Bicalutamide
What is bicalutamide?
Bicalutamide is a hormonal therapy drug. It is used to treat prostate cancer.
It is best to read this information with our general information about hormonal therapy and the type of cancer you have.
Your cancer team will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
More information about this treatment
This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.
You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.
How bicalutamide works
Hormones are chemicals that our bodies make. They act as messengers and help control how cells and organs work. Hormonal therapy drugs change how hormones are made or work in the body.
Most prostate cancers need the hormone testosterone to grow. Testosterone is mainly made by the testicles. A very small amount is made by the adrenal glands, which sit above the kidneys.
Bicalutamide blocks testosterone from reaching the cancer cells. This may shrink the prostate cancer or stop it growing.
You may have bicalutamide:
- on its own or with other hormonal therapies
- for a few weeks when taking hormonal drugs called LHRH agonists – this is to prevent symptoms getting worse because of a temporary rise in testosterone (tumour flare)
- with or after other treatments such as surgery (radical prostatectomy) or radiotherapy
- to treat prostate cancer that has spread to other parts of your body – this is called advanced or metastatic prostate cancer.
How bicalutamide is given
You have bicalutamide as tablets you can take at home.
During your treatment, you will meet someone from your cancer team, such as a:
- cancer doctor
- specialist nurse
- specialist pharmacist.
This is who we mean when we mention doctor, nurse or pharmacist in this information.
Taking bicalutamide tablets
Your cancer team will discuss your treatment plan with you.
Always take the tablets exactly as they tell you to. This is important to make sure they work as well as possible for you. Make sure you:
- swallow them whole with a glass of water
- do not chew, open, break or crush them
- take them at the same time every day.
If you forget to take the tablets, miss the dose for that day. Then take your normal dose the next day. Do not take a double dose to make up for the missed tablets.
Other things to remember about your tablets:
- Keep them in the original package and at room temperature, away from moisture, heat and direct sunlight.
- Keep them safe, where children cannot see or reach them.
- If you are sick (vomit) just after taking them, do not take an extra dose. Take your next dose at the usual time.
- Get a new prescription before you run out, and make sure you have plenty for holidays.
- Do not throw away unused tablets. Return them to a pharmacy.
Your cancer team may also give you other medicines to take home. Take all your medicines exactly as they tell you to. Do not stop taking any of your medicines unless your doctor tells you to.
About side effects
We explain the most common side effects of this treatment here. We also include some that are less common.
You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here.
Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.
When you have this treatment, you will have regular appointments with a doctor, nurse or pharmacist. Always tell them about any side effects you have. They can give you:
- drugs to help control most side effects
- advice about managing side effects.
Most side effects can be managed. But sometimes side effects are harder to control. It is important not to stop taking hormonal therapy without telling your doctor. If side effects cannot be managed, your doctor may suggest a different type of hormonal therapy.
Serious and life-threatening side effects
Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.
Contact the hospital
Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
Very common side effects
Breast swelling or tenderness
This treatment may cause swelling and tenderness of your breast tissue. This is called gynaecomastia. To prevent this, some people have 1 or more low-dose radiotherapy treatments to the chest before treatment starts. Another type of hormonal drug might be used to treat the breast swelling. Your doctor can give you more advice.
Hot flushes and sweats
Hot flushes are a common side effect of this treatment. During a flush, your neck and face may feel warm. If you have white skin, your skin may look red. If you have black or brown skin, your skin colour may deepen. Flushes can last up to 5 minutes. You might also have sweats or feel anxious or irritable during a flush.
Here are some things you can do to reduce the effects of hot flushes:
- Wear natural fabrics, such as cotton.
- Wear layers so you can remove clothes as needed.
- Use cotton sheets and layers of bedding you can remove.
- Try cooling pads or pillows to keep you cool.
- Keep rooms cool or use a fan.
- Have cold drinks and avoid caffeine and alcohol.
You might have fewer hot flushes as your body adjusts to this treatment. You could try therapies to help you cope with hot flushes, such as:
- talking therapies like cognitive behaviour therapy (CBT)
- controlled breathing exercises
- yoga
- acupuncture.
If they do not improve, talk to your doctor. Certain drugs can help to improve hot flushes.
