Casodex (bicalutamide) is a non-steroidal anti-androgen medication specifically developed for the treatment of prostate cancer. It functions as a competitive antagonist at androgen receptors, effectively blocking the action of testosterone and dihydrotestosterone (DHT) on prostate cancer cells. This targeted mechanism makes it a cornerstone in both monotherapy and combination regimens for advanced prostate cancer management. Clinical evidence supports its role in delaying disease progression and improving quality of life parameters in appropriately selected patients.

Features

• Contains bicalutamide as the active pharmaceutical ingredient
• Available in 50 mg film-coated tablets
• Exhibits high affinity binding to androgen receptors
• Demonstrates selective anti-androgenic activity without other hormonal effects
• Features once-daily dosing convenience
• Shows predictable pharmacokinetic profile with steady-state concentration achieved within weeks

Benefits

• Effectively suppresses testosterone stimulation of prostate cancer cells
• Delays disease progression in locally advanced and metastatic prostate cancer
• Provides palliative benefit by reducing cancer-related symptoms
• Maintains quality of life through targeted hormonal manipulation
• Offers convenient dosing regimen supporting treatment adherence
• Serves as essential component in combined androgen blockade therapy

Common use

Casodex is primarily indicated for the treatment of advanced prostate cancer, either as monotherapy or in combination with a luteinizing hormone-releasing hormone (LHRH) analogue. In combination therapy, it is used to block the initial testosterone surge that occurs with LHRH agonist administration. The medication finds application in both metastatic disease (M1 stage) and locally advanced disease (T3-T4 or N+ M0 stage) where hormonal manipulation represents the standard of care. Some clinicians may employ Casodex as part of intermittent androgen deprivation strategies or in specific sequencing protocols.

Dosage and direction

The standard recommended dosage for Casodex is one 50 mg tablet administered orally once daily, preferably at the same time each day. When used in combination with an LHRH analogue, treatment should be initiated simultaneously with the LHRH therapy. Tablets should be swallowed whole with water and may be taken with or without food. Treatment duration depends on individual patient response, disease characteristics, and treatment strategy. Regular monitoring of prostate-specific antigen (PSA) levels, liver function tests, and clinical status is essential throughout therapy.

Precautions

Regular monitoring of liver function is mandatory during treatment, particularly during the first four months of therapy. Patients should be advised to report any signs of hepatitis such as nausea, vomiting, abdominal pain, fatigue, anorexia, “flu-like” symptoms, dark urine, or jaundice. Caution is advised in patients with moderate to severe hepatic impairment. Periodic cardiovascular assessment is recommended due to potential QT interval prolongation. Patients should be monitored for signs of depression or mood changes. Regular bone density assessment may be considered in patients receiving long-term therapy.

Contraindications

Casodex is contraindicated in patients with known hypersensitivity to bicalutamide or any component of the formulation. It should not be used in women, particularly pregnant women or those who may become pregnant, due to potential teratogenic effects. The medication is contraindicated in patients with severe hepatic impairment. Concomitant use with terfenadine, astemizole, or cisapride is contraindicated due to potential QT prolongation effects. It should not be administered to pediatric patients.

Possible side effect

Common adverse reactions include hot flashes (49%), pain (31%), asthenia (22%), constipation (22%), nausea (15%), diarrhea (12%), and infection (10%). Hepatic changes including elevated transaminases and jaundice may occur in approximately 1-5% of patients. Cardiovascular effects such as hypertension (7%) and chest pain (6%) have been reported. Less frequently, patients may experience gynecomastia (39%), breast pain (38%), decreased libido (9%), and impotence (9%). Respiratory disorders including dyspnea (11%) and increased cough (6%) may occur. Hematological changes are uncommon but may include anemia (8%).

Drug interaction

Casodex is primarily metabolized by CYP3A4 enzymes. Concomitant administration with strong CYP3A4 inducers (rifampicin, phenytoin, carbamazepine) may decrease bicalutamide concentrations. CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) may increase bicalutamide exposure. Warfarin co-administration requires careful monitoring of prothrombin time due to potential interaction. Caution is advised with other medications that prolong QT interval including class IA and III antiarrhythmics, macrolide antibiotics, and antipsychotics. The medication may interact with other highly protein-bound drugs.

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 take a double dose to make up for a missed dose. Maintenance of consistent dosing is important for optimal androgen receptor blockade. Healthcare providers should educate patients about the importance of adherence and establish strategies to minimize missed doses.

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. Liver function should be monitored closely, as elevated transaminases and jaundice may occur. Supportive measures including intravenous fluids and monitoring of vital signs are recommended. Hemodialysis is unlikely to be effective due to high protein binding. Cases of overdose should be reported to poison control centers for appropriate management guidance.

Storage

Store at room temperature between 15-30°C (59-86°F). Protect from light and moisture. Keep in the original container with the lid tightly closed. Do not store in bathroom areas where moisture levels may be high. Keep out of reach of children and pets. Do not use beyond 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 should be made by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for specific dosage recommendations and treatment duration. Patients should not alter their treatment regimen without medical supervision. While every effort has been made to ensure accuracy, medical knowledge evolves and the most current prescribing information should always be consulted.

Reviews

Clinical studies demonstrate that Casodex 50 mg daily in combination with LHRH analogues shows equivalent efficacy to other anti-androgen regimens with a generally favorable tolerability profile. The EPC program trials involving over 8,000 patients established its role in advanced prostate cancer management. Many urologists note its convenience of once-daily dosing contributes to patient compliance. Some studies suggest potentially different side effect profiles compared to other anti-androgens, particularly regarding gastrointestinal tolerability. Long-term follow-up data support its sustained efficacy in appropriate patient populations.