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Bicalutamide (Casodex®)

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OncoLink
Last Modified: August 21, 2011

Pronounced: bye-ka-LO-ta-mide
Classification: Nonsteroidal Antiandrogen

About Bicalutamide

Most prostate cancers need supplies of the male hormone testosterone to grow. Testosterone is an androgen (hormone) produced by the testes and adrenal glands. Bicalutamide works 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 Bicalutamide

Bicalutamide is given as a tablet, taken once a day, preferably at the same time each day. Bicalutamide can be taken with or without food. Bicalutamide may be given in combination with other medications, such as LHRH agonists.

Possible Side Effects of Bicalutamide

There are a number of things you can do to manage the side effects of Bicalutamide. 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:

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, nicotiene and alcohol.

Sexual and Reproductive Changes

This drug can affect your reproductive system, resulting in sperm production becoming irregular or stopping permanently. In addition, you may experience erectile dysfunction or a decreased desire for sex during treatment. Talk to your urologist about options for treating erectile dysfunction.

Exposure of an unborn child to this medication could cause birth defects, so you should not father a child while on this medication. Effective birth control is necessary during treatment, even if you believe your sperm is affected. You may want to consider sperm banking if you may wish to have a child in the future. Discuss these options with your oncology team. See OncoLink's section on sexuality for helpful tips for dealing with these side effects.

Breast Tenderness or Increase in Breast Tissue

An increase in breast tissue (gynecomastia) or breast tenderness may develop. Your healthcare team can suggest medications to relieve the tenderness. In rare cases, radiation can be given to relieve severe tenderness.

Nausea and/or Vomiting

Eating a light meal prior to the dose may be helpful in reducing nausea. Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.

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.

Weakening of the bones (osteoporosis)

Men who take hormone therapy for extended periods of time are at risk for bone thinning (osteoporosis). You may be advised to take calcium and vitamin D supplements to help prevent bone loss. You may have a bone density scan (DEXA scan) to assess your bone health. If your physician determines that you are at high risk of developing osteoporosis, they may recommend additional treatment with a type of medication called a bisphosphonate to help strengthen the bones. Learn more about bone health after cancer therapy.

Other Side Effects

Some men experience weight gain, for which exercise and dietary changes may be helpful. You may experience memory problems and while this is unlikely to improve while on treatment, you can find ways to help you cope. Some men report mood swings and depression while on hormone therapy. It can be helpful to talk about concerns and feelings with a partner or close friend. If you find that feelings of sadness are interfering with life, talk with your team about finding a counselor experienced in working with cancer patients.

There have been reports of diarrhea, constipation and dry skin. Blood tests evaluating liver function may become elevated, but this was found to not be harmful and they will return to normal when the medication is stopped.