Xtandi is an androgen receptor inhibitor used to treat prostate cancer in adult male patients. It contains the active ingredient enzalutamide. Xtandi is typically used to treat patients whose cancer hasn’t responded to other medications or treatments. This drug reduces the effects of male hormones. It should be used when prostate cancer continues to develop despite other therapies that reduce testosterone. The most common of these treatments are medications that reduce testosterone levels and surgery to remove the testicles.

How Does Xtandi Work?

Xtandi is an androgen receptor inhibitor, which means that it keeps the body from being able to use androgens. Androgens are sex hormones such as testosterone. Typically, testosterone connects to unique proteins on cell surfaces throughout the body. These proteins have a specific shape that’s a perfect match for testosterone.

When testosterone connects to receptor proteins, it signals the cell to perform actions like activating DNA, making new proteins, and starting other processes. These signals usually keep your body working the way it should. However, testosterone also causes prostate tumors to grow.

Xtandi has a very similar shape to testosterone. When a patient takes Xtandi, the enzalutamide molecules connect to the receptor proteins that usually bond to testosterone. The Xtandi molecules block the receptor proteins, so they can’t connect with testosterone. As a result, Xtandi is associated with decreased cancer spread and tumor size. It is also associated with cancer cell death.

Xtandi Precautions and Warnings

Talk to your doctor about your medical history and allergies before starting Xtandi. You should not use Xtandi if you are allergic to enzalutamide or any of the medication’s inactive ingredients.

Because Xtandi changes how your body uses sex hormones, only male patients should take it. The medication can be absorbed through the skin or by breathing its dust. Female caregivers should avoid touching Xtandi, handling its packaging, or breathing dust from the container. Pregnant and breastfeeding people should be especially cautious around Xtandi.

Xtandi can lead to congenital disabilities. Do not father a child while taking Xtandi or for three months after stopping treatment.

Xtandi can make some conditions worse. These include seizures, heart disease, and risk of falling. Ask your doctor if any of these risks are a concern for you.

Xtandi Side Effects

Xtandi impacts your hormone levels, so it has a range of side effects.

Mild Side Effects

Mild side effects often fade after you adjust to the treatment. These include:

  • Weakness
  • Fatigue
  • Dizziness
  • Low appetite or weight loss
  • Joint pain
  • Hot flashes
  • Elevated blood pressure
  • Headaches

Sexual Side Effects

Xtandi can cause sexual side effects, including erectile dysfunction, low arousal, and difficulty achieving an orgasm.

Severe Side Effects

More severe side effects are rare but possible. Contact your doctor if you notice serious side effects or if symptoms disappear after a few weeks. Many side effects can be managed through lifestyle changes or other medication.

These serious Xtandi side effects include:

  • Trouble urinating, including low urine levels and blood in the urine
  • Seizures
  • Confusion
  • Blindness or other vision changes
  • High blood pressure
  • Ischemic heart disease
  • Falls and bone fractures
  • Osteoporosis

Allergic Reaction

It’s possible to have an allergic reaction to Xtandi, even if you’ve taken the medicine before. Symptoms of an allergic reaction include trouble breathing, hives, swelling of the face or throat, itchiness, and rash. Call your doctor or call 911 if you notice allergic symptoms.

Drug Interactions with Xtandi

Xtandi can change how your body processes other drugs. Additionally, other medications can also impact how your body uses Xtandi. Tell your doctor about all your medicines, including herbs, supplements, vitamins, and over-the-counter drugs.

Do not eat grapefruit or drink grapefruit juice while taking Xtandi. Alcohol, coffee, spicy foods, dairy, and high-fiber foods may also worsen side effects. Ask your doctor if you should change your diet while taking Xtandi to avoid complications.

