Bicalutamide (Casodex): Uses, Side Effects, and Safety Information

Bicalutamide, known by the brand name Casodex, is an anti-androgen medication used primarily for treating prostate cancer. It works by blocking testosterone’s effects, slowing down the growth of cancer cells.

Common Indications

• Prostate Cancer: Often used in combination with other therapies to manage prostate cancer growth. For the 50 mg formulation, current US prescribing information indicates use in combination with an LHRH (luteinizing hormone-releasing hormone) analog for metastatic prostate cancer. It is not approved as a standalone treatment for this indication.

Dosage and Administration

• Standard Dose: For the 50 mg formulation used together with an LHRH analog, the dose is 50 mg once daily. This is not a universal dose across every bicalutamide formulation or clinical situation — dosing should always follow the specific product prescribed and a doctor’s instructions.
• Route: Oral tablets.
• Missed Dose: If a dose is missed, take it at the next scheduled time — do not take an extra dose to make up for the one missed.

Important Precautions

• Liver function is typically checked before starting treatment, regularly during the first few months, and periodically afterward, since Bicalutamide can, in rare cases, cause serious liver injury. Report any signs of liver problems such as yellowing of the skin or eyes, dark urine, unusual fatigue, or abdominal discomfort to a doctor promptly.
• When combined with an LHRH analog, blood sugar changes (including new or worsening diabetes) have been reported; monitoring blood glucose may be advised, especially in patients with risk factors.
• PSA (prostate-specific antigen) levels are typically monitored during treatment to help assess response and watch for signs of disease progression.
• Rare cases of serious lung problems (interstitial lung disease) have been reported with Bicalutamide use. New or worsening shortness of breath or cough should be reported to a doctor.

Adverse Reactions

Common/clinically relevant effects:

● Hot flashes
● Breast tenderness, enlargement, or gynecomastia
● Nausea
● Diarrhea
● Weakness/fatigue

Serious reactions requiring medical attention:

● Liver injury
● Severe allergic reactions
● Significant bleeding in patients taking coumarin anticoagulants (see Drug Interactions below)

Drug Interactions

Bicalutamide can interact with several other medicines, so it’s important to tell your doctor or pharmacist about everything you’re taking, including:

• Warfarin and other coumarin anticoagulants: Bicalutamide can significantly increase their effect, raising the risk of serious bleeding. Close monitoring of blood clotting (PT/INR) is generally needed, with the anticoagulant dose adjusted as necessary.
• Other medicines broken down by the liver enzyme CYP3A4, such as some medicines metabolized by CYP3A4: Bicalutamide can raise the levels of some of these medicines in the blood, which may need a doctor’s attention.

This is not a complete list always share your full medicine list, including OTC drugs and supplements, with your healthcare provider.

Contraindications

• Bicalutamide is contraindicated in women according to current US prescribing information, including during pregnancy, due to the potential for fetal harm.
• Hypersensitivity: Known allergy to Bicalutamide or any component of the tablet is also a contraindication.

Effect on Organ Function

• Liver: Requires monitoring of liver function, as it may elevate liver enzymes.
• Kidney: According to current prescribing information, renal impairment generally does not require a dosage adjustment. Patients should still inform their doctor about any kidney disease or other medical conditions.

Brand Names (India & US)

• India: Calutide, Caluran. Availability varies by manufacturer, formulation, and location — other bicalutamide brands may also be available; please confirm the specific product with your doctor or pharmacist.
• US: Casodex.

Approximate Price in India

Approximate price in India: ₹350–₹450 per strip of 10 tablets (50 mg). Prices vary by brand, strength, pack size, pharmacy, location, and date.

How HealthPil Can Help

Patients can consult a qualified doctor on HealthPil about their treatment plan, monitoring needs, side effects, and any medication-related concerns involving Bicalutamide. Book a consultation for guidance.