- June 4, 2023
- By Dr. Sarah Thompson, PharmD
Casodex is commonly incorporated into treatment plans for prostate cancer, particularly when hormonal control of the disease is required, and it may be administered as part of combination therapy with other medicines or alongside surgical treatment to help manage advanced prostate cancer that has spread beyond the prostate.
When other medication therapies, surgery, or radiation therapy cannot be performed, locally advanced prostate cancers without metastases can be treated with Casodex using higher doses, or as maintenance therapy following surgical removal or radiation.
Casodex is a member of a group of medications known as moderate-strength antineoplastic, antiandrogen, and CYP3A4 inhibitors. Non-steroidal antiandrogen Casodex has no additional impact on the endocrine system. The medication inhibits androgenic stimuli by binding to androgen receptors without triggering gene expression. This inhibition causes the prostate tumor to recede.
In other words, it contains bicalutamide, which is the active component. It prevents androgens’ (male hormones) unfavorable influence on prostate growth. There are certain instances in which individuals experience withdrawal symptoms after they stop taking medicine.
Casodex is only available with a prescription and must be used under the constant supervision of a doctor.
Cost of Generic and Brand
The price for Casodex in the US varies between $200 and $300 for thirty 50mg tablets for a generic version of this medication. The brand Casodex can be around $1000 but can go much higher, up to $4,000. In Canada, the prices are about on the same level, but there is more chance to find a cheaper offer.
| Product | Dosage | Quantity | Listed Origin | Listed Price | Price per Tablet |
|---|---|---|---|---|---|
| Casodex | 50 mg | 30 tablets | UK/EU | $385.99 | $12.87 |
| Casodex | 50 mg | 60 tablets | UK/EU | $712.99 | $11.88 |
| Casodex | 50 mg | 90 tablets | UK/EU | $1,039.99 | $11.56 |
| Bicalutamide | 50 mg | 28 tablets | New Zealand | $59.99 | $2.14 |
| Bicalutamide | 50 mg | 56 tablets | New Zealand | $65.99 | $1.18 |
| Bicalutamide | 50 mg | 84 tablets | New Zealand | $73.99 | $0.88 |
| Casodex | 150 mg | 28 tablets | International | $610.00 | $21.79 |
| Casodex | 150 mg | 84 tablets | International | $1,671.97 | $19.90 |
| Bicalutamide | 150 mg | 28 tablets | International | $65.00 | $2.32 |
| Bicalutamide | 150 mg | 84 tablets | International | $164.00 | $1.95 |
Prescription Requirements for Casodex
Casodex is a prescription treatment, so it is normally started after a clinician has reviewed the prostate cancer diagnosis, stage of disease, current hormone therapy, and other medicines being taken. The prescription should specify bicalutamide strength and how it fits into the overall cancer treatment plan.
The usual process includes:
- Medical assessment. The prescriber reviews the diagnosis, previous treatment, current symptoms, and whether bicalutamide is appropriate for the planned hormonal therapy.
- Baseline liver testing. Serum transaminase levels should be measured before bicalutamide is started because clinically significant liver injury has been reported with treatment.
- Medication review. Other prescription drugs should be checked for relevant interactions. Particular attention is required with coumarin anticoagulants because bicalutamide can increase PT/INR and bleeding risk.
- Prescription and dispensing. Once treatment is selected, the medicine can be dispensed by a pharmacy against a valid prescription. In Canada, Health Canada also classifies marketed bicalutamide 50 mg tablets as prescription medicines.
- Follow-up testing. Liver enzymes are generally checked at regular intervals during the first four months and periodically afterward, with earlier testing if symptoms suggest liver dysfunction.
The prescription should therefore be treated as part of ongoing prostate cancer management rather than as a one-time medication order, since the dose, accompanying hormone therapy, laboratory monitoring, and duration of treatment may need to be adjusted over time.
Can This Medicine Be Shipped from Canada to the United States?
When FDA personnel consider a personal-use shipment, factors may include:
- whether the medicine is intended for the patient’s own treatment rather than resale;
- whether the product presents an unreasonable health risk;
- whether the patient can identify the U.S.-licensed physician responsible for treatment;
- whether the quantity is generally limited to no more than a three-month supply.
Packages entering through international mail or courier facilities can also be reviewed by FDA, and a shipment may be detained or refused if it does not meet applicable U.S. requirements. Canadian pharmacy can arrange shipment of a prescribed medication from Canada to a U.S. address, subject to the applicable import and delivery requirements.
For a patient already receiving Casodex as part of prostate cancer treatment, the safest approach is to confirm the prescription and supply plan with the treating clinician and verify the applicable import requirements before arranging a cross-border shipment.
How to use?
The usual dose is one coated tablet per day that can have 50 mg of the active substance or three times this amount. You should always take the tablets at approximately the same time, such as at breakfast. It doesn’t matter if you swallow the tablets before, during, or after a meal.
If you forget to take a tablet for one day, you should not take it later, but take the next tablet at the usual time of the next day. If you accidentally took double or more of the prescribed dose, you need to let the medical specialist know about it without wasting time. You should never change the prescribed dosage on your own. If you think the medicine is too weak or too strong, have your doctor reevaluate the treatment plan.
