Casodex contains the active drug bicalutamide. This drug is also available in generic form. Generic tablets come in the same strength as Casodex (50 mg).

A generic drug is an exact copy of a brand-name medication. Generics tend to cost less than brand-name drugs.

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

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

Note: The Food and Drug Administration (FDA) tracks side effects of drugs they have approved. If you would like to report to the FDA a side effect you've had with Casodex, you can do so through MedWatch.

More common side effects

The more common side effects of Casodex, (when taken with a type of drug called an LHRH analog, such as Eligard, Lupron, or Zoladex) can include:

  • hot flashes (suddenly feeling warm and flushed)
  • feeling weak
  • constipation
  • diarrhea
  • infection
  • nausea
  • peripheral edema (fluid retention that causes swollen ankles, feet, legs, or arms)
  • feeling short of breath
  • blood in the urine
  • frequently needing to urinate during the night
  • anemia (low red blood cell count)
  • pain (back, pelvic, belly, or general) — see "Side effect details" below

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 Casodex 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, explained in more detail below in "Side effect details," include:

Side effect details

You may wonder how often certain side effects occur with this drug.Here's some detail on several of the side effects this drug may cause.

Allergic reactions

As with most drugs, some people can have an allergic reaction after taking Casodex. It's not known how often this occurs. Allergic reactions weren't reported in clinical studies of Casodex, but they've been reported since the drug has been on the market.

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

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

Liver problems

Severe liver problems can sometimes happen in people taking Casodex. These include hepatitis (liver inflammation) and liver failure that may need hospital treatment or that leads to death. In clinical studies, less than 1% of people taking Casodex had to stop taking the drug because of a liver problem.

Before you start Casodex, your doctor will do blood tests to check how well your liver is working. These tests will be repeated regularly throughout your treatment. Tell your doctor right away if you get any symptoms of a liver problem, such as those below. If you have a liver problem, you may need to stop taking Casodex.

Symptoms of liver problems can include:

  • nausea
  • vomiting
  • abdominal (belly) pain
  • fatigue (lack of energy)
  • loss of appetite
  • flu-like symptoms
  • dark urine
  • jaundice (yellowing of your skin and whites of your eyes)

Raised blood sugar levels

Casodex must be taken with a type of drug called an LHRH analog. However, these drugs can increase your blood sugar levels, which can lead to type 2 diabetes in some men. If you already have diabetes, it could make your blood sugar harder to manage.

Tell your doctor if you get symptoms of high blood sugar levels, which may include:

  • feeling unusually thirsty
  • needing to urinate more often than usual
  • headaches
  • fatigue
  • blurred vision

Your doctor may want to check your blood sugar levels from time to time while you take Casodex with an LHRH analog.

If you have diabetes or prediabetes, your doctor will monitor your blood sugar levels more often than usual. They will recommend new or different treatment to manage your blood sugar levels, if needed.

Breast enlargement or pain

Casodex may cause breast tissue to swell, grow, or become tender or painful. This is called gynecomastia. It happens because your testosterone levels are lowered by the treatment, which can allow the hormone estrogen to have more effect on your breast tissue.

In clinical studies, gynecomastia was reported in 9% of men who took Casodex with an LHRH analog. In comparison, it occurred in 7% of men who took flutamide (another anti-androgen drug) with an LHRH analog.

Talk with your doctor if you're concerned about this side effect.

Fatigue

Cancer and its treatment can often cause fatigue. You may feel tired, weak, or lacking energy when taking Casodex.

In clinical studies, 22% of people who took Casodex with an LHRH analog reported feeling weak or low in energy. In comparison, 21% of people who took flutamide with an LHRH analog felt weak or low in energy. In the group that took Casodex, around 2% to 5% of people reported feeling sleepy. (It's not known how many people who took flutamide felt sleepy.)

Until you know how Casodex affects you, don't drive or do other potentially dangerous activities, such as use machinery, ride a bike, or climb a ladder.

Talk with your doctor if you feel fatigued while taking Casodex. They may be able to suggest ways to improve your energy levels. They may also want to do blood tests to check for other causes of fatigue, such as liver problems or anemia.

