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
• Know that drug is given in combination with luteinizing hormone-releasing hormone (LHRH).
• Administer at same time each day.
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
• 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.
• 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.
Time/action profile (blood levels)
Adverse Reactions/Side Effects
Central nervous system
- weakness (most frequent)
- chest pain
- peripheral edema
- hepatotoxicity (life-threatening)
- constipation (most frequent)
- diarrhea (most frequent)
- nausea (most frequent)
- abdominal pain
- ↑ liver enzymes
- erectile dysfunction
- urinary tract infections
- breast pain (most frequent)
- gynecomastia (most frequent)
- weight loss
- back pain (most frequent)
- pelvic pain (most frequent)
- bone pain
- generalized pain (most frequent)
- hot flashes (most frequent)
- flu-like syndrome
Drug-Drug interactionMay ↑ the effect of warfarin.
Availability (generic available)
- 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 DiagnosesDiarrhea (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.
- 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.
- Decreased spread of prostate carcinoma.
bicalutamideAn oral non-steroidal antiandrogenic used to manage prostate cancer and hirsutism.
Breast tenderness, gynaecomastia, hot flushes, gastrointestinal disorders, diarrhoea, nausea, elevated transaminases, jaundice, asthenia, pruritus.