Midamid (Enzalutamide)

Midamid is used in the management of prostate cancer that has progressed despite hormonal therapy. It provides androgen‑receptor blockade in advanced disease states.

• Metastatic castration‑resistant prostate cancer: delays disease progression and improves overall survival.
• Non‑metastatic castration‑resistant prostate cancer: reduces risk of metastasis and extends survival.
• Advanced prostate cancer: offers androgen‑receptor inhibition for patients who have failed prior hormonal treatments.

• Enzalutamide acts as a selective androgen‑receptor antagonist. It binds to the androgen receptor, preventing its translocation to the nucleus, blocking DNA binding, and inhibiting transcription of androgen‑responsive genes, thereby suppressing tumor growth driven by androgen signaling.

Enzalutamide may cause a range of adverse reactions, from mild to severe. Patients should be monitored regularly for any new symptoms.

Common Side Effects

• Fatigue: persistent tiredness affecting daily activities.
• Hypertension: elevated blood pressure requiring monitoring.
• Diarrhea: loose stools that may lead to dehydration.
• Nausea: feeling of sickness often occurring after dosing.
• Hot flashes: sudden warmth and sweating.
• Decreased appetite: reduced desire to eat.

Serious or Rare Side Effects

• Seizures: convulsive episodes requiring immediate medical attention.
• Hepatic injury: signs of liver dysfunction such as jaundice.
• Interstitial lung disease: breathing difficulties and cough.
• Severe hypertension: markedly high blood pressure with risk of organ damage.
• Cardiac arrhythmia: irregular heart rhythms that may be life‑threatening.
• Posterior reversible encephalopathy syndrome: neurological changes requiring urgent care.

Before initiating therapy, clinicians should assess baseline health status and monitor patients throughout treatment.

• Blood pressure monitoring: check regularly to detect hypertension.
• Liver function tests: assess hepatic enzymes before and during therapy.
• Seizure risk evaluation: review patient history for prior seizures.
• Avoid use in uncontrolled hypertension: ensure blood pressure is well‑controlled prior to starting.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Strong CYP2C8 inhibitors (e.g., gemfibrozil): may increase enzalutamide exposure.
• Strong CYP3A4 inducers (e.g., rifampin): may reduce therapeutic effect.
• Anticoagulants (e.g., warfarin): may heighten bleeding risk.

Moderate Interactions (Monitor Closely)

• Antiepileptic drugs (e.g., carbamazepine): may affect seizure threshold.
• Hormonal therapies (e.g., GnRH agonists): monitor testosterone levels.
• Statins metabolized by CYP2C9: watch for increased toxicity.