Pain

Taking Casodex may cause pain. In clinical studies, some people experienced pain while taking Casodex with an LHRH analog. The types of pain included:

  • general pain (35% of people)
  • back pain (25% of people)
  • pelvic pain (21% of people)
  • belly pain (11% of people)
  • chest pain (8% of people)
  • bone pain (9% of people)
  • breast pain (6% of people)
  • headache (7% of people)

In the studies, similar percentages of people experienced these types of pain in the group that took flutamide with an LHRH analog.

Talk with your doctor about the best way to manage pain while you're having treatment for cancer.

Photosensitivity

Although not reported in clinical studies of Casodex, some people find that their skin becomes more sensitive to sunlight while taking this medication. It's not known how often this occurs. It's a good idea to avoid tanning beds, sun lamps, and excessive sunlight while taking Casodex.

Talk with your doctor about how to best protect your skin while taking Casodex.

The Food and Drug Administration (FDA) approves prescription drugs such as Casodex to treat certain conditions.

Casodex for metastatic prostate cancer

Casodex is approved to treat stage D2 metastatic prostate cancer. This is a form of advanced prostate cancer (also known as stage IV cancer). "Metastatic" means the cancer has spread to other parts of the body, such as the pelvis, spine, ribs, or other bones.

Casodex is approved for use with a type of drug called a luteinizing hormone-releasing hormone (LHRH) analog. Both Casodex and LHRH analogs are hormone therapies for prostate cancer. They reduce the effect of the male hormone testosterone (also called an androgen) on the cancer cells. Testosterone stimulates prostate cancer cells to grow and multiply.

Casodex is a type of drug called an anti-androgen. It blocks testosterone from attaching to prostate cancer cells. LHRH analogs include drugs such as leuprolide acetate (Lupron, Eligard) and goserelin acetate (Zoladex).

These lower the amount of testosterone that your body makes.

Taking Casodex with an LHRH analog helps slow down or stop the growth of prostate cancer cells.

Effectiveness

The effectiveness of Casodex for treating metastatic prostate cancer has been compared with a drug called flutamide. Flutamide is an anti-androgen drug that works in the same way as Casodex. It's a standard treatment option for metastatic prostate cancer, recommended in guidelines from the National Comprehensive Cancer Network.

In a clinical study, researchers compared outcomes between a group of men who took Casodex and a group of men who took flutamide. Men in both groups also took an LHRH analog, either goserelin acetate (Zoladex) or leuprolide acetate (Lupron, Eligard), as an injection or implant.

After 160 weeks, 47.3% of the men who took Casodex were still alive, compared with 42.5% of the men who took flutamide.

The researchers found that the difference in survival rates between the two groups was not significant. (This means the difference was likely due to chance.) The researchers also looked at how long it took for cancers to get worse or spread further in each group. They found no significant difference between the two groups.

These results show that Casodex is just as effective as flutamide for treating metastatic prostate cancer.

Casodex must be used in combination with a type of drug called a luteinizing hormone-releasing hormone (LHRH) analog. (LHRH analogs are also sometimes called LHRH agonists.) They are given as a long-acting injection or as an implant under your skin. These both work for a few months.

Examples of LHRH analogs include:

  • goserelin acetate (Zoladex)
  • histrelin acetate (Vantas)
  • leuprolide acetate (Lupron, Eligard)
  • triptorelin pamoate (Trelstar)

Casodex and LHRH analogs are both hormone therapies. They work in slightly different ways to reduce the action of testosterone on prostate cancer cells.

Testosterone stimulates prostate cancer cells to grow and multiply. LHRH analogs decrease the production of testosterone by your testicles and lower testosterone levels in your body. Casodex, on the other hand, blocks testosterone from attaching to the prostate cancer cells.

Treatment with Casodex and an LHRH analog must be started at the same time.

Casodex and Lupron

Casodex is often used in combination with an LHRH analog called Lupron Depot (leuprolide acetate).

Lupron Depot is an injection that's given into a muscle (intramuscular), usually in your buttock, thigh, or upper arm. The injection forms a reserve of the medication in your muscle. This is released slowly into your blood over a certain period of time, depending on the dose given. You may have a Lupron Depot injection once a month or once every 3, 4, or 6 months.

You'll start taking Casodex the day you have you first Lupron Depot injection.

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 fit your needs.

Drug forms and strengths

Casodex comes as tablets that you take by mouth. They are only available in one strength: 50 mg.

Dosage for metastatic prostate cancer

The recommended dosage for metastatic prostate cancer is one tablet taken once a day. Keep taking Casodex every day for as long as your doctor recommends.

