Apo-Bicalutamide (CA), Casodex, Dom-Bicalutamide (CA), Gen-Bicalutamide (CA), Novo-Bicalutamide (CA), PHL-Bicalutamide (CA), PMS-Bicalutamide (CA), Ratio-Bicalutamide (CA), Sandoz Bicalutamide (CA)

Pharmacologic class: Nonsteroidal antiandrogen

Therapeutic class: Antineoplastic

Pregnancy risk category X


Antagonizes effects of androgen at cellular level by binding to androgen receptors on target tissues


Tablets: 50 mg

Indications and dosages

Metastatic prostate cancer

Adults: 50 mg P.O. once daily


• Hypersensitivity to drug

• Women who are or may become pregnant


Use cautiously in:

• previous hypersensitivity or serious adverse reaction to flutamide or nilutamide

• moderate to severe hepatic impairment

• children.


• Know that drug is given in combination with luteinizing hormone-releasing hormone (LHRH).

• Administer at same time each day.

Adverse reactions

CNS: headache, weakness, dizziness, depression, hypertonia, paresthesia, lethargy

CV: chest pain, peripheral edema, vasodilation, hypertension, thromboembolic disease

EENT: pharyngitis, bronchitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, anorexia, dry mouth

GU: urinary tract infection, impotence

Musculoskeletal: bone and back pain

Respiratory: dyspnea, cough

Skin: rash, alopecia

Other: food distaste, weight gain, edema, pain, hot flashes, flulike symptoms


Drug-drug. Warfarin: increased bicalutamide effects

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, cholesterol, BUN, creatinine: increased levels

Hemoglobin, white blood cells: decreased values

Patient monitoring

• Monitor prostate-significant antigen levels, CBC, and liver and kidney function test results.

• If patient is receiving warfarin concurrently, evaluate prothrombin time and International Normalized Ratio.

Patient teaching

• Instruct patient to take drug at same time each day, along with prescribed LHRH analog.

• Tell patient that any drug-related hair loss should reverse once therapy ends.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.


(bye-ka-loot-a-mide) ,


(trade name)


Therapeutic: antineoplastics
Pharmacologic: antiandrogens
Pregnancy Category: X


Treatment of metastatic prostate carcinoma in conjunction with luteinizing hormone–releasing hormone (LHRH) analogs (goserelin, leuprolide).


Antagonizes the effects of androgen at the cellular level.

Therapeutic effects

Decreased spread of prostate carcinoma.


Absorption: Well absorbed after oral administration.
Distribution: Unknown.
Protein Binding: 96%.
Metabolism and Excretion: Mostly metabolized by the liver.
Half-life: 5.8 days.

Time/action profile (blood levels)

POunknown31.3 hrunknown


Contraindicated in: Hypersensitivity;Women.
Use Cautiously in: Moderate to severe liver impairment; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • weakness (most frequent)
  • dizziness
  • headache
  • insomnia


  • dyspnea


  • chest pain
  • hypertension
  • peripheral edema


  • hepatotoxicity (life-threatening)
  • constipation (most frequent)
  • diarrhea (most frequent)
  • nausea (most frequent)
  • abdominal pain
  • ↑ liver enzymes
  • vomiting


  • hematuria
  • erectile dysfunction
  • incontinence
  • nocturia
  • urinary tract infections


  • alopecia
  • rashes
  • sweating


  • breast pain (most frequent)
  • gynecomastia (most frequent)


  • anemia


  • hyperglycemia
  • weight loss


  • back pain (most frequent)
  • pelvic pain (most frequent)
  • bone pain


  • paresthesia


  • generalized pain (most frequent)
  • hot flashes (most frequent)
  • flu-like syndrome
  • infection


Drug-Drug interaction

May ↑ the effect of warfarin.


Oral (Adults) 50 mg once daily (must be given concurrently with LHRH analog or following surgical castration).

