Bicalutamide (Casodex®)

Last Modified: February 5, 2007

Bicalutamide (bye ka loo' ta mide)
Other Name: Casodex®

How it is given: Bicalutamide belongs to a group of drugs known as nonsteroidal antiandrogens. Taken once a day in tablet form, it is usually given with a type of drug called an LHRH analog. The LHRH analog is injected either monthly or every 3 months. This combination treatment is called combined androgen blockade (CAB).

How it works: Bicalutamide blocks the action of male hormones (androgens) on prostate cancer cells to prevent these cells from growing.

Side Effects and Precautions

Tests of liver function may be necessary when taking bicalutamide. Bicalutamide and an LHRH analog should be started at the same time. Neither drug should be stopped without first talking with your doctor.

  • Drug Interactions:
    Let your doctor know if you?re taking the drug warfarin (Coumadin®) or any other anticoagulant (blood thinner) for your heart. Your doctor may want to give you periodic blood tests and adjust the dosage of warfarin while you?re receiving bicalutamide.
The side effects of bicalutamide differ, depending on whether it is given with an LHRH analog (which it usually is) or given alone.

  • Side Effects of Bicalutamide Given Alone

    • Sudden rushes of body heat causing reddening of the skin and sweating (hot flashes)
      Uncomfortable but not dangerous; may disturb sleep.
      What to do: Ask your doctor about medications that can be taken to relieve the discomfort of hot flashes.

    • Abnormal enlargement of the breasts (gynecomastia) and breast pain
      Usually begins several months after starting treatment with bicalutamide. In most cases, gynecomastia is mild and no treatment is needed.
      What to do: Ask your doctor about medications or radiation treatments to the breast that can prevent or relieve gynecomastia and breast pain caused by bicalutamide treatment. A spandex undershirt may also relieve the discomfort.

    • Gastrointestinal effects (nausea/vomiting, diarrhea/constipation)
      These are less common adverse effects of bicalutamide treatment.
      What to do: Ask your doctor about medications that can treat these adverse effects if they persist after the first week or two. Eating small amounts of food during the day, instead of three larger meals, may help to reduce nausea. Increasing fluid intake and eating bland foods may help if you experience diarrhea. Avoid eating sweet, fatty, salty, or spicy foods.

    • Pain
      Generalized pain and back pain sometimes result from bicalutamide treatment.
      What to do: If your pain is significant, ask your doctor about prescription and over-the-counter medications.

  • Side Effects of Bicalutamide Given With an LHRH Analog

    • Decreased sex drive (loss of libido) and inability to have an erection (impotence)
      These are common adverse effects when bicalutamide and an LHRH analog are given together as combined androgen blockade (CAB).
      What to do: If your sexual desire decreases while taking these medications, there are no treatments that can restore it to normal while the drugs are still being taken. However, there are a number of treatment approaches that can improve sexual functioning. Ask your doctor about them if you experience impotence while receiving bicalutamide/LHRH treatment.


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