What if I miss a dose?

If you forget to take a dose, just skip the missed dose and take your next dose at the regular time. Never take a double dose to make up for a missed dose.

To help make sure 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?

Casodex is meant to be used as a long-term treatment. If you and your doctor determine that Casodex is safe and effective for you, you'll likely take it long term. Don't stop taking it without talking to your doctor first.

Other drugs are available that can treat metastatic prostate cancer. Some may be a better fit for you than others. If you're interested in finding an alternative to Casodex, talk with your doctor. They can tell you about other medications that may work well for you.

Examples of other drugs that may be used to treat metastatic prostate cancer include:

  • other hormone therapies, such as:
    • abiraterone (Zytiga, Yonsa)
    • apalutamide (Erleada)
    • degarelix (Firmagon)
    • enzalutamide (Xtandi)
    • flutamide
    • nilutamide (Nilandron)
  • chemotherapy, such as:
    • cabazitaxel (Jevtana)
    • docetaxel (Taxotere)
  • immunotherapy, such as:
    • sipuleucel-T (Provenge)
    • pembrolizumab (Keytruda)

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

Ingredients

Casodex contains the active drug bicalutamide. Xtandi contains the active drug enzalutamide. Both of these drugs are hormone therapies. They work in the same way to block the action of testosterone in your body.

Uses

Casodex is approved to treat stage D2 metastatic prostate cancer. This is a form of advanced prostate cancer that has spread to other parts of the body, such as the pelvis, spine, ribs, or other bones. Casodex is used with another type of hormone therapy called an LHRH analog.

Xtandi is approved to treat castration-resistant prostate cancer. This is prostate cancer for which other medications or surgical treatments that lower testosterone levels are no longer working. Xtandi can be used to treat cancer that's spread to other parts of the body, as well as cancer that hasn't spread.

Xtandi is only approved for men who've had a bilateral orchiectomy (surgery to remove both testicles) or who're taking another type of hormone therapy called an LHRH analog.

Drug forms and administration

Casodex comes as tablets that are taken by mouth once each day. Xtandi comes as capsules that are taken by mouth once each day.

Side effects and risks

Casodex and Xtandi can cause some similar side effects and others that differ. Below are examples of these side effects.

More common side effects

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

  • Can occur with Casodex:
    • pain (back, pelvic, belly, or general)
    • constipation
    • diarrhea
    • infection
    • nausea
    • peripheral edema (fluid retention that causes swollen ankles, feet, legs, or arms)
    • feeling short of breath
    • blood in the urine
    • frequently needing to urinate during the night
    • anemia (low red blood cell count)
  • Can occur with Xtandi:
  • Can occur with both Casodex and Xtandi:
    • hot flashes (suddenly feeling warm and flushed)
    • feeling weak

Serious side effects

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

  • Can occur with Casodex:
  • Can occur with Xtandi:
    • problems with urination
    • posterior reversible encephalopathy syndrome (PRES), which causes swelling in your brain
    • seizures
    • ischemic heart disease (heart disease caused by lack of blood flow to your heart muscle)
    • falls that may lead to bone fractures
  • Can occur with both Casodex and Xtandi:

Effectiveness

Casodex and Xtandi have slightly different FDA-approved uses, but they're both used to treat metastatic prostate cancer.

The use of Casodex and Xtandi in treating metastatic prostate cancer has been directly compared in a clinical study.

Researchers studied men who had castration-resistant metastatic prostate cancer. Xtandi was found to be more effective than Casodex at improving progression-free survival (PFS) in this study. PFS is the length of time a person lives without their cancer getting worse. The average PFS for men who took Xtandi was 9.9 months longer than for men who took Casodex.

Costs

Casodex and Xtandi are both brand-name drugs. There are currently no generic forms of Xtandi, but there is a generic form of Casodex called bicalutamide. Brand-name medications usually cost more than generics.

According to estimates on WellRx.com, Casodex generally costs about the same as Xtandi. Bicalutamide is significantly less expensive than Casodex or Xtandi. The actual price you'll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Casodex and Zytiga are prescribed for similar uses. Below are details of how these medications are alike and different.

Ingredients

Casodex contains the active drug bicalutamide. Zytiga contains the active drug abiraterone acetate. These are both hormone therapies that reduce the action of testosterone in your body. However, they work in different ways. Casodex blocks the action of testosterone in your body, while Zytiga reduces the amount of testosterone that your body makes.

