Xtandi and Dosage: Strengths, Forms, How to Take, and More

Xtandi Dosage: Strengths, Forms, How to Take, and Complete Safety Guide

Xtandi (enzalutamide) is a prescription medication used in the treatment of certain types of prostate cancer in adults. It belongs to a class of drugs called androgen receptor inhibitors, which work by blocking the effects of male hormones such as testosterone that fuel the growth of prostate cancer cells. By disrupting these hormonal signals, Xtandi helps slow down or stop cancer progression, improving survival and quality of life for many patients.

If you or a loved one has been prescribed Xtandi, understanding the right dosage, how to take it, possible adjustments, and safety considerations is crucial. This guide offers a comprehensive, patient-friendly explanation so you can take this medication confidently and safely.

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What Is Xtandi and How It Works

Xtandi’s active ingredient, enzalutamide, is designed to specifically target prostate cancer cells that rely on androgens (male hormones) for growth. Unlike some treatments that lower testosterone levels, Xtandi works by blocking the androgen receptors inside cancer cells. This prevents testosterone from binding and sending growth signals to the cancer.

By cutting off this hormonal communication, Xtandi can:

• Slow tumor growth
• Prevent the spread (metastasis) of cancer
• Enhance survival rates
• Improve symptom control

Xtandi is typically prescribed for:

• Metastatic castration-resistant prostate cancer (mCRPC)
• Non-metastatic castration-resistant prostate cancer (nmCRPC)
• Metastatic castration-sensitive prostate cancer (mCSPC)

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Available Forms and Strengths of Xtandi

Xtandi comes in two oral forms to provide flexibility for patients and healthcare providers:

1. Xtandi Capsules

• Strength: 40 mg
• Soft gelatin capsules, taken whole with water.

2. Xtandi Tablets

• Strengths: 40 mg and 80 mg
• Film-coated tablets, also swallowed whole.

💡 The main advantage of having both capsules and tablets is that doctors can tailor prescriptions to patient needs—whether that’s based on swallowing ease, pill size, or dosing flexibility.

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Standard Xtandi Dosage for Prostate Cancer

For most adult patients, the recommended dosage is:

• 160 mg once daily
  This usually means four 40 mg capsules OR two 80 mg tablets.

Xtandi is generally taken at the same time each day, which helps maintain steady levels in your bloodstream for maximum effectiveness.

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Why Consistency Matters in Xtandi Dosing

Unlike antibiotics or painkillers, where missing a dose might have short-term consequences, with cancer treatments like Xtandi, consistency directly impacts treatment success. If you skip doses frequently or take them at irregular times, your cancer cells may get a “break” from the drug’s effects, potentially reducing treatment success.

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How Long Will You Take Xtandi?

Xtandi is typically a long-term treatment—often prescribed for months or even years—depending on how well your cancer responds and whether you tolerate the drug without severe side effects.

Your doctor will regularly monitor:

• PSA levels (prostate-specific antigen)
• Imaging scans for tumor changes
• Symptoms like pain or urinary difficulties
• Blood tests for liver function and other safety checks

If the cancer remains stable or shrinks, and you’re tolerating the drug well, you’ll likely continue Xtandi indefinitely.

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Factors That May Influence Your Xtandi Dose

While 160 mg daily is standard, your doctor may adjust your dosage based on:

1. Other Medications – Some drugs can speed up or slow down how your body processes Xtandi, requiring adjustments.
2. Side Effects – Severe fatigue, seizures, or other adverse effects may lead to a lower dose.
3. Individual Response – If your cancer responds exceptionally well or poorly, your doctor might change your treatment strategy.

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Drug Interactions That May Require Xtandi Dosage Adjustments

Xtandi is processed in the liver by enzymes called CYP2C8 and CYP3A4. Drugs that affect these enzymes can alter Xtandi levels.

• Strong CYP2C8 inhibitors (e.g., gemfibrozil) can increase Xtandi in your system → dose reduction may be necessary.
• Strong CYP3A4 inducers (e.g., rifampin) can lower Xtandi levels → dose increase may be required.

📌 Always tell your doctor all medications and supplements you’re taking—even herbal remedies like St. John’s wort can interfere with Xtandi’s effectiveness.

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How to Take Xtandi for Best Results

1. Swallow Whole – Do not crush, chew, or split tablets/capsules.
2. With or Without Food – Xtandi’s absorption is not significantly affected by meals.
3. Same Time Daily – Keeps drug levels stable.
4. Avoid Alcohol Before Taking Xtandi – While not prohibited, alcohol may increase fatigue or dizziness.

💡 Tip: Set a smartphone alarm or take Xtandi right after brushing your teeth to make it a habit.

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Missed Dose Guidelines

• If you remember on the same day, take the missed dose immediately.
• If you remember the next day, skip the missed dose and resume your regular schedule.
• Never double dose to make up for a missed one—this can raise your risk of side effects.

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What to Do in Case of Xtandi Overdose

Overdosing on Xtandi can lead to severe side effects such as:

• Seizures
• Severe fatigue
• Confusion
• Dizziness

If you take more than your prescribed dose:

1. Call your doctor immediately.
2. Contact America’s Poison Centers (1-800-222-1222).
3. Seek emergency care if you experience severe symptoms.

