Casodex: Advanced Androgen Blockade for Prostate Cancer Control
| Product dosage: 50mg | |||
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Synonyms
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Casodex (bicalutamide) is a non-steroidal anti-androgen medication specifically developed for the treatment of prostate cancer. As part of a comprehensive hormonal therapy approach, it works by competitively inhibiting androgen binding at androgen receptors in target tissues, including malignant prostate cells. This mechanism effectively suppresses testosterone-driven tumor growth, making it a cornerstone in both localized and advanced prostate cancer management protocols. Clinical evidence supports its role in maximizing androgen deprivation therapy efficacy when combined with surgical castration or GnRH analogues.
Features
- Contains 50 mg bicalutamide as the active pharmaceutical ingredient
- White, film-coated tablets with cross-scoring on one side for accurate dosing
- Formulated for once-daily oral administration with consistent bioavailability
- Demonstrated high affinity for androgen receptors with selective binding properties
- Stable shelf life of 36 months under proper storage conditions
- Manufactured under current Good Manufacturing Practice (cGMP) standards
Benefits
- Effectively suppresses testosterone stimulation of prostate cancer cells
- Delays disease progression when used as part of combined androgen blockade
- Maintains quality of life through oral administration convenience
- Demonstrates predictable pharmacokinetics with once-daily dosing
- Provides complementary action when combined with LHRH agonist therapy
- Shows favorable tolerability profile compared to older anti-androgens
Common use
Casodex is primarily indicated for use in combination therapy with a luteinizing hormone-releasing hormone (LHRH) analogue for the treatment of advanced prostate cancer. It is specifically prescribed to block the initial surge of testosterone that occurs during the first weeks of LHRH agonist therapy, preventing disease flare. Additionally, it may be used as monotherapy in certain cases where surgical castration is not appropriate or refused by the patient. The medication finds application across various stages of prostate cancer management, from locally advanced disease to metastatic carcinoma.
Dosage and direction
The standard recommended dosage is one 50 mg tablet administered orally once daily, preferably at the same time each day. When used in combination with an LHRH analogue, Casodex should be started simultaneously with the LHRH therapy and continued throughout treatment. Tablets should be swallowed whole with water, with or without food, though consistent administration with regard to meals is recommended. Dosage adjustment is generally not required for elderly patients, but hepatic impairment necessitates careful monitoring and potential dosage modification.
Precautions
Regular monitoring of liver function tests is essential during treatment, particularly during the first four months of therapy. Patients should be advised about potential photosensitivity reactions and recommended to use appropriate sun protection. Those with moderate to severe hepatic impairment require close supervision and possible dosage adjustment. Caution is advised when administering to patients with cardiovascular risk factors due to potential QT interval prolongation. Regular ophthalmological examinations are recommended for patients experiencing visual changes.
Contraindications
Casodex is contraindicated in patients with known hypersensitivity to bicalutamide or any component of the formulation. It must not be administered to women, particularly those who are pregnant or may become pregnant, due to potential teratogenic effects. The medication is contraindicated in patients with severe hepatic impairment unless the potential benefits outweigh the risks. Concomitant use with terfenadine, astemizole, or cisapride is contraindicated due to potential QT prolongation risks.
Possible side effects
Common adverse reactions include hot flashes (49%), pain (general) (18%), constipation (12%), asthenia (16%), nausea (15%), and diarrhea (12%). Hepatic changes, including elevated transaminases and jaundice, occur in approximately 1-10% of patients. Cardiovascular effects may include hypertension (7%) and peripheral edema (5%). Less frequently, patients may experience gynecomastia (39%), breast pain (38%), dyspnea (11%), and rash (8%). Serious but rare side effects include hepatitis, hepatic failure, and interstitial lung disease.
Drug interactions
Casodex is primarily metabolized by CYP3A4 enzymes, necessitating caution with strong CYP3A4 inhibitors (ketoconazole, itraconazole) which may increase bicalutamide concentrations. Concomitant use with warfarin requires close monitoring of prothrombin time due to potential potentiation of anticoagulant effect. Compounds that induce CYP3A4 (rifampicin, phenytoin) may decrease bicalutamide concentrations. Concurrent administration with other QT-prolonging agents requires careful cardiovascular monitoring.
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. Doubling of doses to make up for a missed dose is not recommended. Patients should maintain regular dosing intervals to ensure consistent therapeutic effect, particularly when used in combination with LHRH analogues.
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. Hemodialysis is unlikely to be effective due to high protein binding. Monitoring of vital signs and hepatic function is recommended. Supportive measures should include management of potential endocrine effects and symptomatic treatment of nausea or dizziness if present.
Storage
Store at room temperature between 15°C and 30°C (59°F to 86°F) in the original container to protect from light and moisture. Keep the container tightly closed and out of reach of children. Do not use beyond the expiration date printed on the packaging. Protect from excessive heat and humidity, which may compromise tablet integrity. Proper storage ensures maintenance of pharmaceutical quality throughout the product’s shelf life.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions must be made by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for complete information regarding indications, dosage, and precautions. Patients should not alter their treatment regimen without medical supervision. Always refer to the local prescribing information for country-specific recommendations.
Reviews
Clinical studies demonstrate that Casodex 50 mg in combination with LHRH analogues provides effective androgen suppression with generally manageable side effects. The EORTC 30853 trial showed equivalent overall survival compared to flutamide when combined with LHRH agonists. Patient-reported outcomes indicate better gastrointestinal tolerability compared to older anti-androgens. Long-term follow-up data support its sustained efficacy in advanced prostate cancer management. Healthcare providers consistently report satisfactory therapeutic response in appropriate patient populations when used according to established guidelines.