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bicalutamide

( bye-cal-LOO-ta-mide )
Other Name(s): Casodex® (multiple brands available)
Appearance: tablet

Medication Information Sheet
bicalutamide (bye-cal-LOO-ta-mide)
This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Casodex®, Generic brand(s) available

Appearance:
tablet

What is this medication for?
  • Used alone or with other medications to treat prostate cancer
What should I do before I have this medication?
  • Tell your health care team if you have or had significant medical condition(s), such as:
     
    • diabetes
    • liver or lung problems
    • bone thinning or osteoporosis
    • irregular heartbeat or heart problems
    • any allergies
       
  • This drug contains a small amount of lactose. If you cannot tolerate lactose, talk to your doctor.
     
  • Patients who have cancer are at a higher risk of developing blood clots. Some cancer drug treatments may increase this risk. Discuss this with your doctor.
How will this medication affect sex, pregnancy and breastfeeding?
  • While this may not be directly applicable to you, if there is any chance that your partner may become pregnant, you and your partner together must:   
    ► Use 2 effective forms of birth control at the same time while taking this drug. Keep using birth control for at least 130 days after your last dose unless your health care team told you differently. Talk to your health care team to figure out the best method(s) for you and/or your partner.
     
  • Let your health care team know if your partner is pregnant or becomes pregnant during your bicalutamide treatment.
     
  • This medication may affect fertility (ability to get your partner pregnant).
How is this medication given?
  • Take it exactly as directed by your doctor.
  • Swallow whole with a glass of water, with or without food.

  • Do not crush or chew the tablets.

  • If you miss a dose, skip this and take your next dose as scheduled. Do not double the dose to make up for the forgotten one.
     
  • Bicalutamide is usually taken once a day, at about the same time each day.
     
  • Drinking alcohol while taking bicalutamide may produce excessive facial flushing. Avoid drinking alcohol if this becomes bothersome.
What else do I need to know while on this medication?
  • This medication can interact with other medications and can result in the treatment not working as well or cause severe side effects.

  • Make sure your health care team knows about all your medications (prescription, over-the-counter, herbals and supplements). Check with your health care team before starting or stopping any of them.

  • For mild aches and pain or fever:

    • If you feel unwell, take your temperature before taking any medications for pain or fever. They may hide a fever. 
       
    • You may take acetaminophen (Tylenol®) tablets. Ask your health care team about the right dose for you. 
       
    • Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin (acetylsalicylic acid, ASA), including low dose aspirin for heart conditions, may increase your chance of bleeding. Talk to your health care team before you start or stop these medications.
       
    • Talk to your health care team or go to the closest emergency room right away if you have a fever.  See the Fever pamphlet for more information.
  • Drinking alcohol and smoking during your treatment may increase some side effects and make your medication less effective. Speak to your health care team about smoking and drinking alcohol while on treatment.

How should I safely store this medication?
  • Keep this medication in the original packaging at room temperature in a dry place, away from heat and light. Keep out of sight and reach of children and pets.

  • Do not throw out any unused medications at home. Bring them to your pharmacy to be thrown away safely.

What are the side effects of this medication?

You may not have all of the side effects below. You may have side effects that are not listed.

Side effects and what to do When to contact doctor?
Very Common Side Effects (50 or more out of 100 people)

Hot flashes, feeling or wave of warmth

You may sweat more or have trouble sleeping because of this.

To help prevent hot flashes :

  • Avoid triggers such as spicy food, alcohol and caffeine (tea, coffee, and soft drinks),
  • Exercise regularly. Ask your health care team what exercises are appropriate for you before you start any new exercise.
  • Quitting smoking may also help.

If you have hot flashes :

  • Keep cool; dress lightly or in layers that you can easily remove and drink plenty of liquids unless you have been told otherwise.

Hot flashes may improve over time. Talk to your health care team if this is bothersome for you.

Other symptoms of having low testosterone levels

  • Decreased sexual function or desire to have sex
  • Breast swelling or tenderness
  • Low energy
  • Mood changes, depression
  • Thinning of the bones and increased risk of fracture

Contact your health care team if these feelings bother you.

Contact your health care team if no improvement or if severe

 

Side effects and what to do When to contact doctor?
Common Side Effects (25 to 49 out of 100 people)

Headache; mild joint, muscle pain or cramps 

  • Take your pain medication as prescribed by your doctor.
  • You can take acetaminophen (Tylenol®) tablets as needed for mild aches and pains. Ask your doctor or pharmacist about the right dose for you.
  • Talk to your doctor or pharmacist first before taking ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin. These medication may increase bleeding risk.
  • Rest often and try light exercise as it may help.
Contact your health care team if no improvement or if severe

 

Side effects and what to do When to contact doctor?
Less Common Side Effects (10 to 24 out of 100 people)

Constipation

To help prevent constipation :

  • Drink more liquids and eat well. Drink at least 6 to 8 cups of liquids each day unless you have been told otherwise.
  • Be Active. Exercise can help to keep you regular.
  • Try to eat more fiber (e.g. fruits with skin, leafy greens and whole grains). If you take opioid pain medication, ask your health care team if eating more fibre is right for you.

