Bicalutamide

What Is Bicalutamide?

Bicalutamide is a prescription medicine that belongs to a drug class called nonsteroidal antiandrogens (also called androgen receptor blockers). It is taken by mouth and blocks the effects of male hormones, called androgens, on prostate cancer cells. It is sold under the brand name Casodex, and generic versions are also available.

Approved Uses

In the United States, bicalutamide 50 mg is FDA-approved for use together with a luteinizing hormone-releasing hormone (LHRH) medicine, such as leuprolide or goserelin, to treat advanced (metastatic) prostate cancer. This combination is often called combined androgen blockade.

Bicalutamide is not approved in the United States to be used alone for prostate cancer. Approved uses and strengths can differ in other countries.

Other Prescribed Uses

Specialists sometimes prescribe bicalutamide for conditions or in ways that are not listed on the FDA label. These decisions are individual and are made by an experienced specialist. This guide does not recommend use for any condition that is not FDA-approved. Bicalutamide is not indicated for use in women or children.

Available Formulations and Strengths

• Oral tablets: Bicalutamide 50mg (the strength available in the United States)

Other strengths may be sold in other countries. There is no approved cream, injection, or liquid form in the United States.

What Is the Recommended Dosage of Bicalutamide?

There is no single dose that fits everyone. Your specialist decides the dose and treatment plan based on:

• The stage of the cancer and treatment goals
• Other prostate cancer treatments being used, such as an LHRH medicine, radiation, or surgery
• Liver function: people with liver problems need closer monitoring, and the medicine may need to be stopped if liver tests become abnormal
• Other health conditions, including diabetes and heart conditions
• Other medicines being taken, especially warfarin

Available Dosage Forms

Bicalutamide comes only as a tablet. It is usually taken by mouth once a day at about the same time each day, with or without food. It is normally taken together with the LHRH medicine, and treatment is often long term.

Follow Your Specialist’s Instructions

Doses and treatment length are set by your specialist. Take bicalutamide exactly as prescribed. Do not change the dose or stop the medicine on your own, even if you feel well. Keep taking your LHRH medicine on schedule as well.

How Bicalutamide Works

Prostate cancer cells often depend on male hormones (androgens, such as testosterone) to grow. Bicalutamide attaches to the receptors that androgens normally bind to, which blocks the hormone signal in cancer cells.

• In combination treatment, an LHRH medicine lowers the amount of testosterone made by the body, and bicalutamide blocks the effect of the androgens that remain.
• When first starting an LHRH medicine, testosterone can briefly rise (called a “flare”). Bicalutamide is often started at the same time to help block this effect.

Bicalutamide helps control prostate cancer. It does not cure it. The cancer may eventually stop responding to hormone treatment, and other treatments may then be considered.

Is a Prescription Required to Buy Bicalutamide Online?

Yes. Bicalutamide is a prescription-only medicine. It should be started and monitored by a licensed medical specialist, such as:

• A urologist
• A medical oncologist
• A radiation oncologist (if radiation is part of the plan)

Buying Medicine Safely

• Use only licensed pharmacies that require a valid prescription.
• Be cautious of websites that sell bicalutamide without a prescription. Products from these sources may be counterfeit, expired, contaminated, or the wrong strength.
• Do not use veterinary products or products from unverified sellers.
• If you are unsure whether a pharmacy is legitimate, ask your specialist, your local pharmacist, or your country’s pharmacy regulator.

Side Effects of Bicalutamide

Not everyone has side effects. Many are related to lowering the effect of male hormones and may also come from the LHRH medicine used with it. Tell your care team about any new or bothersome symptoms.

Common Side Effects

• Hot flashes
• Breast tenderness or breast enlargement (gynecomastia)
• Tiredness or weakness
• Nausea, diarrhea, or constipation
• Back pain or pelvic pain
• Need to urinate at night
• Reduced sex drive or erectile problems
• Dizziness
• Swelling in the legs or feet
• Mild anemia (low red blood cells)
• Abnormal liver blood tests (often found only on lab work)
• Skin rash or itching

Serious Side Effects

• Liver injury: Signs include yellowing of the skin or eyes, dark urine, right-sided abdominal pain, severe itching, or unusual tiredness. Serious and, rarely, fatal liver problems have been reported.
• Lung problems: Interstitial lung disease (inflammation and scarring of the lungs) has been reported. Symptoms include new or worsening shortness of breath or cough.
• Severe allergic reactions, including swelling of the face, lips, or throat
• Sun sensitivity, including skin reactions after sun exposure
• High blood sugar or loss of blood sugar control in people with diabetes when used with an LHRH medicine
• Heart rhythm changes: Some hormone treatments can affect the heart’s electrical activity (QT prolongation).
• Bone thinning from long-term hormone treatment
• Bleeding or bruising problems when taken with warfarin

When to Get Medical Help Right Away

Contact your specialist or seek emergency care if you have:

• Yellow skin or eyes, or dark urine
• Severe stomach pain, nausea, or itching that will not go away
• New or worsening shortness of breath or cough
• Swelling of the face, lips, or throat, or trouble breathing
• Chest pain, fainting, or a racing or irregular heartbeat
• Unusual bleeding or bruising
• A severe skin reaction or blistering

Drug Interactions

Bicalutamide can interact with other medicines. Some interactions may need extra monitoring.

Major Interaction Categories

• Warfarin (blood thinner): Bicalutamide may raise the effect of warfarin and increase bleeding risk. Blood clotting tests (INR) need close monitoring.
• LHRH medicines (leuprolide, goserelin, and others): These are used together with bicalutamide on purpose. Your care team manages the combination.
• Medicines that affect heart rhythm (QT-prolonging medicines): Examples include some antiarrhythmic medicines, certain antibiotics, methadone, and some antipsychotic medicines. Using them together may add to the risk of heart rhythm problems.
• Medicines processed by certain liver enzymes: Bicalutamide may raise levels of some medicines, such as midazolam. Medicines that strongly affect the same enzymes may also change bicalutamide levels.
• Other medicines that can affect the liver: These may need extra monitoring.

