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Enzalutamide Side Effects

In Summary

Commonly reported side effects of enzalutamide include: upper respiratory tract infection, headache, hot flash, laryngitis, nasopharyngitis, pharyngitis, rhinitis, and sinusitis. Other side effects include: lower respiratory tract infection, pneumonia, pulmonary infection, altered mental status, amnesia, bronchitis, cognitive dysfunction, falling, hypertension, hypoesthesia, and memory impairment. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to enzalutamide: oral capsule liquid filled

In addition to its needed effects, some unwanted effects may be caused by enzalutamide. In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking enzalutamide:

More common:
  • Back pain
  • bloating or swelling of the face, arms, hands, lower legs, or feet
  • blood in the urine
  • blurred vision
  • chest pain
  • cough with mucus
  • difficulty with breathing
  • dizziness
  • fever or chills
  • loss of bladder or bowel control
  • nervousness
  • painful or difficult urination
  • pounding in the ears
  • slow or fast heartbeat
  • sore throat
  • tingling of the hands or feet
  • unable to move the legs
  • unusual weight gain or loss
Less common:
  • Anxiety
  • confusion or excitement
  • depression
  • fainting
  • falling
  • lightheadedness
  • loss of memory
  • memory or attention span problems
  • nightmares or vivid dreams
  • rapid, shallow breathing
  • Seizures

Minor Side Effects

Some of the side effects that can occur with enzalutamide may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:
  • Body aches or pain
  • bone pain
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • diarrhea
  • difficulty having a bowel movement (stool)
  • difficulty with 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
  • pain or tenderness around the eyes and cheekbones
  • redness of the face, neck, arms, and upper chest
  • sensation of spinning
  • stuffy or runny nose
  • tender, swollen glands in the neck
  • trouble sleeping
  • trouble with swallowing
  • unusual tiredness or weakness
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
Postmarketing reports: Posterior reversible encephalopathy syndrome[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.

2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

Not all side effects for enzalutamide may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

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