Xtandi is known to interact with the following medicines:

  • Phenobarbital
  • Phenytoin (Dilantin)
  • John’s wort
  • Asunaprevit
  • Ergot alkaloids
  • Cobicistat
  • Fentanyl
  • Lurasidone (Latuda)
  • Quinidine
  • Pimoside
  • Sirolimus
  • Suvorexant
  • Tacrolimus
  • Voriconazole

Strengths and Dosages of Xtandi

Xtandi is available in 40mg capsules. These capsules should be taken whole, never broken, crushed, or chewed. Dosages are therefore prescribed in 40mg increments. Your doctor will typically prescribe the lowest dose effective for your symptoms.

The standard dose of Xtandi for castration-resistant prostate cancer is 160mg once each day. Take Xtandi as prescribed at the same time each day. If you miss a dose, take it as soon as you remember that day. If it’s almost time for your next dose, don’t take what you missed. Skip the missed dose. Extra doses will not deliver better results but may increase your adverse side effects.

Cost of Xtandi in America?

A one-month supply of Xtandi costs around $6,700. This price covers the standard 160mg daily treatment. Patients who see results at a lower dose may have a lower cost.

Why is Xtandi So Expensive?

Xtandi is expensive because it’s a limited distribution drug and a specialty cancer medication, so it’s not widely available. It’s typically only sold at specialty pharmacies. There are ways to lower the cost of this drug. If a patient’s health insurance, Medicare, or Medicaid covers Xtandi, they may pay a lower out-of-pocket cost. Prescription savings cards, pharmacy coupons, and patient assistance programs can reduce costs.

If Americans are paying out of pocket, they turn to services such as MyRx Outlet, where they can receive their medication at a lesser price than the average US pharmacy.

Xtandi Alternatives

Xtandi is currently only available as a name-brand drug. Currently, there is not a generic for Xtandi. However, other androgen receptor inhibitors are available. These treatments include:

  • Casodex
  • Erleada
  • Eulexin
  • Nilandron
  • Nubeqa
  • Winlevi

Xtandi FAQs

How long does it take for Xtandi to lower PSA?

Prostate-specific antigen (PSA) levels were reduced by almost 50% after four weeks of treatment during clinical trials.

Do Xtandi side effects go away?

Some Xtandi side effects fade, while others are long-lasting. Patients may experience minor side effects like fatigue, dizziness, joint pain, and more while adjusting to treatment. These side effects often fade once the patient gets used to the medication. However, side effects directly related to hormone levels can last longer. These include erectile dysfunction and hot flashes. Talk to your doctor about ways to manage these symptoms if you experience them.

Xtandi vs. Zytiga: What are the differences and similarities?

Xtandi and Zytiga are both used to treat prostate cancer. These are the significant similarities and differences between these medications.

For metastatic or non-metastatic cancer (cancer that has or has not spread beyond the prostate)Only for metastatic (spreading) cancer


Can be taken with or without foodMust be taken without food
Must be used with testosterone-lowering treatmentMust be taken with prednisone (a steroid)


Unsafe for females to use or handleUnsafe for females to use or handle
Patients should not father a child during treatmentPatients should not father a child during treatment
Increased risk of fractures, high blood pressure, erectile dysfunction, low sex driveIncreased risk of fractures, high blood pressure, erectile dysfunction, low sex drive
Increased risk of seizures, heart diseaseIncreased risk of edema, low blood potassium, irregular heartbeat, adrenal problems, liver problems, hypoglycemia

Can I drink alcohol while taking Xtandi?

It would be best if you asked your doctor for more advice since Xtandi and alcohol are both processed in the liver. Depending on your liver health, symptoms, and other medications, it may or may not be a good idea for you to drink while using Xtandi.

Is Xtandi a chemotherapy drug?

No, Xtandi is not a chemotherapy drug. Xtandi keeps testosterone from reaching your prostate and potentially causing tumor growth. It’s associated with tumor cell death because a lack of testosterone keeps tumors from growing. Xtandi allows tumor cells to go through a typical cell death instead of continuing to grow indefinitely. Chemotherapy drugs, on the other hand, actively attack tumor cells.

What is the Xtandi length of treatment?

Most patients who respond to Xtandi will continue the treatment for life.

Is there a generic for Xtandi?

No, there is no generic for Xtandi. The drug is only available as a name-brand medication.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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