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14-September-2008 11:27:25 - Bicalutamide Bicalutamide Systematic IUPAC name N-4-cyano-3-trifluoromethylphenyl- 3-4-fluorophenylsulfonyl-2- hydroxy-2-methyl- propanamide Identifiers CAS number 90357-06-5 ATC code L02BB03 PubChem 56069 DrugBank APRD00042 Chemical data Formula C18H14F4N2O4S Mol. mass 430.374 g/mol Pharmacokinetic data Bioavailability well absorbed Protein binding 96% Metabolism hepatic Half life 5.8 days Excretion ? Therapeutic considerations Pregnancy cat. XUS Legal status ℞ Prescription only Routes Oral Bicalutamide marketed as Casodex, Cosudex, Calutide, Kalumid is an oral non-steroidal anti-androgen for prostate cancer and hirsutism. It was first launched in 1995 as a combination treatment with surgical or medical castration for advanced prostate cancer and subsequently launched as monotherapy for the treatment of earlier stages of the disease. It is marketed by AstraZeneca with the brand names Casodex and Cosudex. Bicalutamide is recommended 50 mg once daily in combination with an LHRH analogue or surgical castration. Contents 1 Description 2 Indications and use 3 Contraindications and precautions 4 Adverse reactions 5 Physiology 6 External links Description Bicalutamide is an oral non-steroidal anti-androgen with the empirical formula C18H14N2O4F4S and is an off-white powder that is practically insoluble in water. Indications and use For the treatment of stage D2 metastatic prostate cancer in combination with a luteinizing hormone-releasing hormone analogue or as a monotherapy. Has been used in clinical trials for ovarian cancer. Contraindications and precautions Bicalutamide is contra-indicated in females and children and must not be given to any patient who has shown a hypersensitivity reaction to its use. Adverse reactions Adverse reactions include reproductive system and breast disorders, breast tenderness, gynaecomastia, hot flushes, gastrointestinal disorders, diarrhoea, nausea, hepatic changes elevated levels of transaminases, jaundice, asthenia and pruritus. Physiology To understand the physiologic effects of bicalutamide on the body one must first understand the biological effects of testosterone and other androgens on the androgen receptors in the body. Androgen receptors are present in very high concentrations in the tissues that form the external genitalia penis and associated structures such as the pelvic muscles and prostate, scrotum and testicles. During fetal development blocking the androgen receptors of a developing male fetus would prevent the development of the penis causing the male infant to be born with female external genitalia that is, a vagina without a cervix or uterus, and clitoris. As well the testicles would remain undescended. During fetal development any male fetus who cannot respond at the cellular level to testosterone, whether it is from taking an anti-androgen like bicalutamide or 5-alpha-reductase inhibitors, or is a male who has inherited a defective gene causing defective androgen receptors or defective 5-alpha reductase enzyme and cannot produce dihydrotestosterone will not develop a penis. Such males are usually phenotypically identified as female at birth. In adult males blocking the androgen receptors by bicalutamide, and eliminating the effect of testosterone and the other androgens from binding and stimulating the cellular effects of androgens, bicalutamide will cause a decline in sperm count, infertility, and sexual difficulties. The effects of blocking the androgen receptors and blocking the effects of androgens in the body will have significant effects on the ability of a man to get and maintain an erection, resulting usually in profound impotence, and a dramatic reduction in the response to erectile dysfunction medications. Blocking androgens receptors in the brain will eliminate the inhibition of testosterone on the release of Luteinizing hormone LH. Since the body will not detect any testosterone/androgens and there will be a dramatic rise in Luteinizing hormone secretion resulting in a very significant rise in testosterone and estrogen levels. Since bicalutamide will block the effect of testosterone on all tissues, there will be no response by the body to the increased androgen levels, but the rising sex hormone production will increase the estrogen levels in the man to be much higher than they would be in a man who has not been taking bicalutamide. The estrogen levels will rise until they are high enough to suppress the release of LH which is causing the estrogen and testosterone levels to rise. This rise in estrogen level stimulated by the blockade of the androgen receptor is why some of the side effects of bicalutamide are breast tenderness and gynecomastia. As well other feminization effects will occur such as fat accumulation on the hips and thighs. If bicalutamide is combined with an LHRH analogue or surgical castration then the elevation of estrogen levels will be prevented and the risks of excessive estrogen will be reduced. But blocking the rise in estrogen levels will dramatically increase the bone loss and osteoporosis that will result from the effects of bicalutamide blocking the actions of androgens in the bone. Since both testosterone and estrogens are essential for normal bone metabolism, reducing the positive stimulation of both androgens and estrogens on bone metabolism will definitely increase bone loss and osteoporosis. Muscle, tendons, joints, bone, and connective tissues will also be affected resulting in a loss of physical strength, reduction in bone density, osteoporosis,etc. The effects of bicalutamide's blockade of the bodies response to testosterone will be the opposite of what happen to a boys body at puberty when testosterone levels rise and testosterone starts to exert its effect on muscle mass and sexual function. And the effects of taking bicalutamide will essentially be equivalent to a severe form of male andropause since there will be no effect of testosterone or any other androgen in the body. External links Casodex, Cosudex manufacturer's website Bicalutamide patient information v d e Sex hormones and related agents primarily G03, also L02, H01C - human endogenous in CAPS Progestogens: receptor Agonist PROGESTERONE, Dienogest, Desogestrel, Drospirenone, Dydrogesterone, Ethisterone, Etonogestrel, Ethynodiol diacetate, Gestodene, Gestonorone, Levonorgestrel, Lynestrenol, Medroxyprogesterone, Megestrol, Norelgestromin, Norethisterone, Norethynodrel, Norgestimate, Norgestrel, Norgestrienone, Tibolone SPRM Asoprisnil, CDB-4124 Antiprogestogen Mifepristone Androgens: receptor Agonist TESTOSTERONE, Androstanolone, Fluoxymesterone, Mesterolone, Methyltestosterone, see also anabolic steroids Antiandrogen Bicalutamide, Cyproterone, Dienogest, Flutamide, Nilutamide, Spironolactone Estrogens: receptor Agonist ESTRADIOL, ESTRIOL, ESTRONE, Chlorotrianisene, Dienestrol, Diethylstilbestrol, Ethinylestradiol, Fosfestrol, Mestranol, Polyestradiol phosphate SERM Afimoxifene, Arzoxifene, Bazedoxifene, Clomifene, Fulvestrant, Lasofoxifene, Raloxifene, Tamoxifen, Toremifene AI Aminoglutethimide, Anastrozole, Atamestane, Exemestane, Fadrozole, Formestane, Letrozole, Vorozole Antiestrogen Mepitiostane Gonadotropins: FSHR/LHCGR ovulation stim. Clomifene, Urofollitropin Antigonadotropin Danazol, Gestrinone GnRH: receptor Agonist Buserelin, Goserelin, Histrelin, Leuprorelin, Nafarelin, Triptorelin Antagonist Abarelix, Cetrorelix, Ganirelix Retrieved from http://en..org/wiki/Bicalutamide Categories: Antiandrogens Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Nederlands This page was last modified on 4 August 2008, at 21:59
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