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Xtandi Side Effects

Generic name: enzalutamide

Medically reviewed by Last updated on Aug 30, 2021.

Note: This document contains side effect information about enzalutamide. Some of the dosage forms listed on this page may not apply to the brand name Xtandi.

In Summary

Common side effects of Xtandi 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, oral tablet

Side effects requiring immediate medical attention

Along with its needed effects, enzalutamide (the active ingredient contained in Xtandi) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while 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
  • chills
  • cough with mucus
  • difficulty with breathing
  • dizziness
  • fever
  • 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


Incidence not known

  • Headache
  • hives, itching, skin rash
  • hoarseness
  • irritation
  • joint pain, stiffness, or swelling
  • redness of the skin
  • swelling of the eyelids, face, lips, hands, or feet
  • tightness in the chest
  • trouble breathing or swallowing
  • unusual drowsiness, tiredness, weakness, or feeling of sluggishness

Side effects not requiring immediate medical attention

Some side effects of enzalutamide may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

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
  • difficulty with moving
  • dry throat
  • ear congestion
  • feeling of constant movement of self or surroundings
  • feeling of warmth
  • lack or loss of strength
  • loss of voice
  • muscle pain, stiffness, or weakness
  • pain or tenderness around the eyes and cheekbones
  • sensation of spinning
  • stuffy or runny nose
  • tender, swollen glands in the neck
  • trouble sleeping

Less common

For Healthcare Professionals

Applies to enzalutamide: oral capsule, oral tablet

Nervous system

Very common (10% or more): Headache (12%), dizziness/vertigo (11%)

Common (1% to 10%): Spinal cord compression and cauda equina syndrome, paresthesia, hypoesthesia, dysgeusia, restless legs syndrome

Uncommon (0.1% to 1%): Seizures

Postmarketing reports: Posterior reversible encephalopathy syndrome (PRES) (e.g., seizure, headache, lethargy, confusion, blindness, and other visual and neurological disturbances, with or without associated hypertension)[Ref]


Very common (10% or more): Hot flush (20%), peripheral edema (15%), hypertension (14%)[Ref]


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

Postmarketing reports: Rash[Ref]


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


Very common (10% or more): Constipation (23%), diarrhea (22%)

Common (1% to 10%): Hematuria, pollakiuria

Postmarketing reports: Vomiting[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 (19%), decreased weight (12%)[Ref]


Very common (10% or more): Back pain (29%), arthralgia (21%), musculoskeletal pain (15%)

Common (1% to 10%): Muscular weakness, musculoskeletal stiffness[Ref]


Very common (10% or more): Asthenia/fatigue (51%), falls (13%)

Common (1% to 10%): Fall-related injuries[Ref]


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


Very common (10% or more): Upper respiratory tract infection (16%), dyspnea (11%)

Common (1% to 10%): Lower respiratory tract and lung infection, epistaxis[Ref]


Postmarketing reports: Face edema, tongue edema, lip edema, pharynx edema[Ref]


Postmarketing reports: Blindness and other visual disturbances due to posterior reversible encephalopathy syndrome (PRES)[Ref]

Frequently asked questions


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

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.