Bicalutamide (Casodex)

At a glance

Bicalutamide is a medicine used in specialist cancer care. Brand names include Casodex. The practical instructions depend on the exact prescription and product supplied.

Your prescription and the instructions for your own product take priority over a general guide. Keep the medicine leaflet as well as your treatment plan, especially if the brand or formulation changes.

You do not need to remember every possible side effect. Start with the administration instructions and the section on urgent help. Most people experience only some of the effects described here. Tell your team about difficulties early: supportive treatment, a planned pause or a different medicine may make treatment easier to continue.

How it works

Bicalutamide blocks the androgen receptor. It prevents androgen signals from having their usual effect on sensitive cancer cells. Depending on the prescription, it may accompany a testosterone-lowering injection or have a different role within the hormone-treatment plan.

Is this treatment suitable for me?

Some patients receive a short course around the start of a GnRH agonist to help protect against an initial hormone flare; others take it longer. The team should make the intended duration clear. Different licensed strengths have different treatment contexts and must not be substituted by assumption.

Your oncologist considers the biology of the cancer, treatments already received, other illnesses and your preferences. The aim may be to reduce the chance of cancer returning, control cancer that is present, or relieve symptoms. Ask which aim applies to you and how benefit will be assessed. The same medicine can be used for different lengths of time in different treatment plans.

A brand name alone does not tell you whether a medicine is suitable. The dose, formulation and other medicines in the plan also matter. Discuss the possible benefits and risks with your care team.

Before treatment

Tell the team about liver disease, diabetes, heart rhythm problems and any use of warfarin or another blood thinner. Discuss breast discomfort or concerns about breast enlargement before a longer course. Baseline liver tests and a complete medicine check are important.

Bring an up-to-date list of prescription medicines, pharmacy medicines, supplements and traditional or herbal remedies. Include medicines used only occasionally, creams containing hormones, and anything recently stopped. Mention previous allergies and describe what happened, rather than only naming the drug. Your pharmacist can check the whole list together.

Tell the team about any planned operation, dental procedure, travel or difficulty attending appointments. Discuss costs and supply before the first dose if obtaining regular refills may be difficult. Agree who will arrange repeat prescriptions and tests. Keep your own hospital's daytime and out-of-hours contact details where you and a caregiver can find them quickly.

How to take or receive treatment

Bicalutamide is taken once daily, with or without food. A 50 mg daily regimen is commonly used with testosterone-lowering treatment; a 150 mg regimen exists in other specialist settings. Use only your prescribed strength. Swallow the tablet with water at a consistent time.

If a dose is missed, skip it and take the next scheduled dose; do not double up. Do not repeat a dose after vomiting without advice. If it was prescribed as a temporary flare-protection course, follow the stated stop date rather than extending it from leftover tablets.

Swallow the medicine as directed for your product. Do not crush, open, dissolve or divide it unless the oncology pharmacist has confirmed a safe method for that exact formulation. Some products have a specific dispersion method; this is different from crushing tablets yourself. Tell the team before starting if swallowing is difficult or you use a feeding tube.

After vomiting a dose, do not automatically take a replacement because some medicine may already have been absorbed. Follow the drug-specific instructions in this section and call the team if vomiting persists. A missed dose and a vomited dose are different situations, so use the relevant rule.

Store tablets or capsules in their labelled packaging, out of children's sight and reach, away from heat and moisture, within the temperature limits on the pack. Keep any drying container supplied in the bottle. Ask before transferring anticancer medicines into an organiser. A caregiver should avoid direct contact with damaged tablets or powder and follow the pharmacy's handling advice; pregnant caregivers should not handle damaged anticancer tablets. Wash hands after handling. Return unwanted doses to a pharmacy rather than putting them into household waste or a drain.

Use a calendar or a phone reminder that records what was actually taken or given. A tick made after a dose is more useful than one made in advance. If someone helps with medicines, agree who records each dose so it is not accidentally repeated. Keep the drug name, strength and current instructions together; an old prescription may no longer describe your current dose.

