtandi helps to slow down the growth and spread of cancer cells. This may help stop the growth of prostate tumors and lead to death of cancer cells.

Effectiveness

In clinical studies, Xtandi was given to 1,401 men with prostate cancer that no longer improved with medication or surgery that works by lowering testosterone levels. Their cancer hadn't spread to other parts of their body. Men taking Xtandi had a 71% lower risk of their cancer spreading to other parts of their body than did men who took a placebo (treatment with no active drug).

Xtandi was also studied in 1,717 men with prostate cancer that had spread to other parts of their body. Their cancer hadn't improved with surgery or medication that works by lowering testosterone levels. Men taking Xtandi had an 83% lower risk of their cancer getting worse than did men who were taking a placebo.

In addition to the uses listed above, Xtandi is being studied as a treatment for other conditions. Below we describe one of these studies.

Xtandi for breast cancer (under study)

Xtandi is currently being studied as a treatment for a specific type of breast cancer called triple-negative breast cancer (TNBC). It's being studied in people with TNBC whose tumors have androgen receptors, which are attachment sites for male hormones.

Xtandi is also being studied in combination with several other cancer drugs as a treatment for other types of breast cancer.

More studies are needed to know about the safety and effectiveness of Xtandi to treat breast cancer. If you're interested in using Xtandi to treat breast cancer, talk with your doctor about all of your treatment options.

Xtandi can be used alone or in combination with other drugs to treat prostate cancer.

Drugs used to lower testosterone levels

Examples of drugs that may be used with Xtandi to help keep testosterone levels low include:

  • leuprolide (Lupron)
  • goserelin (Zoladex)
  • triptorelin (Trelstar)
  • histrelin (Vantas or Supprelin LA)
  • degarelix

Other cancer drugs

Examples of other cancer drugs that may be used with Xtandi if a single drug isn't working to treat your prostate cancer include:

  • radium-233 (Xofigo)
  • prednisone

It's not known whether Xtandi and alcohol interact with each other.

However, both Xtandi and alcohol are metabolized (broken down) by your liver. Drinking too much alcohol while you're taking Xtandi may prevent your liver from breaking down Xtandi. This increases your risk of side effects from Xtandi.

Talk with your doctor about how much alcohol is safe for you to drink while you're using Xtandi.

Xtandi can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase the number of side effects or make them more severe.

Xtandi and other medications

Below are lists of medications that can interact with Xtandi. These lists do not contain all the drugs that may interact with Xtandi.

Before taking Xtandi, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Drugs that decrease Xtandi levels in your body

Xtandi is metabolized (broken down) by an enzyme (protein) called CYP3A4. Certain other drugs increase the amount of this protein in your body. Taking those drugs with Xtandi can decrease the level of Xtandi in your body. This can reduce how effective Xtandi is in treating your condition.

Examples of drugs that decrease the level of Xtandi in your body, and should be avoided if possible, include:

  • certain antivirals, such as nevirapine
  • certain antibiotics, such as:
    • rifampicin (Rifadin)
    • rifabutin (Mycobutin)
    • rifapentine (Priftin)
    • rifamycin (Aemcolo)
  • certain seizure medications, such as:
    • carbamazepine (Tegretol)
    • fosphenytoin (Cerebyx)
    • phenytoin (Dilantin)
    • pentobarital (Nembutal)
    • phenobarbital (Solfoton)
    • oxcarbazepine (Trileptal)

Many drugs other than those listed are also metabolized by the CYP3A4 enzyme. Talk with your doctor or pharmacist about all medications you're taking with Xtandi. Your doctor or pharmacist can help keep your risk of drug interactions low.

If you do take a drug that lowers Xtandi levels in your body, your recommended dosage of Xtandi will likely be higher than normal. The typical dosage of Xtandi when it's used with drugs that are metabolized by CYP3A4 is 240 mg taken once daily.

Drugs that increase Xtandi levels in your body

Xtandi interacts with other drugs that use the same enzyme (protein) when they're metabolized (broken down) inside your body. This enzyme (called CYP2C8) metabolizes several drugs. Taking those drugs with Xtandi can increase the level of Xtandi in your body. This can increase your risk of side effects from Xtandi.

Examples of drugs that increase the level of Xtandi in your body, and should be avoided if possible, include:

  • certain cholesterol medications, such as gemfibrozil (Lopid)
  • certain platelet inhibitors, such as clopidogrel (Plavix)
  • certain antivirals, such as lopinavir (used with ritonavir in Kaletra)
  • certain antifungals, such as clotrimazole (Canesten)
  • certain high blood pressure medications, such as:
    • felodipine (Cabren, Cardioplen XL, Felendil XL)
    • candesartan (Atacand)
  • certain asthma medications, such as zafirlukast (Accolate)
  • certain cancer medications, such as:
    • sorafenib (Nexavar)
    • erlotinib (Tarceva)
    • cholecalciferol (vitamin D-3)

Many drugs other than those listed are also metabolized by the CYP2C8 enzyme. Talk with your doctor or pharmacist about all medications you're taking with Xtandi. Your doctor or pharmacist can help keep your risk of drug interactions low.

