Melediz (Enzalutamide)

Enzalutamide is used to treat prostate cancer that has progressed despite hormonal therapy.

• Metastatic castration‑resistant prostate cancer: prolongs overall survival and delays disease progression.
• Non‑metastatic castration‑resistant prostate cancer: extends metastasis‑free survival.
• Metastatic hormone‑sensitive prostate cancer (in combination with androgen deprivation therapy): improves radiographic progression‑free survival.

• Enzalutamide selectively binds to the androgen receptor, preventing its translocation to the nucleus, DNA binding, and recruitment of co‑activators. By blocking these steps, the drug inhibits androgen‑driven transcriptional activity in prostate cancer cells, thereby reducing tumor growth and survival signals.

Adverse reactions may vary in frequency and severity.

Common Side Effects

• Fatigue: persistent tiredness reported by many patients.
• Hot flashes: sudden feeling of warmth and sweating.
• Diarrhea: loose stools occurring intermittently.
• Nausea: mild to moderate upset stomach.
• Decreased appetite: reduced desire to eat.
• Hypertension: elevated blood pressure readings.

Serious or Rare Side Effects

• Seizures: rare convulsive episodes, especially in patients with pre‑existing risk factors.
• Severe hepatic injury: marked elevation of liver enzymes or jaundice.
• Interstitial lung disease: inflammation of lung tissue causing cough and breathlessness.
• Allergic reactions: rash, angioedema, or anaphylaxis.
• Posterior reversible encephalopathy syndrome: neurological emergency with headache, visual changes, and seizures.

Before initiating therapy, clinicians should assess several safety parameters.

• Monitor blood pressure: check regularly due to risk of hypertension.
• Assess liver function: perform baseline and periodic hepatic enzyme tests.
• Evaluate seizure risk: avoid in patients with a history of seizures.
• Contraindicated in pregnancy: drug is teratogenic; ensure effective contraception.
• Review concomitant medications: avoid strong CYP3A4 inducers or inhibitors.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Enzalutamide may interact with other medicines through metabolic pathways.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine): may markedly reduce enzalutamide exposure.
• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): can increase drug levels and toxicity.
• Anticoagulants (e.g., warfarin): may enhance anticoagulant effect, raising bleeding risk.

Moderate Interactions (Monitor Closely)

• CYP2C8 inhibitors (e.g., gemfibrozil): may raise enzalutamide concentrations.
• CYP2C9 inhibitors (e.g., fluconazole): require periodic monitoring of drug levels.
• CYP2C19 inhibitors (e.g., omeprazole): may modestly increase exposure.
• Other antiandrogens (e.g., bicalutamide): combined effect on androgen blockade should be evaluated.