An anti-androgen for prostate cancer
Enzalutamide
A strong anti-androgen tablet for advanced prostate cancer, with a small seizure risk and many interactions.
What is Enzalutamide?
Enzalutamide is a hormone-therapy tablet for advanced prostate cancer. It is a stronger androgen-receptor blocker, meaning it powerfully blocks the effect of testosterone that the cancer feeds on. It is started by a cancer specialist and taken at home. Common effects include tiredness, hot flushes and high blood pressure, and it can increase the risk of falls. There is a small risk of seizures, so it is used with care in people prone to them, and it has many drug interactions, so your team needs a full list of everything you take. It does not carry the infection risk of chemotherapy.
Education and reference only. This is a plain-language guide to Enzalutamide — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Enzalutamide is a hormone therapy (a potent anti-androgen) used to treat advanced prostate cancer. It comes as a tablet or capsule taken by mouth and is taken at home as part of treatment planned by a cancer specialist. It is a newer, more powerful blocker of the testosterone signal than older anti-androgens, and is used in prostate cancer that has spread or is no longer controlled by standard hormone treatment alone. Treatment is started and supervised by a specialist.
How it works
Prostate cancer is usually driven by male hormones (androgens) such as testosterone acting on docking points called androgen receptors inside the cancer cells. Enzalutamide blocks these receptors strongly and also interferes with the signal at more than one step, so it shuts down the hormone's growth message more completely than older anti-androgens. This slows the cancer. Because it acts on the brain to some degree, it carries a small risk of seizures, and because it changes how the liver handles many medicines, it has a number of drug interactions.
Company & origin
Originated / developed by: Specialist cancer medicine.
A newer, stronger hormone-therapy tablet used in the UK for advanced prostate cancer, started by a cancer specialist and taken at home.
Practical use
How to take Enzalutamide
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it once a day as prescribed, at about the same time each day; swallow whole and follow the advice you are given about food.
- Take it regularly even when you feel well, as it works by keeping the hormone signal blocked over time.
- Tell your specialist before starting any new medicine, including over-the-counter and herbal products, because of the many interactions.
- Report any fit, blackout or unexplained fall straight away, and take care moving about if you feel unsteady or dizzy.
- Attend your reviews so your blood pressure and how the cancer is responding can be checked.
Weighing it up
Advantages & disadvantages of Enzalutamide
Advantages
- A strong, effective hormone tablet for advanced prostate cancer, taken at home.
- Blocks the testosterone signal more completely than older anti-androgens.
- Does not lower the infection-fighting white cells the way chemotherapy does.
Disadvantages
- Commonly causes tiredness, hot flushes and high blood pressure, and can increase the risk of falls.
- Carries a small risk of seizures, so it needs care in people prone to them.
- Has many drug interactions, so all other medicines must be checked.
Practical use
Good to know
Enzalutamide is a powerful daily hormone tablet taken at home. The most common effects are tiredness, hot flushes and a feeling of weakness, and it can raise blood pressure, which is checked at reviews. Importantly, it can increase the risk of falls and of feeling unsteady, so take care, especially if you also feel dizzy. There is a small but real risk of seizures, so tell your specialist if you have ever had a fit, a blackout or a head injury, or take other medicines that can lower the seizure threshold; report any blackout or fit straight away. Enzalutamide interacts with many medicines because it changes how the liver processes them, so give your team a complete list of everything you take, including over-the-counter and herbal products, and check before starting anything new. It does not work by lowering the infection-fighting white cells, so it does not carry chemotherapy's infection risk. It is for prostate cancer in men and is not for use in women or children.
Who should not take it / use with caution
- It is for prostate cancer in men and must not be used in women or children.
- It is used with particular caution, or avoided, in people with a history of seizures or conditions that raise seizure risk.
- People who have had a serious allergic reaction to enzalutamide should not take it.
Monitoring
- Regular blood pressure checks and reviews of tiredness and steadiness.
- Regular PSA blood tests and reviews to see how the cancer is being controlled.
- Reviewing all other medicines for interactions and any history that raises seizure risk.
Side effects
- Tiredness, weakness, hot flushes and high blood pressure.
- Increased risk of falls and feeling unsteady or dizzy.
- A small risk of seizures; report any fit or blackout urgently.
Key interactions
- It has many interactions because it changes how the liver processes other medicines, which can raise or lower their levels.
- Medicines that lower the seizure threshold add to the small seizure risk.
- Tell your team about everything you take, including over-the-counter and herbal products such as St John's wort, and check before starting anything new.
Available as: Tablets or capsules taken by mouth, usually once a day.
Answers
Enzalutamide: frequently asked questions
How is enzalutamide different from older anti-androgens?
It is a stronger blocker of the testosterone signal and works at more than one step, so it shuts the hormone's growth message down more completely; it is used in advanced prostate cancer.
Is the seizure risk something to worry about?
The risk is small, but it is real, so tell your specialist if you have ever had a fit, blackout or head injury, and report any fit or blackout straight away.
Why must I check before taking any new medicine?
Enzalutamide changes how the liver handles many medicines, so it can raise or lower their levels; always tell your team about everything you take and check before starting anything new.
Does it lower my immune system like chemotherapy?
No. It is a hormone therapy that blocks testosterone's effect and does not lower the infection-fighting white cells the way chemotherapy does.
Why do I feel so tired and unsteady?
Tiredness and feeling unsteady are common with enzalutamide, and it can increase the risk of falls; take care moving about and tell your specialist if it is troubling you.
Authoritative sources
- BNF
- NICE CKS
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