Casodex (Bicalutamide)

What is Casodex used for
Casodex (bicalutamide) is a non-steroidal anti-androgen used in combination with luteinising hormone-releasing hormone (LHRH) analogues for the treatment of advanced prostate cancer. It works by blocking the action of androgens (male hormones), which fuel the growth of prostate cancer cells.
Brand Name: Casodex
Generic Name: Bicalutamide
Strengths Available: 50 mg tablets
Form: Oral tablet
Drug Class: Non-steroidal Anti-Androgen

Prescription Status: Prescription-only (Rx)

Manufacturer: AstraZeneca
Bicalutamide 50 mg

Bicalutamide is a selective androgen receptor inhibitor used primarily in hormone therapy for prostate cancer.
Generic Name: Bicalutamide
Calutide

Bicalu

BICANAT

Bicalon

Bicason

Cosalon

BICAMED

Casodex binds to androgen receptors in prostate cancer cells, thereby blocking testosterone and dihydrotestosterone (DHT) from stimulating cancer cell growth.

Suppresses androgenic activity without lowering testosterone levels

Used as monotherapy or in combination with LHRH analogues or orchiectomy
Advanced Prostate Cancer (in combination with LHRH analogues)

Locally advanced non-metastatic prostate cancer (as monotherapy in specific cases)

Investigational use in hirsutism, androgen excess, and female acne (off-label)
50 mg once daily, with or without food

Start simultaneously with LHRH analogue OR

Start 3 days prior to chemical or surgical castration
Take at the same time each day

Swallow whole with water

Do not stop without physician consultation
No dose adjustment required for elderly or renally impaired patients

Hepatic impairment: Use with caution; monitor liver enzymes

Duration: Usually continued as long as clinical benefit is observed
Pregnancy Category: X – Contraindicated

Lactation: Not indicated for female use

Fertility: May reduce sperm count and fertility

Driving: May cause drowsiness or dizziness

Monitoring: Liver function tests (LFTs), PSA levels
Common Side Effects Serious Side Effects
Hot flashes, breast tenderness Hepatotoxicity (elevated liver enzymes)
Decreased libido, impotence Interstitial lung disease (rare)
Gynecomastia Cardiac QT prolongation (rare)
Fatigue, weakness Severe allergic reactions
Nausea, diarrhea Hematuria, anemia

Hepatic toxicity: Monitor liver enzymes during first 6 months

Gynecomastia and breast pain: Common during therapy

Not for female or pediatric use

Anti-androgen withdrawal syndrome: PSA may rise after discontinuation

Use in combination therapy only unless otherwise specified by oncologist
Pharmacologic Class: Non-Steroidal Anti-Androgen

ATC Code: L02BB03

Legal Category: Schedule H Prescription Drug

Pregnancy Category: X (Contraindicated)
Interacting Drug Interaction / Risk
Warfarin May increase INR – monitor coagulation closely
Cytochrome P450 3A4 substrates Bicalutamide inhibits CYP3A4 enzymes
Midazolam, Fentanyl Enhanced sedative effects
Terfenadine, Cisapride QT prolongation risk
Alcohol May worsen dizziness or hot flashes
EORTC Trial 30986 (2000s): Confirmed Casodex efficacy in combination with LHRH analogues

TOAD Trial (2016): Delayed Casodex use linked to progression in localized disease

Cochrane Review (2015): Casodex demonstrated comparable effectiveness to orchidectomy in combination therapy with LHRH analogues

Frequently Asked Questions (FAQs)
Q1: What is Casodex used to treat?
Casodex is used to treat advanced prostate cancer, typically in combination with other hormone therapies like LHRH analogues.

Q2: How does Casodex work?
Casodex blocks the androgen receptors on prostate cancer cells, preventing male hormones like testosterone from fueling tumor growth.

Q3: How long can I take Casodex?
Casodex is usually prescribed for long-term use in advanced prostate cancer unless side effects occur or cancer progresses.
Q4: Can Casodex cause liver problems?
Yes. Liver function should be monitored as Casodex can increase liver enzymes or rarely cause liver injury.
Q5: Is Casodex effective on its own?
Casodex is usually more effective when used with an LHRH analogue or after surgical castration. However, in select patients, it may be used as monotherapy.
Store below 30°C
Protect from light and moisture
Keep out of reach of children
Do not use past expiry date on pack
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