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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


(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.
Drug Guide, © 2015 Farlex and Partners


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.
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.
References in periodicals archive ?
Net revenues from sales of branded pharmaceuticals increased 33% to $14.0 million from $10.5 million in the prior period, primarily due to sales of Arimidex and Casodex, which were launched under ANI's label in July 2018 and sales of Atacand and Atacand HCT, which were launched under ANI's label in October 2018.
Hormone therapy or androgen-deprivation therapy (ADT) (e.g., Lupron, Casodex, Eligard) 546 (40%) ?
(NASDAQ: ANIP) has acquired US rights to market AstraZeneca's NDAs ATACAND, ATACAND HCT, ARIMIDEX and CASODEX in a transaction valued at USD 46.5m in cash, royalties and sales-based milestones, the company said.
M2 PHARMA-January 2, 2018-ANI Pharmaceuticals acquires NDAs and US marketing rights for ATACAND, ATACAND HCT, ARIMIDEX, and CASODEX
The segment's revenues were partially offset by lower sales of Iressa and legacy products such as Casodex and Arimidex.
Furr, "Use of the nonsteroidal antiandrogen casodex in advanced prostatic carcinoma," Urologic Clinics of North America, vol.
No metastases were detected, and treatment with both the nonsteroidal antiandrogen bicalutamide (Casodex) and goserelin (Zoladex) reduced his PSA level to 0.2 ng/mL within three months.
“I have changed my diet to a strict organic vegan diet and have responded well to hormone drugs Lupron and Casodex. My PSA started at a 989.2 and has dropped to a 5.5 in a matter of weeks.
Comparative effects of chronic administration of the non-steroidal antiandrogens flutamide and Casodex on the reproductive system of the adult male rat.
Kaisary et al., "Casodex (bicalutamide) 150-mg monotherapy compared with castration in patients with previously untreated nonmetastatic prostate cancer: results from two multicenter randomized trials at a median follow-up of 4 years," Urology, vol.