Uses

Casodex is approved to treat stage D2 metastatic prostate cancer. This is a form of advanced prostate cancer that's spread to other parts of the body, such as the pelvis, spine, ribs, or other bones. Casodex is used with another type of hormone therapy called an LHRH analog.

Zytiga is approved to treat metastatic prostate cancer that is:

  • castration-resistant (other medications or surgical treatments that lower testosterone levels are no longer working)
  • high-risk castration-sensitive (the cancer still responds to lowered testosterone levels but requires more aggressive treatment)

Zytiga is only approved for men who've had a bilateral orchiectomy (surgery to remove both testicles) or who're taking another type of hormone therapy called an LHRH analog. Zytiga is used with a corticosteroid drug called prednisone to lower the risk of certain side effects.

Drug forms and administration

Casodex and Zytiga both come as tablets that are taken by mouth once a day.

Side effects and risks

Casodex and Zytiga both reduce the action of testosterone in your body, but they work in different ways. Therefore, these medications can cause some similar side effects and others that differ. Below are examples of these side effects.

More common side effects

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

  • Can occur with Casodex:
    • pain (back, pelvic, belly, or general)
    • feeling weak
    • constipation
    • infection
    • feeling short of breath
    • blood in the urine
    • frequently needing to urinate during the night
  • Can occur with Zytiga:
  • Can occur with both Casodex and Zytiga:
    • hot flashes (suddenly feeling warm and flushed)
    • diarrhea
    • nausea
    • peripheral edema (fluid retention that causes swollen ankles, feet, legs, or arms)
    • anemia (low red blood cell count)

Serious side effects

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

Effectiveness

Casodex and Zytiga have slightly different FDA-approved uses, but they're both used to treat metastatic prostate cancer.

These drugs haven't been directly compared in clinical studies, but studies have found both Casodex and Zytiga to be effective for treating metastatic prostate cancer.

Costs

Casodex and Zytiga are both brand-name drugs. There is a generic form of Casodex (bicalutamide), and a generic form of Zytiga (abiraterone acetate). Brand-name medications usually cost more than generics.

According to estimates on WellRx.com, Casodex is significantly less expensive than Zytiga. Bicalutamide and abiraterone acetate are both significantly less expensive than their brand-name versions. The actual price you'll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

There is no known interaction between Casodex and alcohol. However, if you get side effects such as nausea or diarrhea while taking Casodex, drinking alcohol could make these worse.

Drinking large amounts of alcohol can damage your liver. Casodex can also cause liver problems. It's possible that drinking excessively while taking Casodex might increase the risk of getting liver problems.

Alcohol and Casodex are also both broken down by your liver. If your liver is not working properly, Casodex can build up in your body, which could increase the risk of side effects.

If you drink alcohol, talk with your doctor about how much is safe for you to drink while you're taking Casodex.

Casodex can interact with certain other medications. Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Casodex and other medications

Below is a list of medications that can interact with Casodex. This list does not contain all drugs that may interact with Casodex.

Before taking Casodex, 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.

Casodex and warfarin

Warfarin (Coumadin, Jantoven) is an anticoagulant drug (blood thinner) that's used to treat or prevent blood clots. Casodex can increase the effect of warfarin in your body. This can raise your risk for bleeding.

If you take warfarin, you'll need to have extra blood tests to check how long it takes your blood to clot. This test is called the international normalized ratio (INR). Your INR will be checked when you start taking Casodex and regularly throughout your treatment. Based on your results, your doctor may need to lower your warfarin dose.

Casodex and certain drugs that are broken down in your liver

Certain drugs are broken down in your body by enzymes found in your liver. (Enzymes are protein molecules that speed up chemical reactions.) One important enzyme that's involved in breaking down several different drugs is called CYP3A4.

Casodex can stop the CYP3A4 enzyme from working as well as usual. If you're taking a drug that's normally broken down by this enzyme, Casodex could cause levels of that drug to build up in your body. This can raise your risk for getting side effects.

Examples of drugs that could have an increased risk of side effects when taken with Casodex include:

  • lomitapide (Juxtapid)
  • midazolam

Casodex and herbs and supplements

There aren't any herbs or supplements that have been specifically reported to interact with Casodex. However, you should still check with your doctor or pharmacist before using any of these products while taking Casodex.

