Enzalutamide is a prescription drug used mostly for prostate cancer that keeps cancer cells from using testosterone. Doctors prescribe it for certain types of castration-resistant prostate cancer — the kinds that keep growing even when testosterone is low. If you or a loved one are starting enzalutamide, here’s what matters in plain language.
It works by blocking the androgen receptor, stopping the receptor from moving into the cell nucleus and turning on genes that make cancer grow. Big clinical trials you may hear about (AFFIRM, PREVAIL, PROSPER) showed enzalutamide can slow disease progression and help men live longer or delay metastasis, depending on the situation.
The usual dose for adults is 160 mg once daily, often given as four 40 mg capsules or one 160 mg tablet depending on the product. Take it at the same time each day with or without food. Don’t crush or chew capsules. If you miss a dose and it’s less than 12 hours late, take it when you remember; if more than 12 hours, skip it and go back to your normal schedule. Never double up to catch up.
Bring a medication list to every appointment. Enzalutamide interacts with many drugs via liver enzymes (CYP pathways). Strong CYP2C8 inhibitors, such as gemfibrozil, can raise enzalutamide levels. Strong CYP3A4 inducers, like rifampin, can lower its effect. Your doctor or pharmacist can check interactions — ask them specifically about blood thinners, certain antidepressants, and seizure-risk drugs.
Common side effects include tiredness, hot flashes, joint pain, and mild swelling. High blood pressure and falls can happen, so your doctor will likely check your blood pressure and ask about balance. Seizures are rare but serious — report new fainting, jerking, or unexplained confusion right away.
Other things to watch for: mood changes or memory problems, decreased appetite, and changes in liver tests. Your care team will usually monitor blood pressure, liver function, and ask about side effects at regular visits. If side effects become a problem, there are options: dose adjustment, switching drugs, or supportive measures to manage symptoms.
Alternatives include abiraterone (often combined with prednisone) and newer androgen-signaling inhibitors like apalutamide or darolutamide. Each drug has a different benefit and side effect profile, so talk with your oncologist about what fits your goals and health history.
Insurance coverage and cost can vary. Many manufacturers run patient-assistance programs; social workers or pharmacists can help you apply. Keep an up-to-date medication list, report side effects early, and keep scheduled labs and visits — that simple routine protects your safety and helps treatment work better.
If you want more detail on interactions, dosing adjustments, or what to expect at follow-up visits, ask your care team — and bring this guide to your appointment as a checklist.
Enzalutamide is a common treatment for prostate cancer, but it can sometimes lead to osteoporosis. To maintain good bone health during treatment, it's essential to incorporate a well-balanced diet rich in calcium and vitamin D. Regular exercise, particularly weight-bearing activities, can also help strengthen bones and reduce the risk of fractures. It's important to consult with your healthcare provider about monitoring your bone health and discussing additional treatment options if needed. Finally, quitting smoking and limiting alcohol consumption can also benefit bone health during enzalutamide treatment.
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