COVID-19: Get the latest updates or take a self-assessment.

Screen for hepatitis B virus in all cancer patients starting systemic treatment. Find out more about hepatitis B virus screening and management.

Drug Formulary

About the Drug Formulary Email Drug Formulary Team

enzalutamide

( EN-za-LOO-ta-mide )

Other Name(s): Xtandi®

Appearance: white capsule

enzalutamide patient.pdf

enzalutamide pour le patient.pdf

Medication Information Sheet

enzalutamide (EN-za-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: Xtandi®

Appearance:

white capsule

What is this medication for?

For treating 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), especially if you have / had:
- seizures or at risk of having seizures,
- liver, kidney or heart problems (including irregular heartbeat),
- high blood pressure,
- a history of fainting spells,
- thin bones or are at risk of falls and bone breaks,
- low salt levels in the blood or
- any allergies
Enzalutamide contains a small amount of sorbitol. If you cannot have fructose, talk to your health care team.

Remember to:

Tell your health care team about all of the other medications you are taking.
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.

How will this medication affect sex, pregnancy and breastfeeding?

Talk to your health care team about:

How this medication may affect your sexual health.
Symptoms such as hot flashes.
How this medication may affect your ability to have a baby, if this applies to you.

This medication may harm an unborn baby. Tell your health care team if you or your partner are pregnant or become pregnant during treatment.

If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control (one of which must include condoms) at the same time until 3 months after your last dose. Talk to your health care team about which birth control options are best for you.

How is this medication given?

This medication is usually taken once a day by mouth. Talk to your health care team about how and when to take your medication.
Swallow capsules whole with a glass of water, with or without food.
Do not chew, dissolve, or open the capsules.
If a dose is missed for the day, take it as soon as it is remembered on the same day. If it is forgotten for the whole day, skip this dose and take the next usual dose. Do not double the dose to make up for the missed one.
If you vomit (throw up) after taking your medication, talk to your health care team about what to do.
If you take too much of your medication by accident, or if you think a child or a pet may have swallowed your medication, you must call the Ontario Poison Control Center right away at: 1-800-268-9017.

What else do I need to know while on this medication?

Will this medication interact with other medications or natural health products?
- This medication can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.
- Tell your health care team about all of your:
  - prescription and over-the-counter (non-prescription) medications and all other drugs, such as cannabis/marijuana (medical or recreational)
  - natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements
- Check with your health care team before starting or stopping any of them.
If you are taking a blood thinner (such as warfarin), your health care team may need extra blood tests and may change your dose.

What to DO while on this medication:

DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
DO talk to your health care team about your risk of getting other cancers after this treatment.
DO wear shoes that have nonslip soles and some ankle support. Also try to stand up slowly after sitting or lying down to lower your chance of falling down.

What NOT to DO while on this medication:

DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
DO NOT drive, operate machinery or do any tasks that need you to be alert if you feel tired, drowsy or dizzy.

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.

How to safely touch oral anti-cancer medications

If you are a patient:

Wash your hands before and after touching your oral anti-cancer medication.
Swallow each pill whole. Do not crush or chew your pills.

If you are a caregiver:

Wash your hands before and after touching the oral anti-cancer medication.

If you are pregnant or breastfeeding or there is a chance there is a chance you may become pregnant:

Wear nitrile or latex gloves when touching tablets, capsules or liquids.
Wash your hands before putting on your gloves and after taking them off, even if your skin did not touch the oral anti-cancer medication.
Throw out your gloves after each use. Do not re-use gloves.

What to do if oral anti-cancer medication gets on your skin or in your eyes

If medication gets on your skin:

Wash your skin with a lot of soap and water.
If your skin gets red or irritated, talk to your health care team.

If medication gets in your eyes:

Rinse your eyes with running water right away. Keep water flowing over your open eyes for at least 15 minutes.

What are the side effects of this medication?

The following table lists side effects that you may have when getting enzalutamide. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Refer to this table if you experience any side effects while on enzalutamide.

Common Side Effects (25 to 49 out of 100 people)
Side effects and what to do	When to contact health care team
Fatigue What to look for? Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep. What to do? Be active. 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. Ask family or friends to help you with things like housework, shopping, and child or pet care. Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your health care team has told you to drink more or less). Avoid driving or using machinery if you are feeling tired. Ask your health care team for the Fatigue pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe.
Mild joint, muscle pain or cramps What to look for? New pain in your muscles or joints, muscle cramps, or feeling achy. What to do? Take pain medication (acetaminophen or opioids such as codeine, morphine, hydromorphone, oxycodone) as prescribed. Rest often and try light exercise (such as walking) as it may help. Ask your health care team for the Pain pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe.