Here are answers to some frequently asked questions about Casodex.

Will I have withdrawal symptoms if I stop taking Casodex?

Withdrawal symptoms are negative side effects that can sometimes happen if you stop taking a drug that your body has come to depend on. Stopping Casodex won't cause withdrawal symptoms.

However, in certain situations your doctor might ask you to stop taking Casodex in order to cause an effect called anti-androgen withdrawal. In this case, stopping Casodex actually improves your prostate cancer, rather than causing withdrawal symptoms.

This treatment approach is not right for everyone. If your doctor thinks Casodex has stopped working for you, talk with them about whether stopping treatment could benefit you.

Do older adults have more side effects from Casodex than younger people have?

It's not currently known whether younger people have fewer side effects from Casodex than older adults.

Casodex is only approved to treat prostate cancer, which is a disease that typically affects older men. The American Cancer Society states that the majority of prostate cancer cases occur in men ages 65 years and older. This cancer is rare in men younger than 40 years old. Studies of Casodex use for prostate cancer did not investigate whether age affects how often side effects occur.

Will I have sexual side effects from Casodex?

Possibly. Hormone therapy for prostate cancer blocks the action of testosterone in your body. Therefore, some men may have sexual problems during their treatment.

In clinical studies, 7% of men who took Casodex reported trouble getting an erection. These men were also taking another type of hormone therapy called an LHRH analog.

Talk with your doctor if you get any sexual side effects while taking Casodex. Your doctor may be able to suggest treatments that could help. For example, it may be possible to take medication such as sildenafil (Viagra) to help you get an erection.

If I have diabetes, can I take Casodex?

You may be able to, but it depends on how well your diabetes is managed. Casodex has to be taken with a type of drug called an LHRH analog such as leuprolide acetate (Lupron, Eligard) or goserelin acetate (Zoladex). These drugs can cause high blood sugar levels, which can make your blood sugar harder to manage.

You might need to check your blood sugar more often while taking Casodex. If your blood sugar gets too high, your doctor may increase your dosage of diabetes medication. Or you might need extra medications to manage your blood sugar levels.

If you have diabetes and want to take Casodex, talk with your doctor about the risks and benefits.

As with all medications, the cost of Casodex can vary. To find current prices for Casodex in your area, check out GoodRx.com.

The cost you find on GoodRx.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.

Your insurance plan may require you to get prior authorization before approving coverage for Casodex. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the request and let you and your doctor know if your plan will cover Casodex.

If you're not sure if you'll need to get prior authorization for Casodex, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Casodex, help is available.

Medicine Assistance Tool lists programs that may help lower the cost of Casodex. For more information and to find out if you're eligible for support, visit the program website.

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

When to take

Casodex should be taken once a day. You can take your dose in the morning or the evening, but always take it at the same time of day.

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

Taking Casodex with food

Casodex can be taken either with or without food.

Can Casodex be crushed, split, or chewed?

No, Casodex tablets are meant to be swallowed whole. Do not crush, split, or chew them. If you have trouble taking these tablets, ask your doctor or pharmacist for advice.

Casodex is used to treat stage D2 metastatic prostate cancer.

About metastatic prostate cancer and testosterone

Stage D2 metastatic prostate cancer is a form of advanced prostate cancer that has spread to other parts of the body. This usually includes the pelvis, hips, ribs, or other bones. The cancer spreads when prostate cancer cells travel in the blood or lymphatic system to a different part of the body. The cancer cells in the new site are the same type of cells as those in the prostate gland.

The male hormone testosterone stimulates prostate cancer cells to grow and multiply, wherever they are in your body. It does this by attaching to specific sites called receptors (docking stations) found on the surface of the cancer cells.

About hormone therapy and Casodex

Hormone therapies for prostate cancer work by reducing the action of testosterone on the cancer cells. Some lower the amount of testosterone that your body makes. Others stop testosterone from acting on the cancer cells. When there is less testosterone acting on the cancer cells, this slows and sometimes stops the growth of the cancer.

Casodex contains bicalutamide, which is a type of drug called an androgen receptor inhibitor. It works by attaching to and blocking the testosterone receptors (docking stations) on the cancer cells. This stops testosterone from acting on the cells.

Casodex is used with another type of hormone therapy called a luteinizing hormone-releasing hormone (LHRH) analog. These include drugs such as leuprolide acetate (Lupron, Eligard) and goserelin acetate (Zoladex). LHRH analogs stop your testicles from making testosterone. They lower the amount of testosterone in your body.

