Inzamoda (Enzalutamide)

Enzalutamide is used in prostate cancer therapy, targeting androgen‑driven disease progression.

• Metastatic castration‑resistant prostate cancer: improves overall survival and delays disease progression.
• Non‑metastatic castration‑resistant prostate cancer: delays metastasis and extends metastasis‑free survival.
• Advanced hormone‑sensitive prostate cancer: used in combination with androgen deprivation therapy to enhance progression‑free survival.

• Enzalutamide acts as a selective antagonist of the androgen receptor. It binds to the receptor with high affinity, preventing its translocation to the nucleus, inhibiting DNA binding, and blocking recruitment of co‑activators. By disrupting androgen‑mediated signaling, the drug reduces transcription of genes that drive prostate cancer cell growth and survival, thereby inhibiting tumor progression.

Enzalutamide may cause a range of adverse reactions, varying from mild to serious.

Common Side Effects

• Fatigue: persistent tiredness affecting daily activities.
• Hot flashes: sudden feeling of warmth and sweating.
• Diarrhea: loose stools occurring intermittently.
• Nausea: feeling of sickness often with or without vomiting.
• Decreased appetite: reduced desire to eat leading to weight loss.
• Hypertension: elevated blood pressure readings.

Serious or Rare Side Effects

• Seizures: occurrence of convulsive episodes, requiring immediate medical attention.
• Severe hepatic injury: signs of liver dysfunction such as jaundice or elevated enzymes.
• Interstitial lung disease: breathing difficulties and cough indicating lung inflammation.
• Cardiovascular events: serious heart problems including myocardial infarction.
• Posterior reversible encephalopathy syndrome: neurological symptoms with imaging changes.

Before initiating therapy with Enzalutamide, several precautions should be considered.

• Blood pressure monitoring: check and control hypertension regularly.
• Liver function assessment: evaluate hepatic enzymes before and during treatment.
• Seizure risk evaluation: assess history of seizures or conditions lowering seizure threshold.
• Concomitant medication review: avoid drugs that may increase seizure risk.
• Patient education: inform about signs of serious adverse events and when to seek care.
• Store at room temperature: keep in original packaging, protect from moisture and heat.

Enzalutamide interacts with several medicines that can alter its effectiveness or safety.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine): markedly reduce enzalutamide exposure.
• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): significantly increase enzalutamide levels.
• Other androgen receptor antagonists: combined use may enhance toxicity.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., erythromycin, fluconazole): may raise drug concentrations.
• Moderate CYP3A4 inducers (e.g., phenytoin, St. John’s wort): may lower concentrations.
• Anticoagulants (e.g., warfarin): monitor INR for potential changes.
• Drugs lowering seizure threshold (e.g., bupropion, tramadol): observe for neurological symptoms.