Casodex (bicalutamide) is a non-steroidal antiandrogen medication specifically developed for the treatment of prostate cancer. As part of combination therapy with a luteinizing hormone-releasing hormone (LHRH) analog, it works by competitively inhibiting androgen binding at cellular receptor sites in target tissues. This comprehensive blockade of androgen signaling pathways represents a critical therapeutic approach in managing advanced prostate cancer, particularly in metastatic disease. Clinical evidence supports its role in both localized advanced disease and as part of maximal androgen blockade strategies.

Features

• Contains bicalutamide 50 mg as the active pharmaceutical ingredient
• Non-steroidal antiandrogen with high affinity for androgen receptors
• Oral tablet formulation for convenient administration
• Demonstrated specificity for androgen receptors without intrinsic hormonal activity
• Stable pharmacokinetic profile with once-daily dosing convenience
• Extensive clinical documentation across multiple phase III trials

Benefits

• Effectively suppresses testosterone-mediated tumor growth when combined with LHRH therapy
• Delays disease progression in advanced prostate cancer patients
• Maintains quality of life through oral administration versus injectable alternatives
• Provides predictable androgen receptor blockade with consistent daily dosing
• Supported by long-term clinical data demonstrating survival benefits
• Enables comprehensive hormonal manipulation without additional estrogenic effects

Common use

Casodex is primarily indicated for use in combination therapy with a luteinizing hormone-releasing hormone (LHRH) analog for the treatment of advanced prostate cancer. This includes Stage D2 metastatic carcinoma and locally advanced disease where hormonal manipulation is clinically appropriate. The medication is typically initiated concurrently with LHRH therapy to prevent the clinical flare phenomenon that can occur during the initial phase of LHRH treatment. Medical oncologists and urologists may also consider Casodex in specific neoadjuvant or adjuvant settings, though these uses require careful individual risk-benefit assessment.

Dosage and direction

The standard adult dosage is one 50 mg tablet administered orally once daily, preferably at the same time each day. Administration should begin concurrently with LHRH analog therapy and continue as long as clinically appropriate. Tablets should be swallowed whole with water and may be taken with or without food, though consistency in administration relative to meals is recommended to maintain stable pharmacokinetics. No dosage adjustment is typically required in elderly patients, but hepatic impairment necessitates careful monitoring and potential dosage modification.

Precautions

Regular monitoring of liver function tests is mandatory during treatment, particularly during the first four months of therapy. Patients should be advised about potential hepatotoxicity and instructed to report symptoms including nausea, vomiting, abdominal pain, fatigue, anorexia, flu-like symptoms, dark urine, or jaundice. Periodic bone density assessment may be warranted in patients receiving long-term therapy due to potential effects on bone mineral density. Cardiovascular parameters should be monitored in patients with pre-existing heart conditions. Ophthalmologic examinations are recommended if visual changes occur during treatment.

Contraindications

Casodex is contraindicated in patients with known hypersensitivity to bicalutamide or any component of the formulation. It must not be administered to female patients, particularly those who are or may become pregnant, due to potential teratogenic effects. The medication is contraindicated in patients with severe hepatic impairment unless no alternative therapy exists and benefits clearly outweigh risks. Concomitant use with terfenadine, astemizole, or cisapride is contraindicated due to potential QT prolongation risks.

Possible side effects

Common adverse reactions (≥10% incidence) include hot flashes (49%), pain (general) (29%), asthenia (22%), constipation (22%), nausea (15%), diarrhea (12%), and infection (11%). Hepatic abnormalities may occur, with elevated transaminases reported in approximately 10% of patients. Cardiovascular effects including hypertension (7%) and peripheral edema (6%) have been observed. Less frequently, patients may experience gynecomastia (9%), breast pain (7%), dyspnea (7%), rash (6%), and weight loss (5%). Serious but rare adverse events include hepatotoxicity, interstitial pneumonitis, and thrombocytopenia.

Drug interactions

Casodex is primarily metabolized by CYP3A4 enzymes, creating potential interactions with strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) which may increase bicalutamide exposure. Concurrent warfarin administration requires careful monitoring of prothrombin time due to potential enhancement of anticoagulant effect. Compounds that induce CYP3A4 activity (rifampin, phenytoin, carbamazepine) may decrease bicalutamide concentrations. Caution is advised with medications that prolong QT interval, including certain antiarrhythmics and antipsychotics.

Missed dose

If a dose is missed, the patient should take it as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent daily dosing is important for maintaining stable androgen receptor blockade, so patients should be counseled on adherence strategies and the importance of maintaining the treatment schedule.

Overdose

There is no specific antidote for Casodex overdose. Management should be symptomatic and supportive. In cases of recent ingestion, gastric lavage may be considered. Since bicalutamide is highly protein-bound, dialysis is unlikely to be beneficial. Monitoring of vital signs and hepatic function is recommended. Supportive measures should include assessment of hydration status and management of any gastrointestinal symptoms. Cases of intentional overdose should receive psychiatric evaluation in addition to medical management.

Storage

Store at controlled room temperature between 20°C to 25°C (68°F to 77°F) with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep in the original container with the lid tightly closed to protect from moisture and light. Tablets should not be removed from blister packs until immediately before administration. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Proper disposal of unused medication should follow local regulations for pharmaceutical waste.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions must be made by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for complete information regarding indications, contraindications, warnings, precautions, and adverse reactions. Dosage and administration may vary based on clinical judgment and evolving therapeutic guidelines. Patients should not alter their treatment regimen without medical supervision.

Reviews

Clinical studies demonstrate that Casodex in combination with LHRH analogs provides effective androgen suppression with generally manageable side effects. The 50 mg dosage shows favorable efficacy in advanced prostate cancer management, though individual response may vary. Many clinicians appreciate the convenience of once-daily dosing and the established safety profile. Some reports note the importance of monitoring for hepatic effects, particularly during initial treatment months. Overall, the medication remains a valuable component in the hormonal management of prostate cancer, supported by extensive clinical experience and research data.