Xtandi® (enzalutamide) for Advanced Prostate Cancer Treatment

What Xtandi® Is and How It Works

Xtandi (enzalutamide) is an oral androgen receptor inhibitor for advanced prostate cancer. It treats metastatic castration-resistant disease, non-metastatic castration-resistant disease, and metastatic castration-sensitive disease when used with ongoing androgen deprivation therapy. Many people compare Xtandi cost and access Canadian pricing to manage ongoing treatment expenses while maintaining continuity of care. YouDrugstore is a licensed Canadian pharmacy headquartered in Manitoba; prescriptions are reviewed by licensed pharmacists before dispensing.

Xtandi blocks androgen receptor signaling in prostate cancer cells. By preventing androgens from activating the receptor, it slows tumor growth and disease progression. It is taken once daily and does not require food. Continued medical castration with a GnRH agonist or antagonist is recommended if surgical castration has not been done. The medicine is supplied as film-coated tablets (and some markets may also have capsules). For information about the condition it treats, see our pages on Prostate Cancer.

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Dosage and Usage

• Typical starting dose: 160 mg once daily, taken at the same time each day.
• Use with ongoing androgen deprivation therapy unless already surgically castrated.
• Swallow tablets whole with water. Do not chew, split, or crush.
• May be taken with or without food.
• If a dose is missed, take it as soon as remembered the same day. If the next day has started, skip the missed dose and resume the regular schedule. Do not double up.
• If vomiting occurs after a dose, take the next dose at the usual time the following day.
• When strong CYP2C8 inhibitors (for example, gemfibrozil) are necessary, some patients may need a reduced dose. Prescribers manage this.
• Avoid or monitor combinations with medicines that are sensitive substrates of CYP3A4, CYP2C9, or CYP2C19, as enzalutamide can lower their levels.
• Alcohol and activities requiring full alertness should be considered cautiously in those at seizure risk.

• Store at 20–25 °C (68–77 °F); excursions 15–30 °C (59–86 °F).
• Keep tablets in the original bottle with the desiccant and tight cap.
• Protect from moisture and excessive heat; avoid bathroom storage.
• Keep out of reach of children and pets.
• For travel, carry medicine in hand luggage with the original label and an extra supply.
• Do not leave the bottle in a parked car or near heaters.

Benefits and Savings

Xtandi improves outcomes across several prostate cancer settings. In non-metastatic castration-resistant disease, it lengthens metastasis-free survival. In metastatic castration-resistant and castration-sensitive disease, it extends radiographic progression-free survival and overall survival in clinical trials. Once-daily dosing without routine steroids simplifies daily routines compared with some alternatives. Many patients also appreciate that there is no food timing requirement.

Buying from Canada often lowers ongoing therapy costs. Patients commonly report 60–80% savings versus typical U.S. prices, depending on strength and supply size. If comparing Xtandi price or enzalutamide price for longer treatment courses, multi-month fills can further reduce the effective per-month expense. Some patients also review Xtandi cost per month alongside other agents before starting therapy, and compare Xtandi cost with insurance to their out-of-pocket costs elsewhere. Those enrolled in public plans may ask about Xtandi cost Medicare or the cost of Xtandi per month on different benefit tiers.

To see current deals, visit our promotions page for any available Xtandi discount.

Side Effects and Safety

• Common effects: fatigue, hot flashes, back pain, joint pain, decreased appetite, diarrhea, constipation, and swelling in the legs or feet.
• Other reported effects: high blood pressure, headache, dizziness, falls, fractures, and weight loss.
• Laboratory changes: altered liver tests may occur, so clinicians may monitor periodically.
• Drug interactions: enzalutamide induces CYP3A4, CYP2C9, and CYP2C19, which can reduce exposure to sensitive substrates.

Serious but less common risks include seizures, posterior reversible encephalopathy syndrome, cardiovascular events, and severe allergic reactions. Patients with a history of seizures, significant brain injury, or those on medicines that lower the seizure threshold may have higher risk. Enzalutamide may cause fetal harm; effective contraception is advised for patients with partners who may become pregnant during treatment and for a period after the last dose as guided by the prescriber.

Onset Time

PSA declines may begin within a few weeks of starting enzalutamide, with deeper responses often developing over 8–12 weeks as steady-state levels are reached. Imaging changes usually take longer and are assessed on a schedule set by the oncology team. Symptom improvement, such as reduced cancer-related pain or better energy, varies by disease burden and co-therapies. Sustained benefits depend on adherence and continued androgen suppression.

Compare With Alternatives

Abiraterone acetate is another androgen pathway agent used in similar settings. It is taken with prednisone and requires fasting administration and liver function monitoring. Some patients favor enzalutamide’s steroid-sparing approach, while others do well on Zytiga® depending on clinical goals and tolerability.

Apalutamide and darolutamide are additional androgen receptor inhibitors for certain stages, especially non-metastatic castration-resistant disease. Differences include side-effect profiles and interaction potential, which clinicians weigh against patient comorbidities and preferences.

For selected metastatic castration-resistant tumors with homologous recombination repair gene alterations, a PARP inhibitor such as Lynparza® may be considered alone or in combination per evolving evidence and approvals. Eligibility depends on genetic testing and prior treatments.

Combination Therapy

• Androgen deprivation therapy: continue a GnRH agonist or antagonist if not surgically castrated.
• Bone health: add denosumab or zoledronic acid to reduce skeletal events when indicated; ensure calcium and vitamin D as advised by clinicians.
• Chemotherapy: docetaxel may be given sequentially or in combination in specific metastatic castration-sensitive settings per protocols.
• Radiation: palliative radiation or radiopharmaceuticals may be used for symptomatic bone metastases.
• Drug interactions: review concomitant medicines metabolized by CYP3A4, CYP2C9, and CYP2C19; dose adjustments of affected drugs may be needed.
• Do not combine with other androgen receptor inhibitors outside a protocol, as overlapping mechanisms increase toxicity without added benefit.

Patient Suitability and Cost-Saving Tips

Xtandi is intended for adult men with metastatic castration-resistant prostate cancer, non-metastatic castration-resistant prostate cancer, or metastatic castration-sensitive prostate cancer. It is not indicated for women or children. Caution is warranted in patients with a seizure history, significant cardiovascular disease, uncontrolled hypertension, or severe hepatic impairment. Falls and fractures are more common in some patients; bone health measures may be needed. A careful interaction review is important for warfarin, certain antiplatelets, some statins, and narrow-therapeutic-index drugs metabolized by CYP enzymes.

To manage Xtandi medication cost, many customers choose larger supplies when appropriate, as multi-month fills or bulk promotions can lower the cost of Xtandi per month. Reorder reminders help maintain continuity so treatment is not interrupted. Prescribers may also consider using higher-strength tablets when suitable to reduce pill count. Patients comparing the cost of Xtandi on Medicare with international pricing often find meaningful savings when paying out of pocket through Canadian pharmacies.

Authoritative Sources

Xtandi Official Patient Site

FDA Prescribing Information for Xtandi (enzalutamide)

Health Canada Drug Product Database: Xtandi

Order Xtandi® from YouDrugstore: add to cart, upload your prescription, and we ship with prompt, express shipping.

This page is educational and does not replace professional medical advice. Speak with a qualified healthcare provider for diagnosis and treatment decisions.