Casodex is the brand name of bicalutamide and used in combination with lutenizing hormone-releasing hormones, such as leuprolide or goserelin, for the treatment of prostate cancer that has spread to other parts of the body. It is available with a prescription and is classified as an antiandrogen; it works by blocking a male hormone called androgen, which stops the growth of cancer cells and keeps them from spreading.
Metabolism
The liver is the primary site of Casodex metabolism, or breakdown. The medication is broken down to inactive compounds, called metabolites, and released from the body in the urine and feces. Casodex metabolism can affect dosing and may cause drug interactions and side effects.
Dosage Adjustment
Casodex does not need to be adjusted for mild, moderate or severe liver impairment; however, caution should be used when the medication is administered to patients with moderate to severe liver impairment. Discontinue the medication if alanine aminotransferase, or ALT, is two times above the upper limit of normal. ALT is a liver enzyme usually measured during liver function tests to determine liver health. According to the "Drug Information Handbook," about 7 percent of individuals on the medication can experience elevated liver enzymes, including ALT. Casodex should also be discontinued if you develop jaundice; the symptoms of jaundice include yellowing of the skin and the whites of the eyes, dark or reddish urine, loss of appetite and sluggishness.
Drug Interactions
The cytochrome P450 enzymes are a family of enzymes that are found in the highest concentration in the liver and involved in the breakdown of medications. Casodex is an inhibitor, or blocker, of the cytochrome P450 3A4 enzyme, or CYP 3A4. This can result in an increase in the effects of the medications that are broken down by the CYP 3A4 enzymes. Some examples of the medications that may have an increased level and effect include colchicine, eplerenone, everolimus, fentanyl, salmeterol and saxagliptin. Co-administration of Casodex with midazolam may increase midazolam levels by 1.5 fold, explains RxList.com.
Monitoring
Keep all doctor appointments so your physician can make sure that Casodex is working properly. Liver function tests should be obtained at baseline and then repeated regularly during the first four months of treatment. Afterward, you should have liver function tests done periodically to monitor for liver dysfunction. Your physician can monitor for adverse reactions and adjust the dose of the drug accordingly. Before you start any medication, including herbal products, speak with your physician to avoid drug interactions.
References
- "Drug Information Handbook"; Charles F. Lacy, Lora L. Armstrong, et al.; 2009
- RxList: Casodex
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