Over-the-Counter Medicines

Ask a pharmacist or specialist before using OTC products, including pain relievers such as acetaminophen (which can affect the liver at high doses) and aspirin or ibuprofen (which can raise bleeding risk with warfarin).

Supplements and Herbal Products

Some supplements and herbal products may affect the liver or hormones. Products that claim to change hormone levels should be avoided unless your specialist approves. Do not start any product without checking first.

Share a Full Medication List

Give your licensed medical specialist a complete list of everything you take, including prescription medicines, OTC medicines, supplements, and herbal products. Update the list whenever anything changes.

Safety & Important Considerations

Liver Precautions

Liver blood tests are usually checked before treatment, regularly during the first months, and then as directed. Your specialist may stop bicalutamide if liver tests become too high or if you develop signs of liver injury. People with existing liver disease need extra caution.

Kidney Considerations

People with kidney problems do not usually need dose changes, but your specialist will decide if any monitoring is needed.

Lung Precautions

Report any new or worsening cough or shortness of breath right away. Lung problems may need treatment to be stopped.

Diabetes and Blood Sugar

Hormone treatment can affect blood sugar control. If you have diabetes, your team may check your blood sugar more often.

Heart and Bone Health

Long-term hormone treatment may raise the risk of heart problems and thin the bones. Your team may recommend heart-healthy habits, bone density tests, calcium and vitamin D, or other steps.

Pregnancy and Fertility

• Bicalutamide is not for use by women, and it can harm an unborn baby. Women who are or could be pregnant should avoid handling crushed or broken tablets.
• Bicalutamide and hormone therapy can lower sperm counts and may affect fertility. Talk with your specialist about family planning and any fertility options, such as sperm storage, before treatment.

Children and Older Adults

• Children: Bicalutamide is not indicated for use in children.
• Older adults: Most people treated for prostate cancer are older. Doses are usually not changed for age, but older adults may be more sensitive to some side effects and may have other medicines to consider.

Monitoring

Expect regular visits, PSA blood tests (to follow the cancer), liver tests, and, if needed, tests of blood sugar, blood counts, and bone health. If you take warfarin, expect INR checks. Do not skip these visits.

Sun Protection

Bicalutamide has been linked to sun sensitivity. Use sunscreen, wear protective clothing, and limit sun exposure.

Who This Medication Is For

Bicalutamide is prescribed for men who need treatment for prostate cancer that a specialist has decided it can help manage.

• FDA-approved indication: Advanced (metastatic) prostate cancer, in combination with an LHRH medicine.
• Other uses: Some specialists prescribe it for other conditions or settings based on clinical judgment.

Whether it is right for a particular person depends on the stage of the cancer, liver health, other health conditions, other medicines, and other treatment options.

Who Should Not Take Bicalutamide

Tell your specialist before starting if any of the following apply.

• Allergy: You have had a serious allergic reaction to bicalutamide or any ingredient in the tablet.
• Women: Bicalutamide is not for use in women, especially those who are pregnant.
• Liver disease: Extra caution is needed, and it may not be safe if liver disease is severe.
• History of lung disease or breathing problems: Report any changes right away.
• Taking warfarin: Close monitoring is needed.
• Heart rhythm problems or medicines that affect heart rhythm: Extra caution is needed.
• Diabetes: Blood sugar may need closer monitoring.

Your specialist will review the full list of precautions in the current FDA labeling for your product.

What to Do If You Miss a Dose

• If you miss a dose, take it as soon as you remember.
• If it is almost time for your next dose, skip the missed dose and go back to your regular schedule.
• Never take a double dose to make up for a missed one.
• Keep taking your LHRH medicine on schedule, and tell your care team if you miss doses of either medicine.
• If you are unsure what to do, or you miss more than one dose, contact your licensed medical specialist or pharmacist for guidance.
• Use a pill organizer, phone alarm, or dose log to help stay on schedule.

Related medications to Bicalutamide

The right alternative depends on the stage of the cancer and other factors. Examples of options that may be used in similar situations include:

• Other antiandrogens in the same class: Flutamide and nilutamide.
• Newer androgen receptor inhibitors: Enzalutamide, apalutamide, and darolutamide.
• Other hormone treatments: LHRH agonists (such as leuprolide, goserelin, and triptorelin), LHRH antagonists (such as degarelix and relugolix), and abiraterone (used with a steroid).
• Other treatments: Chemotherapy, radiation therapy, surgery, and other targeted or radioactive therapies, depending on the situation.

These options differ in how they work, their side effects, and their monitoring needs. Do not switch or stop treatment on your own. Any change should be made only after talking with your licensed medical specialist.

Storage Instructions

• Temperature: Store tablets at room temperature, generally between 68°F and 77°F (20°C to 25°C), unless the label says otherwise.
• Moisture and light: Keep tablets in the original tightly closed container, away from moisture (avoid bathrooms) and direct light and heat.
• Child safety: Keep all medicines locked or out of reach and sight of children and pets. Use child-resistant caps.
• Disposal: Do not throw away unused medicine in household trash unless instructed. Ask your pharmacist about safe disposal, or use a medicine take-back program.

Disclaimer:

This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Patients must consult a licensed medical specialist, such as a urologist or oncologist, before starting, changing, or stopping treatment. Treatment decisions must be based on a full clinical evaluation by a qualified specialist. If you think you are having a medical emergency, call your local emergency number right away.