Nilutamide (Oral)

Classed as a nonsteroidal antiandrogen, Nilutamide is used to treat metastatic prostate cancer and may be prescribed alongside surgery.

Overview

Normally used to treat patients who have metastatic prostate cancer, Nilutamide may be prescribed as a hormone therapy following surgery. Once prostate cancer has metastasized, it has spread to other areas. As well as using antineoplastic drugs to treat metastatic prostate cancer, patients may undergo surgery in order to remove cancer from their body. Whilst surgery may be effective in removing a significant amount of cancer cells from the patient's body, it may not be successful in removing the cancer completely. As a result, patients often require additional therapies in order to treat the remaining cancer cells.

As testosterone can cause prostate cancer cells to replicate and spread, Nilutamide works by blocking this hormone. Characterized as a selective antagonist of the androgen receptor, the drug prevents dihydrotestosterone (DHT) and testosterone from activating the relevant receptors. As a result, cell cycles are affected. Once this happens, the affected cells are unable to replicate or grow, meaning that they cannot spread any further. In addition to this, the body is able to destroy the cells which have been affected by Nilutamide, which means that the therapy can enable the body to rid itself of existing cancer cells.

Although Nilutamide can be used as an individual therapy, it may be prescribed alongside a form of GnRH analogue therapy. This enables patients to achieve a maximum adrenal blockade and can increase the efficacy of treatment. Whilst Nilutamide is likely to cause some side-effects, the benefits of using hormone therapy, in addition to surgery, generally outweigh the risk of developing side-effects as a result of the treatment.

Conditions Treated

  • Metastatic prostate cancer

Type Of Medicine

  • Nonsteroidal antiandrogen
  • Antineoplastic hormonal agent

Side Effects

Whilst any type of medication can cause patients to experience side-effects, antineoplastic agents are linked to a considerable number of adverse effects. For example, when patients are treated with Nilutamide, they may experience the following side-effects:

  • Sour or acid stomach
  • Decreased interest in sexual intercourse
  • Belching
  • Decrease in testicle size
  • Body hair loss
  • Depression
  • Bone pain
  • Crawling, numbness, burning, prickling, itching, tingling or crawling or "pins and needles" feelings
  • Rash on the skin
  • Dizziness
  • Pain
  • Changes in vision
  • Difficulty having a bowel movement (stool)
  • Stomach pain, upset or discomfort
  • Dry skin
  • Sudden sweating
  • Feeling of warmth
  • Redness of the neck, arms face and, sometimes, the upper chest
  • Heartburn
  • Loss of sexual desire, performance, drive or ability
  • Inability to have or keep an erection
  • Sleeplessness
  • Increased urge to urinate during the night
  • Difficulty with moving
  • Indigestion
  • Unable to sleep
  • Dry mouth
  • Waking to urinate at night
  • General feeling of illness or discomfort
  • Swelling, pain or redness in the joints
  • Itching
  • Passing of gas
  • Muscle stiffness or pain

The above side-effects may occur more often when patients first start taking Nilutamide. However, once their body becomes accustomed to the medication, the side-effects should be reduced. If the above side-effects are relatively mild and are not troublesome to the patient, they may not require additional treatment for them. However, physicians can often provide assistance with the reduction of side-effects and patients should always seek help if they are concerned about adverse effects associated with Nilutamide.

In addition to this, patients should seek immediate medical advice if they are affected by the following side-effects whilst taking Nilutamide:

  • Blood in the urine
  • Pounding in the ears
  • Blurred vision
  • Pale skin
  • Chest pain
  • Nervousness
  • Chills
  • Nausea
  • Cough
  • Muscle pains or aches
  • Diarrhea
  • Loss of appetite
  • Labored or difficulty breathing
  • Sore throat
  • Joint pain
  • Sneezing
  • Dizziness
  • Headache
  • Fever or chills
  • Shortness of breath
  • Runny nose
  • General feeling of illness or discomfort
  • Tightness in the chest
  • Shivering
  • Fast or slow heartbeat
  • Trouble with sleeping
  • Sweating
  • Unusual bruising or bleeding
  • Troubled breathing with exertion
  • Jaw, back or arm pain
  • Unusual weakness or tiredness
  • Blindness
  • Vomiting
  • Tarry, black or bloody stools
  • Wheezing
  • Change in color vision
  • Fainting
  • Decreased urine output
  • Irregular or fast heartbeat
  • Decreased vision
  • Increased cough
  • Difficulty seeing at night
  • Weight loss or gain
  • Increased sensitivity of the eyes to sunlight or bright lights
  • Vomiting of material that looks like coffee grounds
  • Dilated neck veins
  • Swelling of the fingers, lower legs, feet or face
  • Irregular breathing
  • Vomiting of blood

Dosage

When Nilutamide is prescribed to treat metastatic prostate cancer, patients are usually advised to take 300mg of the medicine once per day, for a period of thirty days. Following this, patients are generally instructed to take 150mg of Nilutamide per day, until they are advised to stop the medicine.

Although this is a standard form of treatment with Nilutamide, every patient will be given unique dosage instructions and should follow their physician's advice. If patients are undergoing additional therapies, for example, their dose of Nilutamide may be altered. Similarly, the patient's current presentation may warrant changing their dose of medication.

In most cases, patients will begin taking Nilutamide on the same day as their surgery or on the following day. However, they should not stop taking Nilutamide unless they are advised to do so by a healthcare practitioner.

