Xtandi Side Effects

Generic Name: enzalutamide

Note: This page contains side effects data for the generic drug enzalutamide. It is possible that some of the dosage forms included below may not apply to the brand name Xtandi.

It is possible that some side effects of Xtandi may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to enzalutamide: oral capsule liquid filled

As well as its needed effects, enzalutamide (the active ingredient contained in Xtandi) may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking enzalutamide, check with your doctor immediately:

More common
  • Back pain
  • bloating or swelling of the face, arms, hands, lower legs, or feet
  • blood in urine
  • blurred vision
  • chest pain
  • cough
  • cough with mucus
  • difficulty breathing
  • dizziness
  • fever or chills
  • headache
  • loss of bladder control
  • loss of bowel control
  • nervousness
  • no sensation in the legs
  • painful or difficult urination
  • pounding in the ears
  • rapid weight gain
  • shortness of breath
  • slow or fast heartbeat
  • sneezing
  • sore throat
  • tightness in the chest
  • tingling of the hands or feet
  • unable to move legs
  • unusual weight gain or loss
  • wheezing
Less common
  • Confusion or excitement
  • fainting
  • falling
  • lightheadedness
  • loss of memory
  • mental depression or anxiety
  • nightmares or unusually vivid dreams
  • problems with memory or attention span
  • rapid, shallow breathing
  • trouble performing routine tasks
  • Seizures

Some enzalutamide side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common
  • Body aches or pain
  • bone pain
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • diarrhea
  • difficulty in moving
  • dry throat
  • ear congestion
  • feeling of constant movement of self or surroundings
  • feeling of warmth
  • hoarseness
  • joint pain
  • lack or loss of strength
  • loss of voice
  • muscle pain, stiffness, or weakness
  • nervousness
  • pain or tenderness around the eyes and cheekbones
  • redness of the face, neck, arms and occasionally, upper chest
  • sensation of spinning
  • stuffy or runny nose
  • tender, swollen glands in the neck
  • trouble with swallowing
  • trouble sleeping
  • unusual tiredness or weakness
  • voice changes
Less common
  • Bloody nose
  • dry skin
  • frequent urination
  • itching skin
  • pale-colored urine

For Healthcare Professionals

Applies to enzalutamide: oral capsule

Nervous system

Very common (10% or more): Headache (up to 12.1%), dizziness/vertigo (up to 11.3%)
Common (1% to 10%): Spinal cord compression and cauda equina syndrome, paresthesia, mental impairment disorders, hypoesthesia, dysgeusia, restless legs syndrome
Uncommon (0.1% to 1%): Seizures[Ref]

It is unknown how the drug may lower the seizure threshold; however, it may be related to the drug's ability to inhibit the activity of the GABA-gated chloride channel. The risk of seizure may be related to dose.

Mental impairment disorders included amnesia, memory impairment, cognitive disorder, and disturbance in attention.[Ref]


Very common (10% or more): Hot flush (up to 20.3%), peripheral edema (up to 15.4%), hypertension (up to 14.2%)[Ref]


Common (1% to 10%): Pruritus, dry skin[Ref]


Common (1% to 10%): Gynecomastia[Ref]


Very common (10% or more): Constipation (up to 23.2%), diarrhea (up to 21.8%)[Ref]


Common (1% to 10%): Hematuria, pollakiuria[Ref]


Very common (10% or more): Neutropenia (15%)
Common (1% to 10%): Thrombocytopenia
Frequency not reported: Leukopenia[Ref]


Very common (10% or more): ALT elevations (10%)
Common (1% to 10%): Bilirubin elevations[Ref]


Very common (10% or more): Decreased appetite (up to 18.9%), decreased weight (up to 12.4%)[Ref]


Very common (10% or more): Back pain (up to 28.6%), arthralgia (up to 21.4%), musculoskeletal pain (up to 15%)
Common (1% to 10%): Muscular weakness, musculoskeletal stiffness[Ref]


Fall-related injuries included non-pathologic fractures, joint injuries, and hematomas.[Ref]

Very common (10% or more): Asthenia/fatigue (up to 50.6%), falls (up to 12.7%)
Common (1% to 10%): Fall-related injuries[Ref]


Common (1% to 10%): Insomnia, anxiety, hallucinations[Ref]


Upper respiratory tract infection included nasopharyngitis, sinusitis, rhinitis, pharyngitis, and laryngitis. Lower respiratory tract and lung infection included pneumonia and bronchitis.[Ref]

Very common (10% or more): Upper respiratory tract infection (up to 16.4%), dyspnea (up to 11%)
Common (1% to 10%): Lower respiratory tract and lung infection, epistaxis[Ref]


1. "Product Information. Xtandi (enzalutamide)." Astellas Pharma US, Inc, Deerfield, IL.

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