If you do take a drug that increases Xtandi levels in your body, your recommended dosage of Xtandi will likely be lower than normal. The typical dosage of Xtandi when it's used with drugs that are metabolized by CYP2C8 is 80 mg taken once daily.

Xtandi and herbs and supplements

Xtandi interacts with certain herbs and supplements that are metabolized (broken down) by an enzyme called CYP3A4.

St. John's wort

St. John's wort is an herb that interacts with Xtandi. This herbal supplement is often used to improve moods. If you take St. John's Wort and Xtandi together, the level of Xtandi in your body will be decreased.

You should avoid taking St. John's wort with Xtandi. Talk with your doctor or pharmacist about all of the supplements you take. They can recommend whether or not you should continue to take those products with Xtandi.

As with all medications, the cost of Xtandi can vary. To find current prices for Xtandi in your area, check out WellRx.com. The cost you find on WellRx.com is what you may pay without insurance. The actual price you'll pay depends on your insurance plan, your location, and the pharmacy you use.

Financial and insurance assistance

If you need financial support to pay for Xtandi, or if you need help understanding your insurance coverage, help is available.

Astellas Pharma US, Inc., the manufacturer of Xtandi, offers the Xtandi Patient Savings Program. For more information and to find out if you're eligible for support, call 855-898-2634 or visit the program website.

You should take Xtandi according to your doctor or healthcare provider's instructions.

When to take

You'll take Xtandi by mouth once each day. It doesn't matter what time of day you take the drug, but you should try to be consistent each day.

To help make sure that you don't miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Taking Xtandi with food

You can take Xtandi with or without food.

Can Xtandi be crushed, split, or chewed?

No, Xtandi is meant to be swallowed whole. You shouldn't crush, split, or chew Xtandi capsules.

Xtandi is used to treat certain types of prostate cancer. (See the "Xtandi uses" section above for more details.) Some types of prostate cancer grow and spread when they're exposed to androgens. Androgens are a group of hormones, which includes testosterone.

Xtandi contains the active drug enzalutamide. It belongs to a class of drugs called androgen receptor inhibitors. Androgen receptor inhibitors work by blocking (inhibiting) androgens from binding to their receptors (attachment sites).

This action can help to slow down the growth and spread of cancer cells. This may help stop the growth of prostate tumors and lead to death of cancer cells.

How long does it take to work?

Xtandi is used to treat certain types of prostate cancer that no longer improves with typical medications or surgical treatments that work by lowering testosterone levels.

Xtandi works by helping to stop cancer cells from growing. How quickly it works depends on how progressed (severe) your cancer is. For this reason, it's hard to say when the drug may start to work for you.

If you have questions about how long Xtandi will take to work for you, talk with your doctor.

It's not known if Xtandi is safe for use by pregnant women. It's only approved to treat prostate cancer, and it hasn't been tested in pregnant women.

If you're a woman who is pregnant or planning to become pregnant, you should not touch or handle Xtandi. In animal studies, Xtandi caused harm and death in some fetuses whose mother was given the drug.

If you have questions about the safety of Xtandi during pregnancy, talk with your doctor.

It's not known if Xtandi is safe to take during pregnancy. It's only approved to treat prostate cancer, and it hasn't been tested in pregnant women.

If you are a male taking Xtandi, and you have a female partner who can become pregnant, it's important that you use effective birth control (such as condoms) during Xtandi treatment. You should continue to use birth control for at least 3 months after your last dose of the drug.

It's not known if Xtandi has any effect on fertility (ability to reproduce) in people taking the drug. However, animal studies have shown that Xtandi may reduce the fertility of animal males who were given the drug.

If you have concerns about how Xtandi may affect your fertility, talk with your doctor.

It's not known if Xtandi is safe for women to take while breastfeeding. It's only approved to treat prostate cancer, and it hasn't been studied in breastfeeding women.

In animal studies, Xtandi did pass into the breast milk of lactating animals. However, it's not known if Xtandi passes into human milk or what effect it might have on a breastfeeding child.

Here are answers to some frequently asked questions about Xtandi.

Can I take Xtandi after using Zytiga?

Yes, Xtandi is usually taken by men with prostate cancer that no longer improves with typical medications or surgical treatments that work by lowering testosterone levels. One of these typical medications is Zytiga.

If your prostate cancer didn't improve with Zytiga treatment, your doctor may recommend that you use Xtandi.

Will I need to take prednisone or other steroids with Xtandi?

You may need to take steroids with Xtandi. In clinical studies, about 48% of people took steroids during Xtandi treatment.

Whether or not you'll take steroids during your Xtandi treatment depends on:

  • the severity of your disease
  • how you've responded to steroid treatment in the past
  • any side effects that you may have

Is Xtandi a form of chemotherapy?

No, Xtandi isn't chemotherapy (traditional drugs used to treat cancer). It works differently in your body than chemotherapy does.