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Storage and Handling Tips

• Store at room temperature (20–25°C / 68–77°F).
• Keep away from moisture, heat, and direct sunlight.
• Always keep in the original container.
• Store out of reach of children and pets.

If you have trouble opening the bottle or reading labels, your pharmacist can provide:

• Easy-open caps
• Large print labels
• Braille labels
• Smartphone-readable QR code labels

Possible Side Effects of Xtandi and How to Manage Them

While Xtandi is generally well-tolerated by many patients, it can cause side effects—some mild, some more serious. Understanding them in advance will help you recognize warning signs early and know when to contact your healthcare provider.

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Common Side Effects

These are the side effects most frequently reported by Xtandi users:

• Fatigue or weakness
• Hot flashes
• Joint or muscle pain
• High blood pressure
• Loss of appetite
• Weight loss
• Swelling in hands or feet
• Dizziness or falls

💡 Tip: If fatigue is an issue, try planning important activities earlier in the day when you have the most energy.

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Serious Side Effects

Some side effects are rare but can be life-threatening if not addressed quickly:

1. Seizures
   • Occur in a small percentage of patients
   • Risk increases if you have a history of seizures or take certain medications
2. Posterior Reversible Encephalopathy Syndrome (PRES)
   • A rare brain condition causing headaches, confusion, and vision changes
3. Severe allergic reactions
   • Swelling, difficulty breathing, or hives
4. Falls and fractures
   • Xtandi may increase the risk of falls, especially in older patients
5. Heart problems
   • Palpitations, shortness of breath, or chest pain should be reported immediately

📌 Seek emergency help immediately if you experience sudden weakness, severe headache, chest pain, or difficulty breathing.

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Tips to Reduce Side Effects While on Xtandi

1. Stay hydrated – Aim for at least 8 glasses of water per day to support kidney and liver function.
2. Monitor blood pressure – Xtandi can raise it, so check regularly at home.
3. Eat a balanced diet – Include high-protein foods to counteract muscle loss.
4. Incorporate light exercise – Gentle walking or stretching can reduce stiffness and improve energy.
5. Report symptoms early – Don’t wait until your next appointment.

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Lifestyle Adjustments to Support Xtandi Treatment

Xtandi works best when paired with healthy lifestyle choices that reduce cancer progression risk and improve overall well-being.

• Diet: Focus on whole foods—fruits, vegetables, lean proteins, and whole grains.
• Exercise: 20–30 minutes of light activity daily can boost mood and immune function.
• Sleep: Aim for 7–9 hours of quality sleep each night.
• Alcohol: Limit consumption, as alcohol can worsen fatigue and dizziness.

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Who Should Avoid Xtandi?

Xtandi may not be suitable for certain patients, including:

• Those with a history of seizures or conditions that increase seizure risk
• People taking strong CYP2C8 or CYP3A4 interacting drugs without medical supervision
• Individuals with severe liver impairment
• Patients allergic to enzalutamide or any inactive ingredients

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Xtandi and Other Treatments: Combination Therapy

Xtandi is often used alongside androgen deprivation therapy (ADT)—such as leuprolide (Lupron)—to maximize effectiveness. In metastatic cases, it may also be combined with chemotherapy agents.

Your doctor will design your treatment plan based on:

• Cancer stage
• Presence of metastases
• Overall health
• Previous treatments

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Patient Stories and Real-World Experiences

While every patient’s journey is different, here’s what some long-term Xtandi users report:

• John, 67: “I’ve been on Xtandi for 14 months. My PSA went from 18 to undetectable. I do get tired in the afternoons, so I rest for 30 minutes, and it makes a huge difference.”
• Robert, 72: “The main issue for me has been hot flashes, but adjusting the thermostat at night and wearing light cotton clothes has helped.”

💡 Reading about other patients’ experiences can give you practical coping strategies, but always confirm with your doctor before making changes.

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Expert Insights on Xtandi Dosage and Safety

Oncology specialists recommend:

• Routine monitoring of PSA, liver enzymes, and blood pressure.
• Dose adjustments if severe side effects develop.
• Open communication between patient and care team to optimize quality of life.

Dr. Helen Martinez, an oncologist specializing in prostate cancer, emphasizes:

“Xtandi has changed the landscape of prostate cancer treatment. When patients stick to their prescribed dosage and work closely with their healthcare team, outcomes can be excellent.”

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Frequently Asked Questions About Xtandi

1. Can Xtandi be taken with food?
Yes. Food does not significantly affect how Xtandi is absorbed.

2. Is there a best time of day to take Xtandi?
No strict requirement, but consistency is key. Many patients take it in the morning to avoid insomnia.

3. Can I drink alcohol while on Xtandi?
Moderate alcohol is generally allowed, but it may increase fatigue or dizziness.

4. How long before I see results?
PSA levels may begin to drop within 4–12 weeks, but cancer progression control is assessed over months.

5. Is Xtandi a cure?
No. It’s a disease-control medication that can extend life and improve symptoms but does not completely eliminate cancer.