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.
References in periodicals archive ?
During the 10 years that he led the Oncology Clinical team, he was responsible for bringing a number of oncology products to market, including Zoladex, Casodex, Arimidex, Tomudex and Faslodex, as well as leading the Phase III program for the novel antipsychotic, Seroquel.
The new treatment is a member of the antiandrogen family of drugs, called Casodex, which has been developed by AstraZeneca.
In 2019 the top three brands in terms of forecast sales will be Arimidex, Lupron (leuprolide; Takeda/Abbott) and Casodex (bicalutamide; AstraZeneca).
Current therapies Androgen inhibitors overview Zytiga (abiraterone acetate; Johnson & Johnson) Xtandi (enzalutamide; Medivation/Astellas) Cytotoxic therapies overview Taxotere (docetaxel; Sanofi) Jevtana (cabazitaxel; Sanofi) Hormonal therapy overview Lupron (leuprolide acetate; Takeda/Abbott) Casodex (bicalutamide; AstraZeneca) Nilandron (nilutamide; Sanofi/Astellas) Eulexin (flutamide; Merck & Co.
The market is currently driven by the use of hormonal therapies, which are prescribed mainly for advanced hormone-dependent PCA, and include AstraZeneca's Zoladex (goserelin) and Casodex (bicalutamide), Abbott/Takeda's Lupron/Lupron Depot (leuprolide subcutaneous injection or intramuscular depot) and sanofi-aventis/Astellas Pharma's Eligard (leuprolide subcutaneous depot).
In 2008, Arimidex (anastrozole; AstraZeneca), Lupron (leuprolide; Takeda/Abbott) and Casodex (bicalutamide; AstraZeneca) were the three leading antihormonal brands in terms of sales.
Arimidex, Lupron and Casodex will remain the top 3 antihormonal brands in 10 years' time 61
The company is facing a number of challenges as it enters 2009, most notably generic competition to Toprol-XL, Nexium, Casodex and Pulmicort.
Product Forecasts Zytiga (abiraterone acetate; Johnson & Johnson) forecast Xtandi (enzalutamide; Medivation/Astellas) forecast Taxotere (docetaxel; Sanofi) forecast Jevtana (cabazitaxel; Sanofi) forecast Provenge (sipuleucel-T; Dendreon) forecast Casodex (bicalutamide; AstraZeneca) forecast Lupron (leuprolide acetate; Takeda/Abbvie) forecast Bone metastases therapies forecast Pipeline therapy forecasts
Safety concerns with AstraZeneca's Casodex (bicalutamide) have also seen a significant proportion of physicians switching to alternatives.
Safety concerns with AstraZeneca`s Casodex (bicalutamide) have also seen a significant proportion of physicians switching to alternatives.
As a result of market dominance by agents such as leuprolide, and AstraZeneca's Zoladex (goserelin) and Casodex (bicalutamide), there is little space in the antihormonal therapies market for new competition unless significant clinical superiority or a unique selling point is demonstrated.