The two drugs have a combined effect on your prostate cancer, called combined androgen blockade. It's more effective than taking Casodex on its own.

How long does it take to work?

Casodex will start to block testosterone receptors as soon as you start to take it. However, it's not known how quickly this affects the cancer cells. Each person's cancer is likely to respond slightly differently to the treatment.

Talk with your doctor about when you may start to see results from taking Casodex.

Casodex can harm a developing fetus. It's only approved for use in men and should not be taken by women, especially those who are pregnant.

Casodex can cause changes to a man's sperm. This could result in harm to a fetus if you were to make your partner pregnant while taking Casodex. Taking Casodex can also lower your sperm count and make you infertile (not able to conceive a child through sexual intercourse). It's not known if this is a permanent effect.

If you want to have biological children in the future, talk with your doctor about this before you start taking Casodex. It may be possible to store your sperm.

Casodex can harm a developing fetus. If you're sexually active and your partner can become pregnant, you need to use effective birth control to prevent a pregnancy. You'll need to use birth control the whole time you're taking Casodex and for 130 days after you stop taking it.

It's not known if Casodex passes into breast milk. It's only approved for use in men and should not be taken by women.

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

  • Allergy to bicalutamide or any other ingredients in Casodex. Don't take Casodex if you are allergic to any of its ingredients. These are listed in the patient information leaflet that comes with the medication. If you're unsure whether you've had an allergic reaction to Casodex in the past, talk with your doctor.
  • Diabetes. Casodex is used along with drugs called LHRH analogs, such as leuprolide acetate or goserelin acetate. LHRH analogs canraise your blood sugar levels. If you have diabetes, this can make your blood sugar harder to manage. Talk with your doctor about whether taking Casodex with an LHRH analog is right for you. You may need to monitor your blood sugar more often. Your diabetes treatment may need adjusting if your blood sugar level gets hard to manage.
  • Liver problems. Casodex can cause and worsen liver problems. Your doctor will do blood tests to check how well your liver is working before you start Casodex. These tests will be repeated regularly throughout your treatment. If you have problems with your liver that get worse while taking Casodex, you may need to stop taking it.
  • A partner who is or could get pregnant. Casodex can cause harm to a fetus if taken by a pregnant woman. Casodex can also cause changes to your sperm that may harm the fetus if you were to make your partner pregnant during treatment. For more information, see the "Casodex and pregnancy" section above.

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

Do not use more Casodex than your doctor recommends.

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 Casodex 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 that the medication is effective 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.

Casodex 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 bathrooms.

Disposal

If you no longer need to take Casodex 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

Casodex 50 mg daily is approved to treat metastatic prostate cancer, stage D2. It's approved for use in combination with a luteinizing hormone-releasing hormone (LHRH) analog.

Casodex 150 mg daily is not approved or available in the United States, either for use with other treatments or for use alone.

Current guidelines from the National Comprehensive Cancer Network state that anti-androgen monotherapy is not recommended for castration-naive metastatic prostate cancer. This is because it is less effective than castration (medical or surgical).

Mechanism of action

Casodex is an anti-androgen that contains bicalutamide as the active ingredient. Bicalutamide is a nonsteroidal androgen receptor inhibitor. It blocks androgens such as testosterone from binding to androgen receptors on prostate cancer cells. This reduces the tumor-stimulating effect of circulating testosterone.

Casodex must be used with an LHRH analog, which reduces the production of testosterone by the testicles and lowers circulating testosterone levels. This approach is known as combined androgen blockade (CAB). It slows and sometimes stops the growth and spread of prostate cancer.

Pharmacokinetics and metabolism

After oral administration of Casodex, bicalutamide is well absorbed. Food does not affect absorption. Bicalutamide is 96% bound to plasma proteins.

Bicalutamide is stereospecific, with the R-enantiomer producing the active effect, while the S-enantiomer is inactive. Both enantiomers are hepatically metabolized, followed by clearance via the urine and feces.

The active enantiomer has a mean half-life of 5.8 days.

Contraindications

Casodex is contraindicated in:

  • men with hypersensitivity to any ingredient of the tablets
  • women
  • pregnancy

Storage

Casodex tablets should be stored at room temperature (68°F to 77°F/20°C to 25°C).

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