Bicalutamide (Casodex®)

Bicalutamide is a hormonal therapy drug used to treat prostate cancer. It is best to read this information with our general information about hormonal therapies and the type of cancer you have.

Bicalutamide is given as tablets. Your cancer doctor, nurse or pharmacist will tell you how often you will have it.

Like all cancer drugs, bicalutamide can cause side effects. Some of the side effects can be serious, so it is important to read the detailed information below.

Your healthcare team can give you advice on how to manage any side effects. Tell your doctor or nurse straight away if you feel unwell or have severe side effects, including any we do not mention here.

Rarely, side effects may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is bicalutamide?

Bicalutamide is a hormonal therapy drug used to treat prostate cancer. It can be given alone or with other types of treatment.

It is best to read this information with our general information about hormonal therapies and the type of cancer you have.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.


How bicalutamide works

Hormones are chemicals that our bodies make. Hormones act as messengers and help control how cells and organs work. Hormonal therapies are drugs that change the way hormones are made or how they work in the body.

Most prostate cancers need the hormone testosterone to grow. Almost all testosterone in men is made by the testicles. A very small amount is made by the adrenal glands above the kidneys.

Bicalutamide blocks testosterone from reaching the cancer cells. It can be given alone or with other hormonal therapies. It can be given with treatment, such as radiotherapy. Your doctor or nurse will explain how long you should take it for.

Sometimes bicalutamide is used for a short time when you start other hormonal therapy drugs such as:

These drugs can temporarily increase your testosterone levels for a few weeks. This can make symptoms caused by the cancer worse for a short time. This is called tumour flare. Your doctor may give you bicalutamide to take before and during the first few weeks of these treatments to prevent this from happening.


Taking bicalutamide tablets

Bicalutamide comes as tablets you can take at home. Your nurse or doctor will talk to you about your treatment plan.

You usually take bicalutamide once a day. Always take the tablets exactly as explained. This is important to make sure they work as well as possible for you. Make sure you:

  • swallow them whole with a glass of water
  • take them at the same time every day.

If you forget to take the tablets, you should take the missed dose as soon as possible within the same day. If a full day has passed, let your doctor or nurse know. Do not take a double dose unless your doctor tells you to.

Other things to remember about your tablets:

  • Keep them in the original package and at room temperature, away from heat and direct sunlight.
  • Keep them safe and out of sight and reach of children.
  • If you are sick just after taking the tablets, contact your healthcare team. Do not take another dose.
  • Get a new prescription before you run out of tablets, and make sure you have plenty for holidays.
  • If your treatment is stopped, return any unused tablets to the pharmacist.

Your nurse or pharmacist may also give you other medicines to take home. Take all your medicines exactly as they have been explained to you. Do not stop taking any of your medicines unless your doctor tells you to.


About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we haven’t listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.


Common side effects

Hot flushes and sweats

These are common. During a flush, your neck and face may feel warm and look red. Flushes can last for a few seconds or for up to 10 minutes. You may have sweats 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:

  • Wear clothes made from natural fabrics, such as cotton.
  • Dress in layers of clothes that you can remove as needed.
  • Use cotton sheets and have layers of bedding.
  • Keep the room temperature cool or use a fan.
  • Have cold drinks rather than hot ones. Try to avoid drinks with caffeine in them.

You may have fewer hot flushes and sweats as your body adjusts to hormonal treatment. Or your doctor can prescribe drugs to help. Some people continue to have flushes and sweats, but they usually stop a few months after treatment finishes.

You can read more about coping with hot flushes and managing hormonal symptoms in our information on prostate cancer.

Breast swelling or tenderness

This treatment can cause swelling and tenderness of your breast tissue. This is called gynaecomastia. Your doctor can give you advice on how this can be prevented or treated.

Sexual effects

Most men lose their sex drive and have erection difficulties during hormonal therapy. Things often return to normal after you stop taking the drug, but some men continue to have difficulties after treatment is over.

Your doctor can prescribe treatments to help with erection difficulties. But these treatments will not increase sex drive.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Skin changes

This treatment may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. The treatment may cause a rash, which may be itchy.

Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

Some people are more sensitive to the sun during treatment. If this happens your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30. You should cover up with clothing and a hat.

Weight gain and loss of muscle strength

You may gain weight, particularly around your waist, and you may lose some muscle strength. Eating a healthy diet and exercising regularly can help control your weight. Resistance exercises, such as lifting weights, may help you to reduce the loss of muscle strength. Ask your doctor or nurse for advice.

Feeling sick

You may feel sick when you are having this treatment. This is usually mild. If you feel sick, your doctor can give you tablets to help. It may also help to take your bicalutamide tablets with food.

Constipation

This treatment can cause constipation. Here are some tips that may help:

  • drink at least 2 litres (3½ pints) of fluids each day
  • eat high-fibre foods, such as fruit, vegetables and wholemeal bread
  • do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Tummy or back pain

You may get pain or discomfort in your tummy area (abdomen) or back. You may also feel bloated or have indigestion or wind. Peppermint capsules, mint tea or charcoal tablets may help with indigestion or wind. Tell your doctor if your symptoms do not improve or if they get worse. They can give you drugs to help.

Dizziness or drowsiness

Tell your doctor or nurse if you have either of these symptoms. It’s important not to drive or operate machinery if you feel this way.

Hair changes

Your hair may become thinner while taking this treatment. This is usually mild. Ask your nurse for advice if this is a problem for you. Some men notice their hair gets thicker during treatment.

Mood changes

Some people have mood changes and feel low or depressed when having this treatment. Let your doctor or nurse know if you notice any changes. There are professionals, who are trained to help you manage your feelings.

Blood in your urine

You may have blood in your urine while taking bicalutamide. Tell your doctor or nurse if you notice this.

Effects on the liver

This treatment may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.

An image of a clinical oncologist talking to a nurse

Cancer and eating playlist

Watch our videos about cancer, eating and managing your diet during treatment. (This playlist includes British Sign Language interpretations.)

Cancer and eating playlist

Watch our videos about cancer, eating and managing your diet during treatment. (This playlist includes British Sign Language interpretations.)

I had a lady in whose husband was going through cancer treatment and was having problems with dry skin. So I talked her through the options and recommended a moisturiser for men.

Jay, Boots Macmillan Beauty Advisor


Less common side effects

Allergic reaction

Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

  • feeling hot or flushed
  • a skin rash
  • itching
  • shivering
  • feeling dizzy
  • a headache
  • feeling breathless.

If you feel unwell or have any of these signs, tell a doctor or nurse straight away. Do not take any more of this treatment until you have spoken to them.

Breathlessness

Rarely, bicalutamide can cause breathlessness or a cough. This may be caused by changes to the lung tissue or an infection. If you have these symptoms it is very important to tell your doctor straight away.


Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain. 

If you have any of these symptoms, contact a doctor straight away. 

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Fertility

Some drugs can affect whether you can father a child.

There may be ways to preserve your fertility. If you are worried about this, it is important to talk with your doctor before you start treatment.

Other medicines

Some medicines can affect the hormonal treatment or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Lactose

These tablets contain a type of sugar called lactose. If you have been told by a doctor that you cannot digest some sugars or are lactose intolerant, talk to your doctor before taking this drug.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.