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Bicalutamide (Casodex®)

OncoLink Team
Last Modified: August 5, 2015

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

About Bicalutamide

Most prostate cancers need a supply 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 comes in tablet form, and is taken once a day, preferably at the same time each day. Bicalutamide can be taken with or without food. If you miss a dose, take your next dose at your regular time.  Do not take two doses at the same time.  Bicalutamide may be given in combination with other medications, such as LHRH agonists.

Storage and Handling

Store this medication at room temperature, in the original container. If you prefer to use a pillbox, discuss this with your oncology pharmacist. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.

Where do I get this medication?

Bicalultamide is available through retail/mail order pharmacy and specialty pharmacies. Your oncology team will work with your prescription drug plan to identify an in-network retail/mail order pharmacy for medication distribution. 

Insurance Information

This medication may be covered under your prescription drug plan.  This medication may also be available at a low cost through Rx Outreach for those who meet financial qualifications.

Possible Side Effects

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

There are a few things you can do to help with hot flashes. Several medications have been shown to help with symptoms, including clonidine (a blood pressure medication), low doses of certain antidepressants (such as venlafaxine and Prozac), and gabapentin. Non-medical recommendations include:

  • Keep well-hydrated with eight glasses of water daily.
  • Drink ice water or apply an ice pack at the onset of a hot flash.
  • Wear cotton or lightweight, breathable fabrics and dress in layers so you can adjust as needed.
  • Exercise on a regular basis.
  • Try practicing meditation or relaxation exercises to manage stress, which can be a trigger.
  • Avoid triggers such as warm rooms, spicy foods, caffeinated beverages, and alcohol.

Muscle or Joint Pain/Aches and Headache

Bicalutamide can cause joint or muscle aches and pains, which can interfere with quality of life. Be sure to talk to your oncology team if you develop this side effect.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.

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.

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. Weight bearing exercise and a healthy diet rich in calcium and vitamin D can also help protect your bone health. 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.

Urinary Problems

This medication can cause increased frequency of urination, urinary retention, urinary incontinence, and blood in the urine. Talk to your healthcare team if your experience these symptoms.

Liver Toxicity

This medication can cause liver toxicity, which your doctor may monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown or pain in your abdomen, as these can be signs of liver toxicity.

Mood Changes

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 are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation.

Nausea and/or Vomiting

Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. 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.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Lung Concerns

Patients can develop an inflammation of the lungs (called interstitial lung disease) while taking this medication. Notify your healthcare provider right away if you develop any new or worsening symptoms, including shortness of breath, trouble breathing, cough or fever.

Other Side Effects

Some men experience weight gain, for which exercise and dietary changes may be helpful. Some patients report memory problems and while this is unlikely to improve while on treatment, you can find ways to help you cope.

When taken in combination with LHRH agonists (goserelin, leuprolide, degarelix), this medication can cause difficulties with your body’s ability to control glucose, which can result in high blood sugars or the development of diabetes. Your oncology team may monitor your blood sugar periodically.

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 you are not producing sperm. 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.


If you have questions or concerns about the medication that you have been prescribed, please contact your healthcare team. OncoLink is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through OncoLink should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider.


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