Availability (generic available)

Tablets: 50 mg

Nursing implications

Nursing assessment

  • Assess patient for adverse GI effects. Diarrhea is the most common cause of discontinuation of therapy.
  • Lab Test Considerations: Monitor serum prostate-specific antigen (PSA) periodically to determine response to therapy. If levels rise, assess patient for disease progression. May require periodic LHRH analogue administration without bicalutamide.
    • Monitor serum transaminases before, regularly during the first 4 mo of therapy, and periodically during therapy. May cause ↑ serum alkaline phosphatase, AST, ALT, and bilirubin concentrations. If patient is jaundice or if transaminases ↑ >2 times normal, bicalutamide should be discontinued; levels usually return to normal after discontinuation.
    • May cause ↑ BUN and serum creatinine, and ↓ hemoglobin and WBCs.
    • May cause ↓ glucose tolerance in males taking LHRH agonists concurrently; monitor blood glucose in patients receiving bicalutamide in combination with LHRH agonists.

Potential Nursing Diagnoses

Diarrhea (Adverse Reactions)


  • Start treatment with bicalutamide at the same time as LHRH analogue.
  • Oral: May be administered in the morning or evening, without regard to food.

Patient/Family Teaching

  • Instruct patient to take bicalutamide along with the LHRH analog as directed at the same time each day. If a dose is missed, omit and take the next dose at regular time; do not double doses. Do not discontinue without consulting health care professional.
  • Advise patient to stop taking bicalutamide and notify health care professional immediately of symptoms of liver dysfunction (nausea, vomiting, abdominal pain, fatigue, anorexia, "flu-like" symptoms, dark urine, jaundice, or right upper quadrant tenderness).
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any new medications.
  • Instruct patient to report severe or persistent diarrhea.
  • Discuss with patient the possibility of hair loss. Explore methods of coping.
  • Emphasize the importance of regular follow-up exams and blood tests to determine progress; monitor for side effects.

Evaluation/Desired Outcomes

  • Decreased spread of prostate carcinoma.


a trademark for an anticancer chemotherapy agent (bicalutamide).


An oral non-steroidal antiandrogenic used to manage prostate cancer and hirsutism.

Adverse effects
Breast tenderness, gynaecomastia, hot flushes, gastrointestinal disorders, diarrhoea, nausea, elevated transaminases, jaundice, asthenia, pruritus.
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8220;I have changed my diet to a strict organic vegan diet and have responded well to hormone drugs Lupron and Casodex.
Purchase drugs Casodex and Seroquel in various dosages for the ASL of Milan.
Comparative effects of chronic administration of the non-steroidal antiandrogens flutamide and Casodex on the reproductive system of the adult male rat.
However this tremendous discrepancy in price does not simply include basic pain relief, but also antibiotics such as Dalacin and Augmentin, cancer medication such as Casodex and Suprefact, along with anti-depression medication such as Xanax and Lexotanil, among others.
Mr Marshall told the jury the prescription-only drugs involved were Zyprexa, a medicine to treat schizophrenia and bipolar disorder with a registered trademark belonging to Eli Lilly pharmaceutical company; Casodex, an AstraZeneca-owned product used to treat advanced prostate cancer; and Plavix, which is prescribed to treat ischemic heart disease, and with a registered trademark owned by Sanofi-aventis.
All five also face charges of selling or supplying Casodex and Plavix without a marketing authorisation and of selling or distributing counterfeit Casodex and Plavix.
We also use pharmaceutical agents with known anticancer activity, including COX-2 inhibitors such as Celebrex, Metformin, Noscapine, Disulfram, LDN (low-dose naltrexone), sodium phenylbutyrate, tetrathiomolybdate, and rapamycin, as well as Lupron, Casodex, Avodart, and Proscar.
Sales of cancer drugs Arimidex and Casodex, which last year had combined revenue of $3 billion, declined 80% and 79% respectively in the U.