Casodex (Bicalutamide)

How does it work?

Casodex tablets contain the active ingredient bicalutamide, which is a type of medicine known as an anti-androgen. It works by blocking the effects of male hormones (androgens) such as testosterone. (NB. Bicalutamide is also available without a brand name, ie as the generic medicine.)

Prostate cancers are sensitive to testosterone and their growth is increased in the presence of this hormone. This is because testosterone binds to androgen receptors on the prostate cancer cells and causes changes within the cells that result in faster growth of the cancer.

Bicalutamide works by preventing testosterone from binding to the androgen receptors on the prostate cancer cells. It therefore starves prostate cancer cells of testosterone, which prevents them growing. Eventually the prostate tumour will shrink.

What is it used for?

  • Prostate cancer.

Bicalutamide is used in two doses. Bicalutamide 150mg is used to treat locally advanced prostate cancer in men who are at high risk of the disease progressing. The tablets are used either on their own, or in combination with radiotherapy or surgery to remove the prostate gland. Bicalutamide 150mg is also used to treat locally advanced prostate cancer in men whose cancer has not spread, and for who surgical castration or other medical treatments are not appropriate or acceptable.

Bicalutamide 50mg is used to treat advanced prostate cancer. The tablets are used in combination with either surgical castration, or a different type of anti-cancer medicine known as a "gonadorelin analogue". This class of medicines can cause a short-term worsening of symptoms before the improvement begins, and bicalutamide can prevent this.


  • Your doctor may want you to have regular blood tests to monitor your liver function while you are taking this medicine.
  • If you are taking this medicine in combination with a gonadorelin analogue (eg buserelin, goserelin, leuprorelin, or triptorelin) your doctor may want to monitor your blood sugar, particularly if you have diabetes.

Use with caution in

  • Moderate to severely decreased liver function.
  • Diabetes.

Not to be used in

  • Children.
  • Women.
  • Casodex tablets contain lactose and may not be suitable for men with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

Very common (affect more than 1 in 10 people)

  • Dizziness.
  • Hot flushes.
  • Feeling sick.
  • Abdominal pain.
  • Constipation.
  • Blood in the urine.
  • Abnormal enlargement of the breasts (gynaecomastia).
  • Breast tenderness.
  • Chest pain.
  • Weakness or loss of strength (asthenia).
  • Fluid retention (oedema).

Common (affect between 1 in 10 and 1 in 100 people)

  • Sleepiness.
  • Decreased sex drive.
  • Impotence.
  • Depression.
  • Loss of appetite.
  • Weight gain.
  • Anaemia.
  • Indigestion.
  • Wind (flatulence).
  • Hair loss (alopecia).
  • Excessive hair growth (hirsutism).
  • Dry skin.
  • Itching (pruritis).
  • Rash.
  • Liver problems.

Uncommon (affect between 1 in 100 and 1 in 1000 people)

  • Decrease in the number of platelets in the blood (thrombocytopenia).
  • Allergic reactions, including hives (urticaria) and swelling of the face, tongue and throat (angioedema). Stop taking this medicine and consult a doctor straight away if you experience these symptoms.
  • Interstitial lung disease.

Rare (affect between 1 in 1000 and 1 in 10,000 people)

  • Liver failure.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.

Bicalutamide must not be taken in combination with any of the following medicines:

  • astemizole
  • cisapride
  • terfenadine.

Bicalutamide may possibly increase the anti-blood-clotting effect of the anticoagulant medicine warfarin. It is recommended that your blood clotting time (INR) is closely monitored if bicalutamide is added to warfarin treatment.

Other medicines containing the same active ingredient

Bicalutamide tablets are also available without a brand name, ie as the generic medicine.