Bicalutamide | Side Effects, Dosage, Uses & More
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Generic Name:

bicalutamide, Oral tablet

All Brands

  • Casodex
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Highlights for bicalutamide

Oral tablet
1

Bicalutamide is used to treat prostate cancer that has spread to other parts of your body. It’s used in combination with another drug. This drug is called a luteinizing hormone-releasing hormone (LH-RH) analogue.

2

Bicalutamide comes in the form of a tablet you take by mouth.

3

Bicalutamide is available as the brand-name drug Casodex. It’s also available as a generic drug.

4

The more common side effects of this drug include breast enlargement and breast pain. They also include hot flashes, weakness, constipation, infection, nausea, and pain in your back, pelvis, or stomach.

5

Bicalutamide raises your risk of liver problems, including liver failure. These problems may require treatment in a hospital and they may be fatal (cause death).

IMPORTANT INFORMATION

Liver problems

This drug raises your risk of liver problems, including liver failure. These problems may require treatment in a hospital, and they may be fatal (cause death). Your doctor will likely do blood tests to check how well your liver works before and during your treatment. Tell your doctor right away if you have any symptoms of liver problems, including:

  • yellowing of your skin or the whites of your eyes
  • dark-colored urine
  • pain in the right upper part of your abdomen
  • nausea
  • vomiting
  • tiredness
  • loss of appetite
  • fever
  • chills

Breast changes and pain

This drug may cause enlarged breasts and breast pain.

What is bicalutamide?

Bicalutamide is a prescription drug. It’s available as a tablet you take by mouth.

Bicalutamide is available as the brand-name drug Casodex. It’s also available as a generic drug. Generic drugs usually cost less. In some cases they may not be available in every strength or dosage form as the brand. 

You’ll take this drug with another type of drug called a luteinizing hormone-releasing hormone (LH-RH) analogue.

Why it's used

Bicalutamide is used to treat stage D2 prostate cancer that is metastatic (has spread to other parts of your body).

How it works

Bicalutamide belongs to a class of drugs called androgen receptor inhibitors.

More Details

How it works

Bicalutamide belongs to a class of drugs called androgen receptor inhibitors. A class of drugs refers to medications that work similarly. They have a similar chemical structure and are often used to treat similar conditions.

Prostate cancer is an androgen-sensitive cancer. This type of cancer needs high levels of androgens to grow. Androgens are hormones such as testosterone and androsterone.

Bicalutamide works by binding to androgen receptors on the cancer cells. As a result, the androgens can’t attach to the receptors. This blocks the action of the androgens and stops your cancer from growing.

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bicalutamide Side Effects

Oral tablet

More Common Side Effects

The more common side effects that can occur with bicalutamide taken with an LH-RH analogue include:

  • hot flashes (short periods of sweating and feeling very warm)

  • whole body pain

  • pain in your back, pelvis, and abdomen

  • weakness

  • constipation

  • infection

  • nausea

  • swelling in your ankles, legs, or feet

  • diarrhea

  • blood in your urine

  • waking from sleep at night to urinate

  • anemia (decreased number of red blood cells)

  • dizziness

  • breast pain or enlargement

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Liver problems or liver failure. Symptoms can include:

    • yellowing of your skin and whites of your eyes
    • dark-colored urine
    • pain in the right upper part of your abdomen
    • nausea
    • vomiting
    • tiredness
    • loss of appetite
    • fever
    • chills
  • Trouble breathing with or without a cough or fever. Bicalutamide can cause an inflammation in the lungs called interstitial lung disease. Your risk is higher if you take a dose greater than 50 mg.

  • Allergic reaction. Symptoms can include:

    • itchy skin
    • hives (raised bumps)
    • swelling of your face, lips, tongue, or throat
    • trouble swallowing
  • High blood sugar levels. Symptoms may include:

    • urinating more often than usual
    • intense thirst
    • intense hunger even when you have eaten
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug may cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
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bicalutamide May Interact with Other Medications

Oral tablet

Bicalutamide can interact with other medications, herbs, or vitamins you might be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Medications that might interact with this drug

Interactions that increase your risk of side effects
  • Side effects from other drugs: Taking bicalutamide with certain medications raises your risk of side effects from these drugs. Examples of these drugs include:
    • Midazolam, donepezil, and colchicine. Bicalutamide can increase the levels of these drugs in your body. This can raise your risk of side effects from these medications. Your doctor will monitor you closely if you take any of these drugs with bicalutamide.

