medication compatibility

[racoonwar]

I've been on bicalutamide for about 2 years and will start on Xtandi July 5th.

Anyone know of problems with Xtandi while on bicalutamide? I already have hot flashes and some fatigue. At 84 years old, maybe a little fatigue is normal.

[Tall_Allen]

There is no point in taking them both at the same time, because they are both anti-androgens (they block the androgen receptor). Bicalutamide is like a drop in the ocean compared to Xtandi. But since your PSA is going up while taking bicalutamide, it is possible your cancer is feeding on the bicalutamide. If that is the case, your PSA will decrease if you just stop taking bicalutamide (this is called "anti-androgen withdrawal syndrome").

You also should be seeing a medical oncologist, not a urologist. Normally, one would take a drug like Lupron at this point, not a more powerful anti-androgen as a monotherapy.

[RyderLake2]

Hello, Casodex (bicalutamide) and Xtandi (enzalutamide) belong to the same family of drugs (the lutamide family). They have the same mechanism of action. Enzalutamide is the big brother of Bicalutamide. Enzalutamide is far, far stronger, so I am not sure why you would want to take both. There are several other members of the lutamide family such as Darolutamide and Apalutamide. Both have been approved recently. The old-timer of the family (Grandpa?) is flutamide.

[LearnAll]

Bicalutamide and enzalutamide both are LUTAMIDE medicines and taking them together is pointless.

[larry_dammit]

Call there (Xtandi) pharmacy and give them a full list of scripts and over the counter stuff your taking. Xtandi does not play well with a lot of other meds.

[racoonwar in reply to larry_dammit]

I discussed this concern with my PCP. He doesn’t have a problem with me taking Xtandi.

[JD-guy]

I went on Xtandi June 5th. I stopped Casedex. I go for lab work on Tuesday July 5th to see how my kidney function and blood counts etc are at. I have not had a PSA yet, but my pain has diminished I think my PSA will be lower also when I get that checked. Probably will have that checked the end of July. There are other posts on here about side effects and fatigue etc. (Use the search) I kind of dreaded the idea of going on the med. But so far it has been manageable. This my experience, I am not a Dr. We all have different side effects etc. This forum has been very helpful for me. Keith

[racoonwar in reply to JD-guy]

You’re right about side effects, some are mild and some are severe. I’m hoping for mild. I start Xtandi this Tuesday.

[Magnus1964]

If bicalutimide is still working why add xtandi? If it's not needed don't do it.

[racoonwar in reply to Magnus1964]

Increasing PSA last 12 months, PET Scan 2 weeks ago revealed metastasis of T5 and L5 plus two lymph glands intensely Pylarify-avid

[Magnus1964 in reply to racoonwar]

Then it would be time to drop bicalutimide and go to zytiga.

[j-o-h-n]

At 84 you're entitled to side effects....It's like wearing a badge of honor.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 07/05/2022 6:07 PM DST

[Hidden in reply to j-o-h-n]

Lol...inded!

[Hidden]

Bicalutamide has failed, that's why Xtandi has been prescribed instead. You may have misunderstood that Bicalutamide is no longer needed. Doctors often throw a lot of info at you at once. Sadly, it's a normal progression for advanced prostate cancer. My husband takes Xtandi plus Lupron injections. Many urologist are very qualified and specialize in prostate cancer. We had a second opinion with an oncologist at a cancer center because our cardiologist suggested it. The oncologist agreed with everything the urologist has done and his plan for treatment. The MO said there was no reason to switch as he would be prescribing the same treatment. Of course he would treat my husband if unhappy with our urologist, but certainly not necessary.