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Enzalutamide (Xtandi)

Enzalutamide is a type of hormone therapy. It is a treatment for prostate cancer that has spread to other parts of the body (advanced prostate cancer). It is also known by its brand name, Xtandi. 

How it works

Most prostate cancers need the hormone testosterone to grow. The testicles make almost all testosterone in men. Just above each kidney are 2 adrenal glands, they also make a small amount of testosterone. 

Enzalutamide is a hormone treatment that blocks testosterone from reaching prostate cancer cells. This can slow the growth of the cancer and may shrink it. You might hear it called an androgen receptor blocker (inhibitor).

How you have it

You take enzalutamide as capsules, once a day. You swallow them whole with a glass of water. You can have the capsules with or without food.

Taking capsules

You must take capsules according to the instructions your doctor or pharmacist gives you.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have it

Enzalutamide is a treatment for prostate cancer that has spread to other parts of your body, advanced prostate cancer. 

You might have it if:

  • other hormone treatments are no longer working for you and you can't have chemotherapy
  • you have already had docetaxel chemotherapy


You might have blood tests before starting treatment and during your treatment. They check your general health and might check your levels of blood cells and other substances in the blood.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse
Early treatment can help manage side effects better.

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them. They include:

Tiredness and weakness (fatigue) during and after treatment

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Tiredness and weakness occurs in about 1 in 3 men (33%).

Hot flushes and sweats

We have some tips for coping with hot flushes and the possible treatments for men and women. Talk to your doctor if your hot flushes are hard to cope with. They might be able to prescribe you some medicines.

Hot flushes happen in about 2 in 10 men (20%).


Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.

Headaches affect about 1 in 10 men (10%).

High blood pressure

During treatment, your blood pressure may be lower or higher than normal. Tell your nurse if you feel dizzy, faint, or if you have headaches, nosebleeds, blurred or double vision, or shortness of breath. Your blood pressure usually goes back to normal while you are on treatment or when treatment ends.

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:

  • memory problems
  • breast swelling
  • Dry skin
  • falls
  • bone thinning
  • anxiety
  • restless legs syndrome

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • risk of seizures
  • bruising, bleeding gums or nosebleeds

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Contraception and pregnancy

This drug may harm a baby developing in the womb. It is important not to father a child while you are having treatment with this drug and for at least 3 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


We don’t know how this treatment might affect fertility. You may not be able to father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Some men might be able to store sperm before starting treatment.

Treatment for other conditions 

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.


This medicine contains sorbitol (a type of sugar). If you have intolerance to some sugars, contact your doctor before taking this medicine.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
24 Sep 2018
  • Electronic Medicines Compendium 
    Accessed September 2018

  • Toxicity, Adverse Events, and Quality of Life Associated with the Treatment of Metastatic Castration-Resistant Prostate Cancer

    S Tonyali and others 

    Current Urology 2016 Volume 10 pages 169–173

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