To help treat constipation :

  • If you have not had a bowel movement in 2 to 3 days you may need to take a laxative. Ask your health care team what to do.

See the Constipation Pamphlet for more information.

 

Contact your health care team if no improvement or if severe

Fatigue (tiredness)

  • Be active and aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days. Check with your health care team before starting any new exercise.
  • Pace yourself, do not rush. Put off less important activities. Rest when you need to.
  • Eat well and stay hydrated by drinking at least 6 to 8 glasses of water or other liquids every day (unless your doctor told you to drink more or less).
  • Avoid driving or using machinery if you are feeling tired

See our Fatigue pamphlet for more information. 

Contact your health care team if no improvement or if severe

Fever, chills, infection

You have a fever if your temperature taken in your mouth (oral temperature) is:

  • 38.3°C (100.9°F) or higher at any time OR
  • 38.0°C (or 100.4°F) or higher for at least one hour.

While you are getting chemotherapy treatments:

  • Keep a digital thermometer at home and take your temperature if you feel hot or unwell (for example, chills).
  • Avoid taking medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen) as they may hide a fever.
  • Do not eat or drink anything hot or cold right before taking your temperature.
  • Wash your hands often.
  • Check with your doctor before getting any vaccines.

If you have a fever, talk to your health care team or go to the closest emergency room. 
See our Neutropenia (Low white blood cell count) pamphlet for more information.

Get emergency medical help right away

Nausea and vomiting (generally mild)

May occur in hours to days after your treatment. 

If you have nausea or vomiting:

  • Take anti-nausea medication(s) as prescribed to you by your doctor. 
  • Drink clear liquids and have small meals. Get fresh air and rest.
  • Do not eat spicy, fried foods or foods with a strong smell.
  • Limit caffeine (e.g. coffee, tea) and alcohol.
  • Contact your health care team if the prescribed anti-nausea medications are not helping to control your nausea and vomiting.

 Also see Nausea & Vomiting pamphlet for more information.

 

Talk to your health care team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if severe

Anemia (low red blood cells)

  • You may feel more tired or weak than normal and have pale skin.
  • This may occur in days to weeks after you start or receive your medication.
  • Rest often and eat well.
  • Light exercise, such as walking may help.
  • You may need medication or a blood transfusion.
  • If it is very bad, your doctor may ask you to stop the medication that is causing the low red blood cells.
Contact your health care team if no improvement or if severe

Cough; feeling short of breath

You may have cough and feel short of breath without any signs of infection, such as a sore throat or a stuffed nose.

Rarely this may be severe with chest pain, trouble breathing or coughing up blood.  If this happens get medical help right away.

Contact your health care team if no improvement or if severe

Mild swelling in arms and legs; puffiness

To help prevent swelling :

  • Eat a low-salt diet.
  • Avoid tight fitting clothing.

If you have swelling in your legs, keep your feet up when sitting.

Contact your health care team if no improvement or if severe

Diarrhea

May happen days to weeks after you get your treatment.

If you have diarrhea :

  • Take anti-diarrhea medication if your health care team prescribed it.
  • Avoid foods or drinks with artificial sweetener (e.g. chewing gum, “diet” drinks), coffee and alcohol.
  • Eat many small meals and snacks instead of 2 or 3 large meals.
  • Drink at least 6 to 8 cups of liquids each day. Talk to your health care team if you can’t drink 6-8 cups of liquids each day when you have diarrhea. You may need special liquids with salt and sugar, called Oral Rehydration Therapy.

​See the Diarrhea pamphlet for more information.

 

Contact your health care team if no improvement or if severe

Bladder problems 

  • You may feel like you need to pee often, have burning or pain when peeing, have bloody pee or pee leaks and dribbles due to bladder control problems.
  • In some cases you may also have fever.
Contact your health care team as soon as possible (office hours)

Pains or cramps in the belly

  • If you have constipation or diarrhea it may be causing the pain in your belly.
  • If the pain is severe, gets worse or doesn’t go away, talk to your health care team about other possible causes.
Contact your health care team if no improvement or if severe

Dizziness

  • You may feel light headed.
  • Lay down if this happens.
  • Get up and move slowly once you feel better.
  • Do not drive a motor vehicle or use machinery if you feel dizzy.
Contact your health care team if no improvement or if severe

Other rare, but serious side effects are possible.
If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:

  • itchiness, rash, swollen lips, face or tongue, chest and throat tightness
  • severe or unusual bone pain or difficulty moving
  • feeling thirsty and peeing more often than usual
  • irregular heartbeat, fainting spells or unusual swelling in your legs, ankles and belly
  • chest pain, shortness of breath or coughing blood
  • pain in your arm or leg, swelling and hardening of the vein in your arm or leg
  • feeling confused, having a sudden loss of vision, trouble speaking or using your arms or legs
  • yellowish skin or eyes, unusually dark pee or pain on the right side of your belly
  • severe belly pain, vomiting blood or what looks like coffee-grounds, or passing poo with bright red blood or which looks black or tarry-coloured


For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.