Contact the treating team if a supply problem or illness is likely to interrupt treatment. Do not stretch the supply by taking smaller doses or lengthening intervals yourself. If you receive too much medicine, seek urgent advice and have the packaging and dose times available. Do not induce vomiting.

Monitoring your treatment

Liver function is checked before treatment, regularly during the first four months, and periodically afterwards, with immediate tests if liver symptoms occur. If you take warfarin, additional clotting tests may be needed after starting or stopping bicalutamide. Blood glucose is particularly relevant with accompanying GnRH treatment.

Monitoring has two purposes: checking whether treatment is helping and detecting problems that may be silent at first. Your schedule depends on the medicine, any partner treatment and your general health. Ask which results need to be reviewed before the next prescription or injection, and who will contact you if a result is abnormal.

Record symptoms that affect eating, walking, sleep or daily activities, along with when they began. Bring this record to appointments. A single symptom or blood result rarely explains the whole picture; the team may compare trends, examination findings and scans. Feeling well is welcome, but it does not remove the need for planned monitoring.

Common side effects

Effects to discuss with your team

Hot flushes, fatigue, nausea, breast tenderness or enlargement, and reduced sexual interest can occur. Breast symptoms can be particularly noticeable with some higher-dose regimens. Mention troublesome symptoms early; preventive or supportive options may be available, depending on the plan.

Lowering or blocking androgen activity can cause hot flushes, reduced interest in sex, erection difficulties and changes in muscle strength or body composition. These effects can arise from the accompanying testosterone-lowering treatment as well as this medicine. Tell your team what matters most to you; advice about sexual health, exercise and symptom control can be part of routine cancer care.

Long-term treatment that reduces testosterone can affect bone strength, blood sugar and cardiovascular health. Discuss fracture risk, weight, blood pressure and diabetes monitoring. Resistance and balance exercises may help maintain function when adapted to your condition. If you have bone involvement, get advice before lifting heavy weights or beginning strenuous exercise.

If your plan includes a separate testosterone-lowering injection, taking a tablet does not usually replace it. Follow the combination schedule exactly. Some patients have had surgery that permanently lowers testosterone, and some specific regimens differ; your team will explain your own plan. A change in PSA should be interpreted alongside symptoms and other assessments, not used as a reason to change treatment yourself.

Making symptoms easier to manage

Tell the team which symptom is causing the most difficulty. Describe its effect on ordinary tasks: for example, whether pain prevents dressing or tiredness stops you preparing food. This helps the team choose practical support and judge whether treatment needs adjustment. Avoid waiting until the next routine visit if symptoms are worsening.

For mild nausea, try smaller meals and regular sips of fluid, following any food rule for the medicine. Ask about an anti-sickness medicine if needed. Repeated vomiting, inability to keep fluids down or very little urine needs prompt advice. If you have been told to restrict fluids for another illness, use that plan rather than forcing extra drinks.

Energy and emotional wellbeing

Pace demanding activities and allow rest, but keep some gentle movement in your day if you can. Persistent exhaustion deserves assessment; poor sleep, anaemia, low mood and other illnesses may contribute. Tell the team about persistent anxiety, sadness or loss of interest. If you feel at risk of harming yourself, seek emergency help and ask someone to stay with you.

Important side effects

The effects below are important because they may require tests or a change in treatment. They are not a prediction that you will develop them. New symptoms can also come from the cancer or an unrelated illness. Reporting them promptly allows the team to work out the cause; do not assume that everything is a routine treatment effect.

Serious liver injury is an important risk. Bicalutamide can increase the effect of coumarin anticoagulants and cause significant bleeding. Rare lung inflammation and severe allergic reactions have been reported. Treatment may also make skin more sensitive to sunlight.

