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Enzalutamide (Xtandi®)

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OncoLink
Last Modified: September 16, 2012

About Enzalutamide

Most prostate cancers need supplies of the male hormone testosterone to grow. Testosterone is an androgen (hormone) produced by the testes and adrenal glands. The production of testosterone can be stopped by surgically removing the testicles or through medication therapy. Anti-androgen medications (also called nonsteroidal anti-androgens) work by blocking testosterone receptors on the prostate cells, and therefore preventing testosterone from attaching to the receptors on the surface of the prostate cancer cells. Without testosterone, the cancer cells may either grow more slowly, or stop growing altogether.

How to Take Enzalutamide

Enzalutamide is given as a capsule, taken once a day, preferably at the same time each day. Take the capsule whole, do not break, open, dissolve or chew them.

The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: grapefruit, grapefruit juice, dexamethasone, ketoconazole, rifampin, phenytoin, St. John’s wort, and modafanil. Be sure to tell your healthcare provider about all medications and supplements you take.

Possible Side Effects of Enzalutamide

There are a number of things you can do to manage the side effects of Enzalutamide. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Seizure

In clinical trials, some patients experienced a seizure. You should avoid activities where a sudden loss of consciousness could cause serious harm to you or others. Contact your oncology team right away if you experience a seizure.

Hot Flashes

Most men find that hot flashes decrease after a period of time on the medication. There are a few things you can do to help with hot flashes. Several medications have been studied, including some low doses of antidepressants (such as venlafaxine and Paxil), and certain hormone therapies (medroxyprogesterone acetate and cyproterone acetate). Non-medical recommendations include: keeping well-hydrated with eight glasses of water daily, wearing all-natural fiber clothes, dressing in layers, exercising on a regular basis (generally walking exercise is best), practicing relaxation exercises, and avoiding triggers such as warm rooms, spicy foods, caffeinated beverages, nicotine and alcohol.

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4 F), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bath daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your doctor or nurse before scheduling dental appointments or procedures.
• Ask your doctor or nurse before you, or someone you live with, has any vaccinations.

For more suggestions, read the Neutropenia Tip Sheet.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Fatigue

While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.

Muscle or Joint Pain/Aches and Headache

Your doctor or nurse can recommend medication and other strategies to relive pain. Also view OncoLink's page on pain management.

Reproductive Concerns

This medication may be harmful to a developing fetus. Men should use a condom if having intercourse with a pregnant woman. Effective birth control should be used if having intercourse with a woman of child-bearing potential during treatment and for 3 months after treatment with enzalutamide.

Other Side Effects

This medication may cause dizziness, weakness, confusion and falls. Additional side effects include: swelling in the feet and ankles and high blood pressure.