If patients forget to take a dose of Nilutamide, they are normally advised to skip the missed dose and continue with their normal treatment schedule. Patients should not attempt to take a double dose or an extra dose of Nilutamide, even if a previous dose has been missed. However, if patients are unsure how to take Nilutamide or when to take their medication, they should seek advice from their physician or pharmacist.

Potential Drug Interactions

As some medications can interact with one another, patients should tell their physician if they are taking any prescription medicines, over-the-counter medicines, supplements and/or vitamins before they start using Nilutamide.

If patients are taking the following medicines, it may increase their risk of side-effects when taking Nilutamide:

  • Phenytoin
  • Fosphenytoin
  • Warfarin
  • Theophylline

However, patients should not alter their dose of medicine or stop taking any medications because of increased side-effects. Instead, patients should seek medical advice so that their side-effects can be reduced.

Similarly, patients should obtain medical advice before using any new medicines, vitamins or supplements once they have started taking Nilutamide.

Warnings

If patients have any existing medical conditions or a history of certain conditions, it may affect their treatment with Nilutamide. Due to this, patients should discuss their existing health concerns and medical history with their doctor before they start taking this medication. The following conditions, in particular, can be relevant if treatment with Nilutamide is being considered:

  • Lung disease
  • Breathing problems

As prostate cancer is a disease which typically affects adult male patients, the effects of Nilutamide on pediatric patients have not been studied. As a result, pediatric patients are not usually prescribed Nilutamide as a treatment for any condition.

If patients experience shortness of breath, difficulty breathing and/or chest pain whilst taking Nilutamide, they will need to obtain urgent medical help.

Whilst taking Nilutamide, patients may develop liver problems. If patients exhibit one or more of the following symptoms, they should stop taking Nilutamide and seek immediate medical attention:

  • Loss of appetite
  • Dark-colored urine
  • Clay-colored stools
  • Headache
  • Fever
  • Nausea or vomiting
  • Yellowing of the skin or eyes
  • Unusual weakness or tiredness
  • Tenderness or pain in the upper right side of the stomach

Nilutamide can have a temporary effect on the way the patient's eyes react to light. When going from an area with bright lights into a darker area, patients may have trouble seeing or not see as well as they usually do. Due to this, patients must show extreme caution when driving at night and should not drive if they feel unable to do so safely. Similarly, if patients drive in or out of tunnels, their vision may be affected by the change in light. Wearing glasses with tinted lenses may help patients to see more easily in the dark.

If patients drink or consume alcohol whilst taking Nilutamide, they may experience unpleasant symptoms, such as:

  • Flu-like symptoms
  • Lightheadedness, dizziness or faintness when getting up from a sitting or lying position
  • Flushing of the face

Patients may be advised to refrain from drinking alcohol whilst using Nilutamide and should not consume any alcohol if they experience the above symptoms whilst taking this medicine.

If male patients impregnate a sexual partner whilst taking Nilutamide, it is not known if the medication will cause harm to the unborn fetus. Due to this, patients are normally advised to use an effective form of birth control whilst taking Nilutamide and for some time afterward.

If patients taking Nilutamide impregnate a sexual partner, they should inform their physician immediately.

In some cases, antineoplastic drugs and antiandrogen hormonal therapies may affect the fertility of male patients. Whilst this can be temporary in some cases, anti-cancer treatments can also have a permanent effect and may cause infertility in some patients.

If patients are planning to have children in the future or are undecided about having children, they should discuss this with their physician before they commence treatment with Nilutamide.

Before taking Nilutamide, patients should tell their doctor if they have any allergies or if they have ever exhibited an allergic reaction to any substances before. This includes allergies to medicines, foods, preservatives, animals and dyes. In rare cases, patients may experience an allergic reaction whilst taking Nilutamide and, if so, they will require emergency medical treatment. An allergic reaction may include the following symptoms:

  • Wheezing
  • Hives
  • Difficulty swallowing
  • Difficulty breathing
  • Itching
  • Hoarseness
  • Shortness of breath
  • Swelling of the tongue, throat, lips, mouth, face and/or hands
  • Rash on the skin

Storage

As patients are normally advised to take Nilutamide on a daily basis, they will need to store their medication at home. However, patients must use a secure location when keeping Nilutamide in the home and should ensure that no-one else can access it. It is particularly important that children and/or pets cannot gain access to Nilutamide or other medicines which may be in the home.

When keeping Nilutamide at home, patients should follow the manufacturer's instructions. Generally, Nilutamide can be kept at room temperature but should always be stored in a closed container. In addition to this, Nilutamide should be kept away from heat, moisture and direct light.

If the medicine reaches its expiration date or if patients are advised to stop taking Nilutamide, they will need to dispose of it carefully. It is not appropriate to throw medications out with regular household waste as they may cause harm to other people. Patients should contact their physician's office or pharmacist and use a designated medicine disposal service instead.

Summary

When patients are diagnosed with cancer, it's vital that treatment is started as quickly as possible. If prostate cancer has become metastatic, it has already spread to other areas so it's crucial that physicians take action quickly. Often, metastatic prostate cancer is treated with surgery but additional treatment may be required.

Once the patient has undergone surgery, treatment with Nilutamide may be started. As Nilutamide blocks the effects of testosterone on the cancer cells, it can significantly reduce the spread of the cancer and enable the body to destroy existing cancer cells. As a result, Nilutamide can be effective in treating patients with metastatic prostate cancer and is a commonly-used form of antineoplastic hormone therapy.