Brand and Other Names:Xtandi
- Classes: Antineoplastics, Antiandrogen
Dosing & Uses
Dosage Forms & Strengths
Androgen receptor inhibitor indicated for the treatment of metastatic castration-resistant prostate cancer in patients who have not received chemotherapy and those who have previously received docetaxel
160 mg PO qDay
≥Grade 3 toxicity or an intolerable side effect: Withhold dose for 1 week or until symptoms improve to ≤Grade 2, then resume at the same or a reduced dose (120 mg or 80 mg), if warranted
Concomitant strong CYP2C8 inhibitors
- Avoided if possible
- If must be coadministered with a strong CYP2C8 inhibitor, reduce enzalutamide dose to 80 mg qDay
- If coadministration of the strong inhibitor is discontinued, re-establish enzalutamide to the dose used prior to initiation of the strong CYP2C8 inhibitor
May administer with or without food
Swallow capsule whole; do not chew, dissolve, or open the capsules
Not indicated in this population
Serious - Use Alternative
Significant - Monitor Closely
Asthenic conditions (50.6%)
Back pain (26.4%)
Hot flush (20.3%)
Neutropenia, all grades (15%)
Musculoskeletal pain (15%)
Peripheral edema (15.4%)
Muscular weakness (9.8%)
Spinal cord compression (7.4%)
Mental impairment (4.3%)
Nonpathologic fracture (4%)
Dry skin (3.5%)
Neutropenia, grades III/IV (1%)
Pregnancy; not indicated for use in women
Because of risk of seizure associated with XTANDI use, advise patients of risk of engaging in activities where sudden loss of consciousness could cause serious harm to themselves or others; permanently discontinue therapy in patients who develop seizure during treatment
CYP2C8 substrate; avoid coadministration with strong CYP2C8 inhibitors (see Dosage Modifications)
Enzalutamide is a strong CYP3A4 inducer and a moderate CYP2C9 and CYP2C19 inducer; shown to reduce the plasma exposure to midazolam (CYP3A4 substrate), warfarin (CYP2C9 substrate), and omeprazole (CYP2C19 substrate); caution if coadministered with narrow therapeutic index drugs that are substrates of the aforementioned CYP isoenzymes
Posterior reversible encephalopathy syndrome (PRES) reported with use; discontinue therapy in patients who develop PRES
Pregnancy & Lactation
Pregnancy Category: X
Not indicated for use in women
Can cause fetal harm when administered to a pregnant woman based on its mechanism of action
Lactation: Unknown whether distributed in breast milk
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Androgen receptor inhibitor; competitively inhibits androgen binding to androgen receptors; also inhibits androgen receptor nuclear translocation and interaction with DNA resulting in decreased proliferation and induced cell death
Major metabolite, N-desmethyl enzalutamide, exhibited similar in vitro activity to enzalutamide
Peak Plasma Time: 1 hr
Peak Plasma Concentration (steady-state): 16.6 mcg/mL (parent compound); 12.7 mcg/mL (active metabolite)
Steady-state achieved by Day 28
Protein Bound: 97-98% (parent compound); 95% (active metabolite)
Vd: 110 L
Metabolized by liver by CYP2C8 and CYP3A4; CYP2C8 is primarily responsible for the formation of the active metabolite (N-desmethyl enzalutamide)
Metabolites: N-desmethyl enzalutamide (active); carboxylic acid metabolite (inactive)
Strong CYP3A4 inducer; CYP2C9 and CYP2C19 moderate inducer
Excretion: 14% feces, 71% urine (as inactive metabolites)
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