Enzalutamide (Xtandi ®)
Enzalutamide (Xtandi ®) is a hormonal therapy drug used to treat prostate cancer that has spread to other parts of the body.
This information describes enzalutamide, how it is given and some of its possible side effects. It’s best to read this with our information about advanced (metastatic) prostate cancer.
Most prostate cancers need a supply of male hormones to grow. These hormones are called androgens. Testosterone is one of the sex hormones and is produced by the testes and the adrenal glands.
Enzalutamide stops the action of male hormones, such as testosterone. It does this by blocking androgen receptors on the surface of prostate cancer cells. As the hormones cannot attach to the receptors, this stops or slows down the growth of the cancer cells.
How enzalutamide is givenBack to top
Enzalutamide is given if you have prostate cancer that has spread to other parts of the body. This is known as advanced (metastatic) prostate cancer. It is used when other hormonal treatments are no longer helping to control prostate cancer.
It may be given:
- after you have had treatment with a chemotherapy drug called docetaxel
- if you have no or few symptoms of prostate cancer and chemotherapy is not yet recommended.
Enzalutamide may only be available in some situations. Your cancer doctor can tell you if it's appropriate for you. Some people may be given it as part of a clinical trial.
If a drug isn’t available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice. We have further information about what to do if a treatment isn’t available.
You take enzalutamide as capsules once a day. Swallow the capsules whole and don’t chew them, as this can affect how they work. Take them at the same time each day. They can be taken with or without food, and before or after food.
Always take your capsules exactly as your nurse or pharmacist explained. This is to make sure they work as well as possible for you. For most people, enzalutamide is taken as four capsules in a single daily dose. Here are some important things to remember when taking your tablets:
- If you forget to take your capsules take them as soon as you remember unless it’s nearly time for your next one. Don’t take a double dose.
- Keep them in the original package at room temperature away from heat and direct sunlight.
- Keep them safe and out of the reach of children.
- Get a new prescription before you run out of capsules and make sure you have enough for holidays
- Return any remaining capsules to the pharmacist if your treatment is stopped.
You can usually carry on having enzalutamide for as long as it is controlling the cancer.
Possible side effects of enzalutamideBack to top
We explain the most common side effects of enzalutamide here. But we don’t include all the rare ones that are unlikely to affect you. You may get some of the side effects we mention, but you are very unlikely to get all of them. If you are having other drugs as well, you may have some side effects that we don’t list here.
Always tell your doctor or nurse about the side effects you have. They can prescribe drugs to help control some of them and give you advice about managing them. Don’t stop taking enzalutamide unless your doctor advises you to.
Serious and life threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
More information about this drug
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).
Hot flushes and sweats
These are common and can be mild or more severe. During a flush, you feel warmth in your neck and face and your skin may redden. Mild flushes last for a few seconds up to about a couple of minutes. More severe flushes can last for 10 minutes or more. You may have sweats and then feel cold and clammy. Some people feel anxious or irritable during a hot flush.
There are things you can do to try to reduce flushes, such as cutting down on nicotine, alcohol and hot drinks that contain caffeine, such as tea and coffee.
If hot flushes are worrying you, your doctor can prescribe drugs to help reduce them.
You may have less hot flushes and sweats as your body adjusts to hormonal treatment.
Feeling very tired is a common side effect of many cancer treatments. If this happens to you, it’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Some men have headaches while taking enzalutamide. It’s important to drink plenty of fluids to help with this. Try to drink around two litres (three and a half pints) per day. Let your doctor know if you have headaches as they can prescribe medicines to help.
High blood pressure (hypertension)
Enzalutamide may cause a rise in blood pressure. Your blood pressure may be checked before you start taking enzalutamide and during the course of your treatment.
Muscle and bone pain
If you have pain in your muscles or bones, tell your doctor. Your doctor can prescribe painkillers to ease this.
You may find that your skin gets dry. Some men develop a skin rash, but this is usually mild and often gets better without treatment. Tell your doctor if you notice any skin changes.
Breast tenderness or fullness
You may sometimes notice slight breast swelling and tenderness, known as gynaecomastia. Your doctor can advise you on how this can be prevented or treated.
You may experience mood swings or feel nervous, which you can talk to your doctor about. Some men may get hallucinations. Let your doctor know if this happens.
Memory and concentration
You may notice changes in your memory or ability to concentrate. Try using a notebook, post it notes and a calendar to help you keep track of things.
Dizziness, blurred vision, drowsiness
Enzalutamide may cause dizziness, blurred vision and drowsiness. Let your doctor know if you have any of these side effects. Don’t drive or operate machinery if you have them.
Dizziness and blurred vision can also increase your risk of falls and broken bones (fractures). If you feel dizzy when walking, you should sit down straight away until it passes. Try to keep areas that you walk through free of clutter and make sure there aren’t things that you could trip over, such as loose rugs.
Make sure rooms are well lit and always put a light on if you get up during the night.
Loss of sex drive (libido) and erection difficulties (impotence) can occur in some men. Let your doctor know if you have any of these side effects, as they may be able to prescribe medication to help.
Less common side effects of enzalutamideBack to top
Risk of infection
Enzalutamide may reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low it’s called neutropenia.
Contact the hospital or your doctor straight away if:
- your temperature goes over 37.5°C (99.5°F) or 38°C (100.4°F) depending on the advice given by your hospital team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
You will have blood tests whilst taking enzalutamide to check the number of white blood cells. If they get too low, your doctor may ask you to stop taking enzalutamide or reduce the dose for a time.
Very rarely, enzalutamide can cause seizures (fits). If you have a seizure, stop taking enzalutamide and see a doctor straight away. Let your doctor know if you are already taking medication for seizures.
It is important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about enzalutamideBack to top
Enzalutamide can interact with several other drugs. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including ones you can buy for yourself, complementary therapies, vitamins and herbal drugs.
It’s not known whether enzalutamide is present in semen. To protect your partner, it’s safest to use a barrier form of contraception while having treatment.
It's not advisable to father a child while taking enzalutamide, as it may harm the developing baby. If your partner is pregnant or of child-bearing age, it’s important to use effective contraception, such as condoms and another form of birth control, while taking this drug and for three months after finishing treatment. You can discuss this with your doctor or nurse.
Medical and dental treatment
If you need to go 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.
Always tell your dentist you are taking enzalutamide.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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