Less Common Side Effects (10 to 24 out of 100 people)
Side effects and what to do	When to contact health care team
Diarrhea What to look for? Loose, watery, unformed stool (poo) that may happen days to weeks after you get your treatment. What to do? If you have diarrhea: Take anti-diarrhea medication if your health care team prescribed it or told you to take it. Do not eat foods or drinks with artificial sweetener (like chewing gum or ‘diet’ drinks), coffee and alcohol, until your diarrhea has stopped. Eat many small meals and snacks instead of 2 or 3 large meals. Drink at least 6 to 8 cups of liquids each day, unless your health care team has told you to drink more or less. Talk to your health care team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need to drink special liquids with salt and sugar, called Oral Rehydration Therapy. Talk to your health care team if your diarrhea does not improve after 24 hours of taking diarrhea medication or if you have diarrhea more than 7 times in one day. Ask your health care team for the Diarrhea pamphlet for more information.	Talk to your health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in one day).
Changes to your hormone levels Your treatment causes changes in the levels of testosterone in your body. This can affect your mood, energy levels or physical appearance, among other things. You may have many of these symptoms or none at all. Your symptoms may also change at different times in your treatment. What to look for? Hot flashes: A hot flash feels like a sudden warmth in your upper body and face. It can happen quickly and with no warning. Your face may get flushed (turn red) and you may sweat more Hot flashes can cause you to have trouble sleeping Other symptoms of having low testosterone levels: Problems with erectile dysfunction (getting or keeping erections) or less desire to have sex Breast swelling or tenderness Low energy Mood changes, depression Thinning of the bones and higher risk of fracture High cholesterol and effects on your heart What to do? 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 : To keep cool, dress in light, cotton clothing or in layers that you can easily remove. Use a fan Drink plenty of water or other liquids (at least 6 to 8 cups) unless your health care team has told you to drink more or less. Lay a towel on top of your bed sheet before you sleep so you can change it easily if you sweat at night. Hot flashes may improve over time. Talk to your health care team if this or any symptoms of low testosterone are bothersome for you.	Talk to your health care team if it does not improve or if it is severe.
Mild swelling What to look for? You may have mild swelling or puffiness in your arms and/or legs. Rarely, this may be severe. What to do? To help prevent swelling: Eat a low-salt diet. If you have swelling: Wear loose-fitting clothing. For swollen legs or feet, keep your feet up when sitting.	Talk to your health care team if it does not improve or if it is severe.
High blood pressure (May be severe) What to look for? There are usually no signs of high blood pressure. Rarely, you may have headaches, shortness of breath or nosebleeds. What to do? Check your blood pressure regularly. Your doctor may prescribe medication to treat high blood pressure. If you have a severe headache get emergency help right away as it may be a sign your blood pressure is too high.	Talk to your health care team if it does not improve or if it is severe.
Dizziness What to look for? You may feel light-headed and like you might faint (pass out). What to do? Lay down right away so you do not fall. Slowly get up and start moving once you feel better. Do not drive a motor vehicle or use machinery if you feel dizzy.	Talk to your health care team if it does not improve or if it is severe.
Nausea or vomiting (Generally mild) What to look for? Nausea is feeling like you need to throw up. You may also feel light-headed. You may feel nausea within hours to days after your treatment. What to do? To help prevent nausea: It is easier to prevent nausea than to treat it once it happens. If you were given anti-nausea medication(s), take them as prescribed, even if you do not feel like throwing up. 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 (like coffee, tea) and avoid alcohol. If you have nausea or vomiting: Take your rescue (as-needed) anti-nausea medication(s) as prescribed. Ask your health care team for the Nausea & Vomiting pamphlet for more information. Talk to your health care team if: nausea lasts more than 48 hours vomiting lasts more than 24 hours or if it is severe	Talk to your healthcare team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if it is severe.
Low appetite or weight loss What to look for? Loss of interest in food or not feeling hungry. Unusual weight loss. What to do? Try to eat your favourite foods. Eat small meals throughout the day. You may need to take meal supplements to help keep your weight up. Talk to your health care team if you have no appetite. Ask your health care team for the Loss of Appetite pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe.

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

signs of an allergic reaction such as flushing, itchiness, rash, swollen lips, face or tongue, wheezing, chest or throat tightness
feeling anxious or confused, having trouble remembering things, seeing and/or hearing things that are not there
passing out or seizures
irregular heartbeat, chest pain, shortness of breath, or swelling in your legs, ankles and belly
severe headache, trouble speaking or changes in your vision
severe or unusual bone pain
sudden, severe pain in your belly or stomach area
blood in your stools (poo) or black stools (poo), or vomiting (throwing up) blood
unusual bleeding or bruising
signs of infection of the blood such as fever or very low body temperature, chills, less urine (pee) than usual, low blood pressure

Who do I contact if I have questions or need help?

My cancer health care provider is: ______________________________________________

During the day I should contact:________________________________________________

Evenings, weekends and holidays:______________________________________________

Other Notes:

____________________________________________________________________________

April 2024 Updated rare side effects

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.

enzalutamide

Who do I contact if I have questions or need help?

Funding & Reimbursement

Symptom Management

Drug Safety and Administration