Bicalutamide (Casodex ®)
This information is about a hormonal therapy drug called bicalutamide, which is also called Casodex ®. It is used to treat prostate cancer. Throughout this information we refer to it by its more commonly used name, Casodex.
This information describes Casodex, how it is given and some of its possible side effects. It should ideally be read with our general information about prostate cancer.
Casodex is a type of hormonal therapy used to treat prostate cancer.
Hormones are substances produced naturally in the body. They act as chemical messengers and help control the activity of cells and organs. Hormonal therapies work by interfering with the production or action of particular hormones in the body.
You will see your doctor regularly while you have this treatment so they can monitor its effects.
Most prostate cancers need supplies of a hormone called testosterone to grow. Testosterone is produced by the testes and adrenal glands.
Prostate cancer cells have proteins called receptors that sex hormones attach to. Testosterone attaches to these receptors and causes cancer cells to grow.
Casodex has a structure similar to testosterone. It works by preventing testosterone from attaching (binding) to the receptors. Without testosterone the cancer cells either grow more slowly or stop growing altogether. The cancer may shrink in size as a result.
Casodex is a tablet that's taken once a day. It is available in two different strengths: 50mg and 150mg.
Casodex may be used to treat prostate cancer that has begun to spread into the tissues around the prostate gland (locally-advanced prostate cancer). It can either be given on its own or after surgery or radiotherapy.
In prostate cancer that has spread to other parts of the body (called advanced or metastatic cancer), Casodex may be given in combination with injections of another hormonal-therapy drug called a pituitary down-regulator such as goserelin, buserelin, triptorelin or leuprorelin. These drugs block the production of a hormone produced by the pituitary gland (luteinising hormone), which stimulates the production of testosterone.
For men with prostate cancer that is contained within the prostate gland (early prostate cancer), Casodex may be given as a short-term treatment (for a few weeks only) to prevent 'tumour flare'. Tumour flare is a temporary increase in symptoms that can occur when a man first starts treatment with a pituitary down-regulator.
Your doctor will discuss the length of treatment they feel is appropriate for your situation. Casodex is often given for several months or years. Treatment may continue for as long as it is effective in controlling your cancer.
Possible side effects of Casodex
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Each person's reaction to any medicine is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone and may be different if you are having more than one drug.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or nurse.
You may have some of the following side effects, to varying degrees:
Breast tenderness or fullness
Many men may notice breast swelling and tenderness known as gynaecomastia. Your doctor can prescribe medicines or other treatments to reduce any discomfort.
There are a number of ways to help reduce hot flushes and sweats. Some men find it helps to cut down on tea, coffee, nicotine and alcohol. Tell your doctor if hot flushes are causing you any problems, as research suggests that some treatments may help control them.
Some men find that complementary therapies help. Your GP may be able to give you details about having these on the NHS.
You can read more about hot flushes and other hormonal symptoms in our section on prostate cancer and hormonal symptoms.
Skin rash or itching and dryness of the skin
This is usually mild. Let your doctor know if it is a problem for you. Sometimes creams or medicines can reduce this effect.
Feeling sick (nausea)
If you experience any nausea it is usually mild and easily controlled. It can sometimes be relieved by taking the Casodex tablet with food. Let your doctor know if you have any nausea, as they can prescribe medicines to help.
Loss of sex drive (libido) and erection difficulties (impotence) can occur. These usually return to normal after you stop taking the drug. Talk to your doctor or nurse if these effects are a problem, as they can prescribe drugs to help.
Casodex can sometimes cause weakness and lack of energy
You may notice that you gain weight, especially around your waist or chest. Eating a health diet and exercising regularly may help control your weight. You might find our section about weight management helpful.
Some men notice that their hair becomes thinner, but this is usually mild. If this is a problem let your doctor know.
Less common side effects of Casodex
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Some men experience pain, especially in the tummy (abdomen) or the back. Let your doctor know if you develop any new pain as they can give you painkillers.
Your doctor may need to take regular blood tests to make sure Casodex isn't affecting your liver. Tell your doctor if you notice any yellowing of the skin or eyes.
Rarely Casodex can cause breathlessness. If you develop breathlessness while taking Casodex you should let your doctor know as you may need to stop taking it.
Always let your doctor or nurse know about any side effects you have. There are usually ways in which they can be controlled or improved.
Things to remember about Casodex tablets
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Casodex may interact with other medicines, such as drugs to prevent blood clots (anti-coagulants) and some drugs that treat blood pressure and heart conditions. Tell your doctor about any medicines you're taking. This includes non-prescribed drugs such as complementary therapies, vitamins and herbal drugs.
Keep the tablets in a safe place, out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Don't flush them down the toilet or throw them away.
Don't worry if you forget to take your tablet. Do not take a double dose. The levels of the drug in your blood will not change very much, but try not to miss more than one or two tablets in a row.
Remember to get a new prescription a few weeks before you run out of tablets and make sure you have plenty for holidays.
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If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having hormonal treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home.
This information has been compiled using information from a number of reliable sources, including:
British National Formulary. 63rd edition. 2012. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed September 2012).
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
Thank you Jane Depledge, Senior Lecturer; Kavita Kantilal, E-Prescribing Pharmacist; Debbie Wright, Oncology Pharmacist; and all the people affected by cancer who reviewed this information.