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Xtandi (Enzalutamide 40mg)

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Xtandi 40mg tablets are majorly indicated for prostate carcinoma, which contains Enzalutamide, as an active component considered as non-steroidal anti-androgen medication.

Xtandi 40mg is a prescription medicine, which can be used under the guidance of medical practitioners.

Xtandi 40mg tablet indication

The primary usage of Xtandi 40mg tablet is contained in the specific treatment of metastatic castration-resistant prostate cancer (mCRPC), taken orally.

The anti-androgen effect exhibits by obstruct the testosterone production by interfering with androgen synthesis, the hormone which is responsible for tumor cell growth.

Xtandi 40mg is majorly used to treat prostate cancer in men.

Dosing conditions of Xtandi 40mg

The usual prescribed dosage of Xtandi is 160mg as a single dose by taking with or without food.

Xtandi is available in the strength of 40mg; four tablets of Xtandi should be administered at a same time.

Xtandi tablet should not crush, not chew taken with glass of water.

Dose adjustment

In patients with ≥ grade III toxicity:  Xtandi 40mg therapy should be refuse for one week or the symptoms should be reduced to grade II, then restart with same dose or decreased to 80mg or 120mg

Strong CYP2C8 inhibitors: While combining with Xtandi tablet, the dosage should be modified by reducing to 80mg as a single dose or avoid this combination.

Strong CYP3A4 inducers: Co administration of Xtandi with Strong CYP3A4 inducers, the dosage of Xtandi tablet increased up to 240mg or stop this combination.

Xtandi 40mg overdosage

In the case of over dosage of Xtandi tablets, causes severe seizures.

If over dosage is occurring, immediately stop the therapy and maintain the safety measures.

In dose acceleration study, seizure does not occur at ≤ 240mg daily.

Seizures may report in the dose of 360mg, 480mg & 600mg at high risk

Xtandi 40mg works as

Prostate carcinoma is developed by using male hormone known as androgen.

Testosterone is the one of the major hormones secreted by testes and adrenal glands

Xtandi containing Enzalutamide will interfere with testosterone production, causes tumor cell growth depletion.

Xtandi interfere with androgen receptor signaling transduction and leads to cancer cell lysis

Xtandi 40mg ADME properties


After receiving 160mg of Xtandi for mCRPC, from median time to attain peak plasma concentration time at 1 hour (variation with 0.5 to 3 hours).

Food does not cause any alteration in absorption of Xtandi tablets.


Maximum plasma protein bounding capacity of Xtandi tablets is occurs as 97% to 98%


Two most prominent cytochrome isoenzymes are involved in metabolism of Xtandi tablets;

The isoenzymes like CYP2C8 & CYP3A4; whereas CYP2C8 is essential for production of N-desmethyl Enzalutamide which is an active metabolite of Enzalutamide.


Xtandi tablets go through elimination by hepatic metabolism

Major route of elimination;

71% in urine; 14% in feces

The terminal half-life period of Xtandi tablets is 5.8 days (range at 2.8 to 10.2 days); N-desmethyl Enzalutamide has half-life period of relatively 7.8 to 8.6 days.

Xtandi 40mg causes some side effects

Some side effects during the therapy using with Xtandi,

Hypertension & hot flush, Dizziness, headache, Asthenia conditions, Peripheral edema, Spinal cord compression, paresthesia, Mental impairment, Hypesthesia, Respiratory tract infections, Hematuria, Pollakiuria, Dry skin, Back pain, Arthralgia, Muscular weakness, pain, Diarrhea, Pruritus, Neutropenia, Thrombocytopenia, Increasing bilirubin level, Epistaxis, Infections like sepsis, Fall associated injuries like fractures, joint injury, and hematomas, Hallucinations.

Xtandi 40mg contraindication occurs as

Xtandi tablets are contraindicated to pregnancy condition, which may cause fetal harm leads to death.

An Anaphylactic reaction happens, if patients are contraindicated to the ingredient present in Xtandi tablets.

Xtandi 40mg storage conditions

Xtandi tablet container should be stored at the temperature of 20oC to 25oC (68oF to 77oF).

Keep the container in cool and dry place

Protect from light.

Xtandi 40mg warning and precautions

During the treatment with Xtandi tablets, patient may suffer with some adverse effects like;

Posterior reversible encephalopathy syndrome


In PRES, some neurological disorders occur in patients. It may overcome by providing safety measures or discontinue the therapy as soon as possible.

PRES is recognized by using MRI

In seizures, patient must counsel about this adverse reaction before starting the therapy. Stop the therapy if possible.

Spermatogenesis occurs which may interfere with male fertility leads to hypo spermatogenesis.

In androgen depletion therapy, may have increase exposure of cardiovascular disease like worsening hypertension.

Xtandi 40mg interact with some drugs like

Xtandi combined with CYP2C8 strong inhibitors, causes elevation of plasma concentration time curve of Enzalutamide and its active metabolite. So avoid this combination, otherwise dosage of Xtandi should be reduced to 80mg.

Xtandi with CYP2C8 strong inducers causes variation in plasma exposure of Xtandi, to minimize this problem to avoid this concomitant.

Co administration of Xtandi tablets with strong inhibitors or CYP3A4, leads to elevate the AUC of Enzalutamide and its metabolite.

CYP3A4 strong inducers example like; phenytoin, Phenobarbital, carbamazepine etc combines with Xtandi tablets causes depletes the plasma exposure of Xtandi.

Moderate CYP3A4 inducers like Bosentan, efavirenz, modafinil, st Johns wort causes decreasing the plasma concentration of Xtandi tablet.

Xtandi tablets are strong CYP3A4 inducers and moderate CYP2C8 & CYP2C19.

CYP3A4 strong inducers like Midazolam, CYP2C8 inducers like warfarin, & CYP2C19 inducers like Omeprazole with Xtandi causes reducing the plasma risk of Midazolam, warfarin & Omeprazole.

Xtandi 40mg specifically used in


Pregnancy category of Xtandi tablet is D

Xtandi is contraindicated to pregnancy; it may cause fetal harm even to death.


Breast feeding is not suggested, Xtandi is contraindicated in lactation

Xtandi 40mg missed dose

Xtandi 40mg is a chem. Drug, used in prostate cancer. Xtandi tablet should not be self-medicated, used by the patients only after getting advice from the medical oncologist.

If patient missed a dose, must consult with the physician and follow the instructions as per the guidance of medical adviser, the missed dose should be taken within a time or the missed dose should be avoid and follow the regular schedule.

  • Trade name Xtandi
  • Substance Enzalutamide 40mg
  • Manufacturer Astellas Pharma Inc
  • Packaging 28 tablets
  • Country of origin India
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