Xtandi Enzalutamide 40 Mg

Q1: What is Xtandi Enzalutamide 40mg used for?

Enzalutamide treats metastatic castration-resistant prostate cancer (mCRPC), non-metastatic CRPC with rising PSA, and metastatic castration-sensitive prostate cancer — covering multiple stages of hormone-sensitive disease.

Q2: How does Enzalutamide work?

Enzalutamide is a next-generation androgen receptor inhibitor. It blocks androgen binding to the AR, prevents the AR from moving to the cell nucleus, and inhibits AR-mediated DNA transcription — blocking all androgen signaling steps simultaneously.

Q3: How is Enzalutamide (Xtandi) taken?

Take 160mg once daily as four 40mg capsules, with or without food. Swallow capsules whole. Take at the same time each day.

Q4: Why is seizure risk important with Enzalutamide?

Enzalutamide has a seizure risk of approximately 1% due to its CNS activity. It is contraindicated in patients with a history of seizures. Inform your oncologist of any seizure history, brain injury, or concurrent medications that lower the seizure threshold.

Q5: How long is Enzalutamide treatment continued?

Treatment continues until disease progression or unacceptable toxicity. PSA and imaging are monitored regularly. In non-metastatic CRPC, treatment continues until metastasis or PSA progression.

Q6: What are the most common side effects?

Common side effects include fatigue, hot flashes, hypertension, diarrhea, dizziness, and headache. Cognitive effects (memory, concentration) can occur in some patients.

Q7: What serious side effects require emergency care?

Seek immediate care for: seizures, falls and fractures (especially in older patients), signs of posterior reversible encephalopathy syndrome (PRES — headache, confusion, vision changes), or significant cardiovascular events.

Q8: Does Enzalutamide interact with other drugs?

Enzalutamide is a strong CYP3A4 inducer and can significantly reduce levels of many drugs including warfarin, tacrolimus, and some statins. It also inhibits CYP2C8. A comprehensive medication review is essential before starting.

Q9: Can Enzalutamide be taken with food?

Yes, it can be taken with or without food. Consistent dosing timing is important. Avoid CYP3A4 inducers (rifampicin) and inhibitors (ketoconazole) without medical review.

Q10: Is Enzalutamide safe for older patients?

Older patients have higher rates of falls and fractures. Bone health monitoring (DXA scan) and fall prevention measures are important. Regular neurological assessment for cognitive effects is also recommended.

Q11: What monitoring tests are needed?

Regular PSA testing, imaging to assess response, blood pressure monitoring, and liver function tests are required. Bone mineral density should be assessed given the risk of fractures.

Q12: Is a prescription required for Enzalutamide?

Yes. Enzalutamide is a prescription-only oncology medication that requires specialist prescribing, molecular staging of prostate cancer, and regular monitoring throughout treatment.