Other medicines and vaccinations

Warfarin requires particular attention, and medicines processed through CYP3A4 or affecting heart rhythm may need review. Do not stop anticoagulation yourself. Use sun protection and avoid excessive ultraviolet exposure. Discuss blood-sugar monitoring if you also receive a GnRH agonist.

Ask the oncology pharmacist to check new medicines before you start them, including antibiotics prescribed elsewhere. Do not stop essential treatment for another illness on your own. If an interaction is possible, the prescribers can choose an alternative, adjust a dose or arrange monitoring. Herbal products labelled natural can still alter drug levels or have hormone-like effects.

Vaccination advice depends on your complete treatment plan. Hormone treatment alone does not automatically mean that every vaccine is unsuitable. Ask about influenza, COVID-19 and other recommended vaccines; live vaccines need a specific check if you also receive chemotherapy, an immune-suppressing medicine or certain doses of steroid. Tell the vaccination service all the treatments you receive.

Everyday life

Food and movement

Aim for regular meals with enough protein and a varied range of foods that you can tolerate. Tell the team about unplanned weight loss, rapid weight gain or difficulty eating. A dietitian can adapt advice to diabetes, kidney problems, bowel symptoms or a restricted appetite. Do not start a restrictive diet or high-dose supplement as a substitute for treatment.

Choose activity that suits your strength and balance. Short walks or gentle exercises may be easier to sustain than occasional strenuous sessions. If cancer affects your bones, or you have osteoporosis, ask which movements and resistance exercises are safe before starting a new programme. New focal bone pain should be assessed rather than exercised through.

Work and travel

Many people continue some usual activities, but flexibility helps while you learn how treatment affects you. Discuss rest breaks, shorter hours or help with physically demanding work if needed. Avoid driving or operating machinery when dizzy, sleepy, confused or affected by visual symptoms. Follow any additional driving advice after a seizure or loss of consciousness.

Plan travel around prescriptions, injections and tests. Carry an up-to-date medicine list and enough supply for the agreed trip, with advice about storage and time-zone changes. For long journeys, discuss mobility and your individual clot risk. Do not start aspirin or a blood thinner simply because you are travelling.

Relationships and support

Changes in energy, body image or sexual function can affect relationships. You can ask for help privately, with or without a partner present. There may be practical measures or specialist support for discomfort and intimacy. A caregiver can help record symptoms and organise appointments while leaving treatment decisions and personal information under your control.

Fertility, pregnancy and breastfeeding

For males with partners who could become pregnant, effective contraception is advised throughout treatment and for a further 130 days after the final tablet. Fertility may be impaired, but treatment is not a reliable contraceptive. Bicalutamide is not intended for use during pregnancy or breastfeeding.

Tell the team before treatment if having children in the future matters to you. Fertility preservation needs discussion before exposure where possible. Reduced fertility is not the same as reliable contraception, and an absence of periods or reduced sexual function does not prove that pregnancy is impossible.

Ask your team which contraception to use and how long to continue it, taking account of every medicine in your regimen. A partner drug may require a longer precaution period than this medicine alone. If pregnancy is suspected in you or a partner during a risk period, contact the treating team promptly for individual advice. Do not make pregnancy or breastfeeding decisions from a generic time interval without checking your own treatment plan.

After treatment

If a short course ends, confirm that the planned injection or other treatment continues. If it is stopped because of liver injury or bleeding, follow-up tests may be necessary. Do not restart without the oncologist's agreement.

Before a planned stop, confirm which medicines end, which continue, and when the next review is due. Return unused medicine through the pharmacy's recommended route; do not give it to another person. Keep a record of the last dose and any side effects that still need follow-up.

Changes caused by treatment may settle gradually, and some need ongoing support. Report persistent symptoms or new problems after treatment rather than assuming they will disappear on their own. Continue the agreed follow-up and screening plan. If treatment is being changed, ask your team to help you update your treatment schedule so that old and new instructions are not accidentally combined.

Common questions