Flushes usually stop a few months after treatment ends. But some people continue to have them.
Skin changes
This treatment can affect your skin. It may cause a rash, which may be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Changes to your skin usually improve when treatment ends.
Feeling weak
Bicalutamide can cause you to feel weak and lack energy. You may lack strength to do the things you normally do. You may feel tired. Try to pace yourself and plan your day so you have time to rest between activities.
Being physically active may help to manage tiredness and give you more energy. It also:
- helps you sleep better
- reduces stress
- improves your bone health.
If you feel sleepy, do not drive or operate machinery.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:
- very low in energy
- breathless
- dizzy and light-headed.
If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Other side effects
Sexual effects
It is common to lose your sex drive and have erection difficulties with hormonal therapy. Hormonal therapy may also make your penis shorter and your testicles smaller.
Your doctor can prescribe drugs and treatments to help with erection difficulties. These will not increase your sex drive. But they might work, even with a low sex drive.
Things can improve a few months after you stop taking the drug. But it depends on how long you take hormonal therapy, and what other treatments you have had. Some people continue to have problems after treatment ends.
Dizziness or drowsiness
Tell your doctor or nurse if you have either of these symptoms. If you feel dizzy or drowsy, it is important not to drive or operate machinery.
Tummy pain
You may get pain in your tummy (abdomen), or have indigestion. Your doctor, nurse or pharmacist can give you advice or treatment to help. Contact the hospital straight away on the 24-hour number if your symptoms do not go away, or get worse.
Feeling sick
You may have blood in your urine while taking bicalutamide. If you notice this, tell your doctor or nurse.
Constipation
This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help.
If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away.
Loss of appetite
This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.
Blood in your urine
You may have blood in your urine while taking bicalutamide. If you notice this, tell your doctor or nurse.
Mood changes
You may feel low or depressed, or have mood swings, during this treatment. Talking to family and friends about how you feel might help. If mood changes last for more than a few weeks, tell your doctor, nurse or pharmacist. They can talk to you about different ways to manage low mood or depression.
Effects on the liver
This treatment may affect how your liver works. This is usually mild. You will have blood tests to check how well your liver is working.
Hair thinning
While you are having this treatment, the hair on your head might become thinner, drier and more brittle. This is usually mild.
You might also lose some:
- body hair, such as chest and pubic hair
- facial hair.
If you are worried about this, talk to your nurse about hair care.
Effects on the heart
This treatment might increase certain risk factors for heart problems. Tell your doctor if you have:
- had any problems with your heart
- high blood pressure
- high levels of cholesterol – a fatty substance in your blood.
They can monitor or treat these if needed. Talk to your doctor if you are worried about this.
Things you can do to take care of your heart include:
- not smoking
- maintaining a healthy weight
- being physically active.
Weight gain
You may gain weight when you are having this treatment. Eating healthily and being active can help you keep to a healthy weight. Your doctor, nurse or dietitian can give you more advice.
Allergic reaction
This treatment might cause an allergic reaction. But this is not common. Signs of a reaction can include:
- a skin rash or itching
- feeling breathless or wheezy
- swelling of your face, mouth or throat.
If you feel unwell or have any of these signs, contact the hospital straight away on the 24-hour number. Do not take any more of this treatment until you have checked with them.
Always call 999 if swelling happens suddenly or you are struggling to breathe.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor, nurse or pharmacist if you develop:
- a cough that does not go away
- wheezing
- breathlessness.
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
Other important information
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:
- throbbing pain or swelling in a leg or arm
- reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
- suddenly feeling breathless or coughing.
Always call 999 if you have:
- chest pain
- difficulty breathing.
A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.
Other medicines
Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop, pharmacy or online
- vitamins or supplements
- herbal drugs and complementary or homeopathic therapies
- recreational drugs – for example, cannabis.
Lactose
This treatment may contain lactose. If you have a lactose allergy or intolerance, ask your doctor, nurse or pharmacist for more information.
Contraception
Your doctor, nurse or pharmacist will advise you not to make someone pregnant while having this treatment. The drug may harm the developing baby. It is important to use effective contraception during treatment and for a while after it finishes.
Fertility
Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.
If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for more detailed information. The leaflet lists all known side effects.
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.