Effectiveness and safety of Casodex
In a combined evaluation of three double-blind, placebo-controlled studies including more than 8,000 participants, the treatment of localized or locally progressed prostate cancers without metastases with casodex at a dosage of 150 mg was investigated.
Casodex was administered as supportive medication for radiation or radical prostatectomy as well as emergency hormonal therapy. Almost 10 years later, there was a noticeable disease progression in 36.6% of men using Casodex and 38.17% of those taking a placebo, respectively.
A reduction in the risk of health issue progression was recorded in a significant number of individuals, but it was most noticeable in individuals at high risk. Accordingly, the doctor may decide that the best way to go for low risk individuals, in particular with the use of the drug after radical prostatectomy, may be to delay hormones until signs that the sickness is worsening appear.
In a clinical study, the mean concentration of (R)-bicalutamide in the semen of men treated with Casodex at a dosage of 150 mg was 4.9 µg/ml. The amount of bicalutamide potentially ingested by a female partner during intercourse is low and may be around 0.3 µg/mL, which did not lead to an exposure of offspring in laboratory animals.
Contraindications
There is not enough research to determine if this drug is safe for children. As a result, it is not typically prescribed to people of this age.
Casodex shouldn’t be given to women, especially if they are expecting a baby or breastfeeding. Men and/or their partners are encouraged to adhere to effective methods of contraception during the Casodex treatment course and three months after it.
Increased sensitivity to any of its chemical elements means a healthcare provider might need to turn to alternatives.
Precautions of Generic Casodex
As is the case with many medications, moderate to severe liver disease should create a more thorough analysis of the risk versus benefits of using Casodex. Therefore, your doctor may check how your liver is working before prescribing it and during the reception of the medication.
Moderate to severe liver illness should necessitate a more thorough risk vs benefit assessment of Casodex usage, as is generally the case for plenty of drugs. Therefore, both before and after you receive the drug, your doctor may assess how your liver is responding.
If you have any heart or blood vessel ailments such as irregular heartbeats, and if you are taking any medications for them, let your healthcare provider know. The chance of having an irregular heartbeat may rise if you use Casodex.
Quinidine, Procainamide, Amiodarone, and Sotalol are a few examples of pharmaceuticals that may interact with Casodex. When used with additional drugs including Methadone, Moxifloxacin, and antipsychotics, Casodex may further raise the risk of irregular heartbeats.
Anticoagulant medication’s effects may be boosted by the substance. Therefore, you should talk to your doctor before taking any anticoagulants or blood thinners.
Lactose is part of Casodex. As a result, lactose-intolerant individuals ought to be properly watched. Casodex might alter or worsen your blood sugar levels if you already have diabetes.
The duration of antiandrogen therapy may alter the morphology of sperm. Despite the fact that the impact of bicalutamide on the structure of sperm has not been studied, Casodex users have not reported seeing such alterations. Impaired fertility has been seen in animal studies. It was, though, reversible. It should be assumed that males may have infertility or experience periods of insufficient reproductive function.
You must use a reliable form of birth control while taking the medication and for three months after stopping it. This goes for your partner as well. If you are worried, your doctor may provide you with further information on this topic.
Casodex’s adverse effects, such as tiredness and dizziness, might impair your ability to be responsive, use machinery or tools, and drive.
Any additional medical issues or allergies you may have, or other drugs you may be taking, including topical treatments, should be disclosed to the specialized practitioner who advised this prescription.
Drug interactions
It is not recommended to give Casodex together with Terfenadine, Astemizole, or Cisapride. It could be required to lower the dose of these medications, particularly if there’s evidence that their impact or adverse effects are intensifying.
If a patient is taking medications like Cimetidine or Ketoconazole, which can prevent medicines from being oxidized, it is crucial to take caution when administering this medication. The level of Casodex in the blood plasma may alter as a result, which theoretically might result in more severe or frequent adverse effects.
What are the side effects of Bicalutamide?
The accompanying information about the potential side effects of Casodex will assist patients in making more knowledgeable decisions about taking the drug and will also help them become ready for any negative effects that could arise. These might include:
- chest pain, swelling, or discomfort in the chest,
- allergic reaction,
- fever and chills,
- wheezing or dry cough,
- shortness of breath,
- pale skin,
- trouble concentrating,
- nausea and upper stomach aches,
- tiredness,
- worsening of appetite or hunger,
- dark urine or blood in the urine,
- clay-colored stools,
- jaundice,
- increased thirst,
- frequent urination,
- dry mouth and skin,
- fruity breath,
- drowsiness,
- blurred vision,
- decreased sex drive,
- erectile dysfunction,
- weight gain or loss,
- increased blood sugar,
- anemia,
- hair loss.
Casodex does not affect the ability to drive a car or operate complex mechanisms. However, it should be borne in mind that drowsiness can often occur, very often dizziness. Individuals taking this drug should be careful.
If you experience any adverse effect that bothers you or does not go away shortly thereafter, call your healthcare provider. Please take note that this is not a complete list of all potential issues. More information on what to look out for may be obtained from your doctor or pharmacist.
Storage
Casodex is a highly effective medicine and should be kept out of the reach of children. It should be protected from light and not be stored above 30°C.
The drug should be used only until the date marked “Expiration date” on the box. If you have expired film-coated tablets, take them to the pharmacy for disposal.