Casodex: Advanced Androgen Blockade for Prostate Cancer Control
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Synonyms
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Casodex (bicalutamide) is a non-steroidal antiandrogen 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 therapeutic outcomes when used according to established protocols.
Features
- Contains bicalutamide as the active pharmaceutical ingredient
- Available in 50 mg film-coated tablets
- Exhibits high affinity for androgen receptors
- Demonstrates selective antiandrogen activity without intrinsic hormonal effects
- Features once-daily dosing convenience
- Maintains stable pharmacokinetic profile with consistent absorption
Benefits
- Effectively suppresses androgen stimulation of prostate cancer cells
- Delays disease progression in locally advanced and metastatic prostate cancer
- Provides palliative benefit through reduction in cancer-related symptoms
- Enables combination therapy with luteinizing hormone-releasing hormone (LHRH) analogues
- Maintains quality of life through targeted action with generally manageable side effects
- Offers convenient oral administration without requirement for medical supervision of each dose
Common use
Casodex is primarily indicated for the treatment of advanced prostate cancer, either as monotherapy or in combination with a gonadotropin-releasing hormone (GnRH) analogue. It is commonly prescribed for patients with metastatic disease (stage D2) and locally advanced prostate cancer (stage C) where surgical castration is not appropriate or is unacceptable to the patient. The medication may also be used as adjuvant therapy following radical prostatectomy or radiotherapy in high-risk patients. Clinical guidelines support its use in intermittent androgen deprivation therapy protocols and as part of combined androgen blockade approaches.
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 a GnRH analogue, treatment should be initiated simultaneously with the LHRH analogue administration. Tablets should be swallowed whole with water and may be taken with or without food. Treatment duration depends on individual patient response, disease stage, and therapeutic strategy, often continuing until disease progression or unacceptable toxicity occurs. Dosage adjustment is not typically required for elderly patients but should be considered in cases of hepatic impairment.
Precautions
Regular monitoring of liver function tests is essential 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, as bicalutamide is extensively metabolized in the liver. Patients should avoid excessive alcohol consumption during therapy. Regular follow-up including prostate-specific antigen (PSA) monitoring, physical examinations, and appropriate imaging studies is recommended to assess treatment response and disease status.
Contraindications
Casodex is contraindicated in patients with known hypersensitivity to bicalutamide or any component of the formulation. It must not be used in women, particularly pregnant women or those who may become pregnant, due to potential teratogenic effects. The medication is contraindicated in pediatric patients. Concurrent use with terfenadine, astemizole, or cisapride is contraindicated due to potential QT prolongation risks. Patients with severe hepatic impairment should not receive Casodex therapy due to altered metabolism and increased risk of adverse effects.
Possible side effect
Common adverse reactions include hot flashes (49%), pain (general) (29%), asthenia (22%), constipation (22%), nausea (15%), diarrhea (12%), and infections (13%). Hepatic effects may include elevated transaminases (8-10%), hepatitis, and rarely hepatic failure. Cardiovascular effects can include hypertension (7%) and peripheral edema (15%). Other reported effects include gynecomastia (38%), breast pain (39%), decreased libido (10%), impotence (9%), dyspnea (13%), anemia (8%), and rash (8%). Most adverse reactions are mild to moderate in severity and often diminish with continued therapy.
Drug interaction
Casodex may interact with drugs metabolized by CYP3A4, potentially altering their plasma concentrations. Concurrent use with warfarin may potentiate anticoagulant effects requiring close monitoring of prothrombin time. Caution is advised with concomitant administration of medications that prolong QT interval. Bicalutamide may interact with other highly protein-bound drugs through displacement mechanisms. The medication may reduce the efficacy of oral contraceptives. Inducers of CYP3A4 (such as rifampicin, phenytoin, or carbamazepine) may decrease bicalutamide concentrations, while inhibitors may increase exposure.
Missed dose
If a dose is missed, patients 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 double the dose to make up for a missed administration. Consistent daily dosing is important for maintaining stable androgen blockade, so patients should be advised to establish a routine for medication administration. Healthcare providers should be informed about pattern of missed doses during follow-up visits.
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. Since bicalutamide is highly protein-bound, dialysis is unlikely to be beneficial. Monitoring should include assessment of hepatic function and supportive care for any clinical manifestations. The maximum reported single dose in clinical trials was 600 mg daily, which was associated with increased incidence of adverse events but no life-threatening reactions. In case of suspected overdose, medical attention should be sought immediately.
Storage
Store at room temperature between 15°C and 30°C (59°F and 86°F) in the original container to protect from light and moisture. Keep the medication out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Tablets should be protected from excessive heat and humidity. Proper disposal of unused medication should follow local regulations for pharmaceutical waste to prevent environmental contamination or accidental ingestion.
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 dosage or discontinue medication 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 an LHRH analogue provides effective androgen suppression with generally favorable tolerability. The EPC program, involving over 8,000 patients, showed that bicalutamide 150 mg monotherapy provided survival outcomes equivalent to castration in locally advanced non-metastatic disease with better preservation of physical capacity and sexual interest. Combination therapy studies indicate improved progression-free survival compared to monotherapy approaches. Patient-reported outcomes suggest better maintenance of quality of life parameters compared to conventional androgen deprivation therapy. Long-term follow-up data support its sustained efficacy in advanced prostate cancer management.