Midamid (Enzalutamide)

Enzalutamide is used in the management of advanced prostate cancer that no longer responds to hormonal therapy.

• Metastatic castration‑resistant prostate cancer: improves overall survival and delays disease progression.
• Castration‑resistant prostate cancer: reduces tumor growth and extends time to symptomatic progression.
• Non‑metastatic castration‑resistant prostate cancer: delays metastasis and prolongs disease‑free interval.

• Enzalutamide selectively binds to the androgen receptor, blocking androgen binding, preventing receptor nuclear translocation, and inhibiting DNA binding and transcription of androgen‑responsive genes. This antagonism suppresses prostate cancer cell proliferation driven by androgen signaling.

Enzalutamide may cause a range of adverse reactions. The most frequently reported events are generally mild to moderate.

Common Side Effects

• Fatigue: persistent tiredness affecting daily activities.
• Hot flashes: sudden feeling of warmth and sweating.
• Diarrhea: loose, watery stools.
• Nausea: sensation of queasiness.
• Decreased appetite: reduced desire to eat.
• Constipation: difficulty passing stools.

Serious or Rare Side Effects

• Seizures: convulsive episodes requiring immediate medical attention.
• Severe hypertension: markedly elevated blood pressure.
• Hepatic injury: signs of liver dysfunction such as jaundice.
• Interstitial lung disease: breathing difficulties and cough.
• Anaphylaxis: severe allergic reaction with rash, swelling, and airway compromise.
• Cardiac arrest: sudden loss of heart function.

Before initiating therapy, clinicians should assess patient-specific risk factors and monitor for known safety concerns.

• Blood pressure monitoring: check regularly to detect hypertension.
• Liver function assessment: evaluate baseline enzymes and repeat as needed.
• Seizure risk evaluation: avoid in patients with a history of seizures.
• Hypersensitivity screening: discontinue if allergic reactions occur.
• Elderly patients: use caution due to increased susceptibility to adverse effects.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Enzalutamide can interact with several medications, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin): may reduce enzalutamide exposure.
• Strong CYP3A4 inhibitors (e.g., ketoconazole): may increase enzalutamide levels.
• Antiepileptic drugs that lower seizure threshold (e.g., carbamazepine): may increase seizure risk.

Moderate Interactions (Monitor Closely)

• Warfarin: may enhance anticoagulant effect, requiring INR monitoring.
• Antihypertensives: enzalutamide can raise blood pressure, necessitating dose adjustments.
• CYP2C9 substrates (e.g., phenytoin): may experience altered plasma concentrations.