Interactions that can make your drugs less effective
  • When other drugs are less effective: When certain drugs are used with bicalutamide, they may not work as well. This is because the amount of these drugs in your body may be decreased. Examples of these drugs include: 
    • Blood thinners, such as warfarin. Bicalutamide can keep blood thinners from working well. Your doctor will likely monitor you closely if you take any of these drugs with bicalutamide. Your doctor may adjust your warfarin dose.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Drug warnings
liver disease
People with liver disease

This drug is broken down by your liver. If your liver doesn’t work as well as it should, this drug may build up in your body. Your doctor will likely do blood tests to check how well your liver works before and during your treatment. They may do these tests every month for the first 4 months of your treatment, and from time to time during the rest of your treatment.

diabetes
People with diabetes

Your doctor may ask you to test your blood sugar levels more often. This drug is used with an LH-RH analogue. These medications can reduce your body’s glucose tolerance. This means that your body is less able to use sugar from your blood. This effect leads to high blood sugar levels.

for seniors
For seniors

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. Your doctor may monitor you more closely for signs of any side effects from this drug.

for children
For children

The safety and effectiveness of this drug haven’t been established in people younger than 18 years of age.

contact with drug
Contact with drug

This drug can be absorbed through your skin if you touch it. If you’re a woman who is pregnant or plans to become pregnant soon, you should not touch this drug. This drug can cause birth defects.

allergies
Allergies

This drug can cause a severe allergic reaction. Symptoms may include:

  • itching
  • hives (raised bumps)
  • swelling of your face, lips, or tongue
  • trouble breathing or swelling of your throat

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room. 

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

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How to Take bicalutamide (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Prostate cancer

Generic: bicalutamide

Form: Oral tablet
Strengths: 50 mg

Brand: Casodex

Form: Oral tablet
Strengths: 50 mg
Adult dosage (ages 18–64 years)
  • Take one 50-mg tablet by mouth once per day, in the morning or evening.
  • You’ll take this drug with a luteinizing hormone-releasing hormone analogue.
Child dosage (ages 0–17 years)

This drug has not been shown to be safe and effective for use in people younger than 18 years of age.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all

Your cancer may get worse.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away. 

What to do if you miss a dose

Take only the next dose at your regular time. Don’t take two doses to try to make up for the missed dose. Doing so could cause harmful side effects.

How to tell if the drug is working

During your treatment with this drug, your doctor may do blood tests that measure your prostate-specific antigen (PSA). PSA is a hormone produced by your prostate. These tests will tell your doctor if this drug is working to treat your cancer.

This drug is a long-term drug treatment.

Store this drug carefully

  • Store this drug at room temperature between 68oF and 77oF (20oC and 25oC).
  • Don’t store this medication in moist or damp areas, such as bathrooms.

A prescription for this medication is not refillable

You or your pharmacy will have to contact your doctor for a new prescription if you need this medication refilled.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.
  • If you’re traveling to a warm climate, keep this drug in air conditioning. Keep it in a tightly closed container, away from heat and moisture. 

Self-management

Don’t stop taking this drug unless your doctor tells you to.

Clinical monitoring

Your doctor may check certain health issues before and during your treatment with this drug. This can help make sure you stay safe while you take this drug. These issues include:

  • Prostate-specific antigen (PSA) level. Your doctor may do a blood test to check your prostate.
  • Liver function. Your doctor will likely do blood tests to check how well your liver is working.
  • Blood sugar levels. Your doctor will check your blood sugar levels. This is because the LH-RH analogue you will take with this drug can raise these levels.

Sun sensitivity

This drug can make your skin more sensitive to the sun. You should avoid direct exposure to sunlight or ultraviolet light. Wear sunscreen and protective clothing when you’re outside.

Not every pharmacy stocks this drug

When filling your prescription, be sure to call ahead. Your pharmacy may be able to order this drug for you with advanced notice.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor may need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about other drug options that may work for you.

What does the pill look like?

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How Much Does bicalutamide Cost?

Oral tablet

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These prices represent the lowest priced national pharmacies for bicalutamide on GoodRx. They may be lower than your insurance.

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on March 18, 2016

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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