Bicalutamide, sold under the brand name Casodex among others, is an antiandrogen medication that is primarily used to treat prostate cancer. It is typically used together with a gonadotropin-releasing hormone (GnRH) analogue or surgical removal of the testicles to treat advanced prostate cancer. Bicalutamide may also be used to treat excessive hair growth in women, as a component of feminizing hormone therapy for transgender women, to treat early puberty in boys, and to prevent overly long-lasting erections in men. It is taken by mouth.
|Trade names||Casodex, others|
|Drug class||Nonsteroidal antiandrogen|
|Bioavailability||Well-absorbed; absolute bioavailability unknown|
(Mainly to albumin)
• Hydroxylation (CYP3A4)
• Glucuronidation (UGT1A9)
• Bicalutamide glucuronide|
• Hydroxybicalutamide gluc.
Acute: 5.8 days|
Chronic: 7–10 days
|Chemical and physical data|
|Molar mass||430.373 g/mol|
|3D model (JSmol)|
|Chirality||Racemic mixture (of (R)- and (S)-enantiomers)|
|Melting point||191 to 193 °C (376 to 379 °F) (experimental)|
|Boiling point||650 °C (1,202 °F) (predicted)|
|Solubility in water||0.005 mg/mL (20 °C)|
Common side effects in men include breast enlargement, breast tenderness, and hot flashes. Other side effects in men include feminization and sexual dysfunction. While the medication appears to produce few side effects in women, its use in women is not recommended by the Food and Drug Administration (FDA). Use during pregnancy may harm the baby. Bicalutamide causes elevated liver enzymes in around 1% of people. Rarely, it has been associated with cases of liver damage, lung toxicity, and sensitivity to light. Although the risk of adverse liver changes is small, monitoring of liver function is recommended during treatment.
Bicalutamide is a member of the nonsteroidal antiandrogen (NSAA) group of medications. It works by blocking the androgen receptor (AR), the biological target of the androgen sex hormones testosterone and dihydrotestosterone (DHT). It does not lower androgen levels. The medication can have some estrogen-like effects in men. Bicalutamide is well-absorbed, and its absorption is not affected by food. The elimination half-life of the medication is around one week. It is believed to cross the blood–brain barrier and affect both the body and brain.
Bicalutamide was patented in 1982 and approved for medical use in 1995. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. Bicalutamide is available as a generic medication. The wholesale cost in the developing world is about US$7.07 to US$144.22 per month. In the United States it costs about US$10 and above per month. The drug is sold in more than 80 countries, including most developed countries. It is the most widely used antiandrogen in the treatment of prostate cancer, and has been prescribed to millions of men with the disease.