Bicalutamide

About Bicalutamide

Bicalutamide is a nonsteroidal androgen receptor inhibitor: it blocks the action of male hormones (androgens), to which prostate cancer is sensitive, and it does not cure the cancer. The label approves 50 mg once a day in combination with an LHRH analog for stage D2 metastatic carcinoma of the prostate, started at the same time as the LHRH medicine and taken in the morning or evening, with or without food, at the same time each day. A 150 mg dose is not approved, alone or with other treatments. No dose change is needed for kidney impairment or for mild to moderate liver impairment, and it is used with caution when liver impairment is moderate to severe.

There is no boxed warning. Severe liver injury, including liver failure and death, has been reported, usually within the first three to four months, so liver enzymes are measured before starting, at regular intervals for the first four months and periodically after that; it is stopped at once for jaundice or an ALT above twice the upper limit of normal. It is contraindicated in women, in pregnancy and in anyone allergic to it. With an LHRH medicine, hot flashes are the most common side effect, and pain, weakness, constipation, nausea, diarrhea, swelling of the legs, shortness of breath, infection, blood in the urine, urinating at night and anemia are also common; breast enlargement and breast pain can occur. Interstitial lung disease, sometimes fatal, has been reported, mostly at doses above 50 mg.

Bicalutamide can strengthen warfarin and other coumarin blood thinners, and serious bleeding has occurred, so the INR is watched closely and the blood thinner dose may need adjusting. It inhibits the liver enzyme CYP3A4, so medicines cleared that way, such as midazolam, are used with caution. LHRH medicines can reduce glucose tolerance, so blood sugar may be checked, and regular PSA tests can help follow the response. The label asks men with a partner who could become pregnant to use effective contraception during treatment and for 130 days after the last dose, notes that it may impair fertility, and advises avoiding excess sun or ultraviolet light and taking care with driving if it causes sleepiness.

Taking Bicalutamide

How to take it

One 50 mg tablet once a day, in the morning or evening, at the same time each day, with or without food, starting at the same time as the LHRH medicine. Keep taking it unless the prescriber tells you to stop.

If you miss a dose

The label says not to take a missed dose: take the next dose at the usual time, and do not double it.

Storage

At room temperature in the container it came in, tightly closed, away from excess heat and moisture, out of reach of children. Do not flush it; use a take-back program.

Interactions to know about

Warfarin and other coumarin blood thinners need close INR checks, and levels of medicines broken down by CYP3A4, such as midazolam, can rise. Report yellow skin or eyes, pain in the upper right abdomen, extreme tiredness or trouble breathing; avoid excess sun and tanning beds, and take care driving if it makes you sleepy.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Bicalutamide differs from pharmacy to pharmacy

Generic bicalutamide has several makers and costs pharmacies little, so quotes for the same tablet differ mainly by dispensing fee and markup, and whether it is on a pharmacy’s flat-price generic list varies. For ongoing treatment, a ninety-day fill spreads one fee over three months, while a prescription that names Casodex and blocks substitution is priced as a brand. The quote covers only the tablets: the LHRH medicine it is paired with is a separate product.

Ways to pay less for Bicalutamide without insurance

• Ask for generic bicalutamide, and make sure the prescription allows substitution rather than naming Casodex only.
• Ask whether bicalutamide is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Once treatment is settled, ask the prescriber for a ninety-day supply with refills.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Bicalutamide

1. 1.When will my liver tests be done, and which symptoms should I report?
2. 2.Should I start it on the same day as my LHRH treatment?
3. 3.Does it change how my warfarin or other blood thinner works?
4. 4.Will my blood sugar and PSA be checked while I take it?

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