Chemotherapy targets fast-growing cells in your body. Since cancer cells typically multiply (make more cells) quickly, they're affected by chemotherapy. However, some healthy cells in your body also multiply quickly. These healthy cells can also be affected by chemotherapy.

Xtandi is a type of hormonal therapy, called an androgen receptor inhibitor. It works on more specific types of cells than chemotherapy does.

Androgen receptor inhibitors work by blocking (inhibiting) androgens from binding to their receptors (attachment sites). Androgens are a group of hormones, which includes testosterone.

This action can help to slow down the growth and spread of certain cancer cells. This may help stop the growth of prostate tumors and lead to death of prostate cancer cells.

Does Xtandi cause hair loss?

No, Xtandi doesn't cause hair loss. If you're concerned about hair loss during your treatment, talk with your doctor.

Why can't I get Xtandi at my local pharmacy?

Xtandi is only available in specialty pharmacies or at your doctor's office. Specialty pharmacies are similar to traditional pharmacies that you're used to. However, specialty pharmacies offer additional services for people. These pharmacies typically focus on chronic (long-term) or complex conditions, such as cancer.

Complex conditions typically require more expensive or very complicated treatments. The pharmacists at specialty pharmacies are trained to be experts in helping you understand your insurance coverage for these treatments. The pharmacists can also assist you while you're using specialty medications, such as by monitoring you for certain side effects.

Before taking Xtandi, talk with your doctor about your health history. Xtandi may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Seizure disorder. Xtandi may increase your risk of seizures. If you have a seizure disorder, your risk may be even higher while you're using this drug. It's not known if taking a seizure medication while you're using Xtandi will help prevent seizures. Talk with your doctor about any history of seizures before taking Xtandi.
  • Heart disease. Xtandi may increase your risk of ischemic heart disease, which results from a lack of blood flow to certain areas of your heart. If you already have heart disease, your risk may be even higher while you're taking this drug. Talk to your doctor about any history of heart problems before starting Xtandi.
  • Increased risk of falls and fractures. Xtandi may increase your risk of falls and fractures. If you already have a high risk of falling or having bone fractures, taking Xtandi may increase those risks even more. Your doctor will evaluate you for your risk of falling before you start taking Xtandi.
  • Pregnancy. It's not known if Xtandi is safe for use during pregnancy. It's only approved to treat prostate cancer. If you're a woman who's pregnant or planning to become pregnant, you should not touch or handle Xtandi capsules. For more information, please see the "Xtandi and pregnancy" section above.
  • Breastfeeding. It's not known if Xtandi is safe for use while breastfeeding. It's only approved to treat prostate cancer. For more information, please see the "Xtandi and breastfeeding" section above.

Note: For more information about the potential negative effects of Xtandi, see the "Xtandi side effects" section above.

Using more than the recommended dosage of Xtandi can lead to serious side effects.

Overdose symptoms

Taking Xtandi can increase your risk of having a seizure. This risk is further increased if you take more than the recommended dosage of Xtandi.

Symptoms of a seizure can include:

  • loss of consciousness
  • convulsions
  • drooling
  • rapid eye movements

What to do in case of overdose

If you think you've taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

When you get Xtandi from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee the effectiveness of the medication during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Xtandi tablets should be stored at room temperature (68°F to 77°F/20°C to 25°C) in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as in bathrooms.

Xtandi should not be handled by anyone who is not taking Xtandi or who is not a caregiver to the person taking the drug. If you're a woman who is pregnant or planning on becoming pregnant, do not handle or touch Xtandi.

Disposal

If you no longer need to take Xtandi and have leftover medication, it's important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

The following information is provided for clinicians and other healthcare professionals.

Indications

Xtandi is indicated for the treatment of patients with castration-resistant prostate cancer (CRPC).

Mechanism of action

Xtandi contains the active drug enzalutamide, which is an androgen receptor inhibitor. It competitively inhibits the binding of androgen to its receptors, thus inhibiting nuclear translocation of androgen receptors and their interaction with DNA. Ultimately, enzalutamide decreases proliferation and tumor volume and induces cell death in prostate cancer cells.

Pharmacokinetics and metabolism

Following oral administration, time to reach maximum plasma concentration is 1 hour. Steady state is achieved at day 28 with daily dosing.

Xtandi is 97% to 98% bound to plasma proteins, with no clinically relevant albumin interactions.

Xtandi is eliminated via hepatic metabolism, with 71% excreted in urine and 14% excreted in feces. The terminal half-life of Xtandi after a single oral dose is 5.8 days, whereas the mean terminal half-life of the active metabolite N-desmethyl enzalutamide is 7.8 to 8.6 days.

Contraindications

There are no contraindications to Xtandi.

Storage

Xtandi tablets should be stored at room temperature (68°F to 77°F/20°C to 25°C) in a tightly sealed container away from light and humidity.

Xtandi should not be handled by anyone who is not taking Xtandi or who is not a caregiver to the person taking the drug. Woman who are pregnant or planning to become pregnant should not handle or touch Xtandi.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.