Casodex (Bicalutamide)

Casodex Review

This medicine is an anti-androgen, used in combination with another medicine to treat prostate cancer. This medicine is not intended for use in women. Casodex may interact with warfarin (Coumadin). Therefore, the dose of Coumadin may need to be adjusted.

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Casodex Drug Class and Mechanism

Bicalutamide is an oral medication that is used for treating cancer of the prostate. It belongs to a class of drugs called anti-androgens which includes flutamide (Eulexin) and nilutamide (Nilandron). Androgens (an example of which is testosterone) are hormones that are produced and released by the adrenal glands. They are responsible for supporting (stimulating) tissues that primarily are thought of as male, for example, the male prostate gland. Male traits that also are influenced by androgens include facial and body hair and small breasts. Anti-androgens prevent the action of androgens by blocking the receptors for androgens on the cells of tissues, for example, the cells of the prostate gland. In addition to normal prostate cells, androgens also have been shown to stimulate the growth of cancer cells within the prostate. Bicalutamide is thought to prevent the growth of prostate cancer by blocking the effects of androgens on the cancer cells.

Casodex Uses

Bicalutamide (marketed as Casodex, Cosudex, Calutide, Kalumid) is an oral non-steroidal anti-androgen for prostate cancer. It was first launched in 1995 as a combination treatment (with surgical or medical castration) for advanced prostate cancer and subsequently launched as monotherapy for the treatment of earlier stages of the disease. Casodex should be taken as one 50mg tablet in the morning or the evening at the same time each day. It may be taken with or without food. Once bicalutamide therapy has begun, it should not be interrupted or stopped without consulting a physician.

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Casodex Side Effects

When bicalutamide and a gonadotrophin releasing factor analog are given together, the most common side effect is hot flashes (50% of patients) and facial flushing. Alcohol may worsen this reaction, and so it should be cautiously consumed. Other common side effects of the combination are diarrhea, constipation and overall pain including pain in the back, hips and stomach. Less common side effects are breast enlargement and breast pain, which may be due to the bicalutamide alone.

Casodex Pregnancy

CASODEX has no indication for women, and should not be used in this population, particularly for non-serious or non-life threatening conditions. Further, CASODEX should not be used by women who are or may become pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. CASODEX may cause fetal harm when administered to pregnant women.

Casodex Overdose

Long-term clinical trials have been conducted with dosages up to 200 mg of CASODEX daily and these dosages have been well tolerated. A single dose of CASODEX that results in symptoms of an overdose considered to be life-threatening has not been established. There is no specific antidote; treatment of an overdose should be symptomatic. In the management of an overdose with CASODEX, vomiting may be induced if the patient is alert. It should be remembered that, in this patient population, multiple drugs may have been taken. Dialysis is not likely to be helpful since CASODEX is highly protein bound and is extensively metabolized. General supportive care, including frequent monitoring of vital signs and close observation of the patient, is indicated.

Casodex More Information

Patients should be informed that therapy with CASODEX and the LHRH analogue should be initiated concomitantly, and that they should not interrupt or stop taking these medications without consulting their physician. Treatment with CASODEX should be started at the same time as treatment with an LHRH analogue.