Casodex (Bicalutamide) - Oral

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What Is Casodex?

Casodex (bicalutamide) is an oral medication used to treat prostate cancer that has spread to other areas of the body (metastatic). An antiandrogen therapy, Casodex is given in combination with another medication called a luteinizing hormone-release hormone (LHRH) agonist.

It works by blocking testosterone, a male sex hormone that is also known as an androgen, from binding to androgen receptors. Testosterone can stimulate the growth of prostate cancer cells. By blocking the action of testosterone in the body, Casodex helps slow or stop the cancer.

Drug Facts

  • Generic Name: Bicalutamide
  • Brand Name(s): Casodex
  • Administration Route(s): Oral
  • Drug Availability: Prescription
  • Therapeutic Classification: Antiandrogen
  • Available Generically: Yes
  • Controlled Substance: N/A
  • Active Ingredient: Bicalutamide
  • Dosage Form(s): Tablet

What Is Casodex Used For?

The Food and Drug Administration approved Casodex to treat metastatic prostate cancer. Casodex must be used in combination with an LHRH agonist (e.g., goserelin or leuprolide).

How to Take Casodex

Take Casodex once a day, in the morning or evening, and around the same time each day. It can be taken with food or on an empty stomach.

Storage

Casodex should be stored at room temperature, between 68 F and 72 F.

How Long Does Casodex Take to Work?

It can’t be predicted how long it will take hormone therapy to be effective in treating your prostate cancer. Your healthcare provider will check your progress at regular visits.

What Are the Side Effects of Casodex?

This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.

People who take Casodex for metastatic prostate cancer may have side effects from the medication. Contact your healthcare provider if you have side effects that worsen or don't go away.

Common Side Effects

Common side effects of Casodex can include:

  • Hot flashes
  • Fatigue
  • Body pain (typically in the back, abdomen, and pelvis)
  • Infection
  • Constipation
  • Muscle weakness
  • Shortness of breath
  • Nausea
  • Swelling in the hands, ankles, or feet
  • Diarrhea
  • Increased urination at night
  • Blood in the urine
  • Anemia (low red blood cells)
  • Gynecomastia (enlarged breast tissue in men)

Severe Side Effects

Though not common, there are some severe side effects associated with taking Casodex.

Casodex can cause liver injury, which can present with symptoms including:

  • Abdominal pain
  • Nausea
  • Yellowing of the eyes (jaundice)
  • Dark urine
  • Elevated liver enzymes in blood testing

Other serious side effects can include elevated blood sugar and bleeding in people also taking warfarin, a blood thinner.

Call your healthcare team right away if you have any severe side effects. If the side effects are life-threatening or you’re having a medical emergency, call 911 or go to the nearest emergency room right away.

Report Side Effects

Casodex may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting Program or by phone (1-800-332-1088).

Dosage: How Much Casodex Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (tablets):

For prostate cancer:

  • Adults—50 milligrams (mg) once a day, in the morning or in the evening.
  • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of Casodex, take it at the next scheduled time. Do not take a double dose to make up for a missed dose.

Overdose: What Happens If I Take Too Much Casodex?

Studies have shown no severe effects associated with high daily doses of Casodex. However, it is important to contact your healthcare provider or call Poison Control at 800-222-1222 if you think you may have overdosed on Casodex.

What Happens If I Overdose On Casodex?

f you think you or someone else may have overdosed on Casodex, call a healthcare provider or the Poison Control Center (1-800-222-1222).

If someone collapses or isn't breathing after taking Casodex, call 911 immediately.

Precautions

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It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Women who are pregnant or may become pregnant should not use bicalutamide tablets. Using this medicine while you are pregnant can harm your unborn baby. It may also cause birth defects if the father is using it when his sexual partner becomes pregnant. Male patients who have female partners should use effective birth control during treatment with this medicine and for 130 days after the last dose. If you think your female partner has become pregnant while using this medicine, tell your doctor right away.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Bicalutamide may cause serious bleeding when you use it together with a blood thinner medicine (eg, warfarin). Talk to your doctor if you have concerns.

This medicine may cause swelling of the breasts (gynecomastia) and breast pain in some patients. If you have questions about this, talk to your doctor.

Using this medicine with an LHRH analog may affect your blood sugar levels. If you notice a change in the results of your blood sugar tests or if you have any questions, check with your doctor.

This medicine may affect the results of the prostate specific antigen (PSA) test, which may be used to detect prostate cancer. Make sure any doctor or dentist who treats you knows that you are using this medicine.

If you plan to have children, talk with your doctor before using this medicine. This medicine may cause some men to become infertile (unable to have children), at least temporarily.

This medicine may make you sleepy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Casodex?

There are a couple of situations in which you should not take Casodex.

Casodex is not indicated for use in females. If you are pregnant, you should not take Casodex, as it can harm your unborn baby. You should also not use Casodex if you are allergic to the medication. Symptoms of an allergic reaction can include:

  • Itching
  • Swelling
  • Hives
  • Trouble breathing or swallowing
  • Swelling of the face, lips, or tongue

What Other Medications Interact With Casodex?

Casodex should be used cautiously in people taking the blood thinner warfarin, as the combination can cause increased bleeding. Your provider may adjust your warfarin dose.

What Medications Are Similar?

Casodex is not the only drug in its class. Flutamide (Eulexin) and nilutamide (Nilandron) are other antiandrogen therapies that are also available.

There are also second-generation antiandrogen medications for prostate cancer.

These second-generation medications are more effective than first-generation therapies, such as Casodex, in blocking testosterone:

  • Enzalutamide (Xtandi)
  • Apalutamide (Erleada)
  • Darolutamide (Nubeqa)

Frequently Asked Questions

  • What is Casodex used for?

    Casodex can treat prostate cancer when it is metastatic, meaning it has grown in areas outside of the prostate.

  • How does Casodex work?

    Casodex works by blocking the action of testosterone, preventing it from fueling cancer cell growth.

  • What are the side effects of Casodex?

    Common side effects of Casodex can include:

    • Hot flashes
    • Fatigue
    • Body pain (typically in the back, abdomen, and pelvis)
    • Infection
    • Constipation
    • Muscle weakness
    • Shortness of breath
    • Nausea
    • Swelling in the hands, ankles, or feet
    • Diarrhea
    • Increased urination at night
    • Blood in the urine
  • When do I stop taking Casodex?

    Do not stop taking Casodex unless instructed by your healthcare provider.

How Can I Stay Healthy While Taking Casodex?

It is important to take Casodex as prescribed by your healthcare provider. Hopefully, any side effects you experience are mild and tolerable. However, if you have any concerns about any of the potential side effects of the medication, be sure to reach out to your healthcare team.

Medical Disclaimer

Verywell Health's drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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2 Sources
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  1. Food and Drug Administration. Casodex (bicalutamide) tablets, for oral use. Updated October 2017.

  2. National Cancer Institute. Hormone therapy for prostate cancer. Updated February 22, 2021.