If you're on Xtandi for prostate cancer and worried about side effects, here's what matters most: what's common, what's serious, and what you can do today to feel safer.
We'll walk through mild-to-serious Xtandi side effects, red flags to act on now, and simple, doctor-approved ways to manage themwithout losing sight of the benefits of treatment. Think of this as a practical companion for your next appointment, written with care and clarity.
Quick take
Xtandi (enzalutamide) is a powerful anti-androgen that helps slow prostate cancer growth by blocking the signals that fuel it. It's used in different stagesfrom hormone-sensitive disease to castration-resistant prostate cancerand is commonly taken alongside GnRH therapy (hormone shots). In plain language: it's a cornerstone treatment for many men and can improve survival and symptoms over time.
But yes, there are trade-offs. Some people glide through with only mild tiredness or hot flashes. Others face tougher challenges like high blood pressure, falls, or (rarely) seizures. The goal isn't to scare you; it's to give you a clear map so you can act early, adjust wisely, and keep your life as full as possible while on therapy.
Why it's used
Xtandi is often started when cancer is still responding to hormone therapy (hormone-sensitive) or when it keeps growing despite low testosterone (castration-resistant). It's usually combined with ongoing hormone shots to suppress testosterone. According to respected patient guidance from Prostate Cancer UK, Xtandi is part of modern combination strategies that have boosted outcomes for many men, particularly when added early to systemic therapy.
How do you decide if it's right for you? A simple, human way to weigh it: what are your goals (living longer, staying active, keeping symptoms quiet), what's your current health (especially heart and brain health), what other meds are you on, and which side effects would be deal-breakers for you? Naming those priorities with your clinician is surprisingly powerful.
Side effects
Let's start with the ones you're most likely to notice and move toward the seriousbut less commonXtandi side effects. I'll also show you practical ways to manage them without derailing your life.
Common symptoms you may notice
People frequently report fatigue, hot flashes, muscle or joint aches, headache, bowel changes (diarrhea or constipation), decreased appetite, and sometimes increased blood pressure. Falls and bone fractures can happen, especially when Xtandi is combined with long-term hormone therapy that thins bones. These are well-described on the official Xtandi safety pages and in drug info summaries, and they're manageable with early attention.
Serious effects to know now
Serious but less common risks include seizure, Posterior Reversible Encephalopathy Syndrome (PRES), ischemic heart disease events (like heart attack), severe allergic reactions, and significant falls or fractures. I know that list looks heavy. Keep in mind: these are uncommon. Awareness simply helps you spot red flags fast.
When to call vs go now
Call your care team promptly for new or worsening chest pain, shortness of breath, severe headache, confusion, vision changes, persistent bleeding, fainting, or uncontrolled diarrhea. Headaches paired with visual changes or confusion deserve urgent attention. Go to the emergency room if you have a seizure, trouble breathing or swelling of the face, lips, tongue, or throat, crushing chest pain, or signs of stroke (sudden weakness, facial droop, speech trouble). If your gut says "this isn't right," trust it.
Daily management
Here's where the rubber meets the roadpeople-first ways to manage common Xtandi side effects at home, and what to bring up with your team.
Fatigue
Fatigue can sneak up like a heavy coat you didn't ask to wear. Try pacing: spread tasks across the day, schedule high-energy activities for your best hours, and allow short power naps (2030 minutes). Gentle daily movementlike an easy walk or light resistance bandsoften restores energy better than full rest. Protect your sleep with a wind-down routine, dim lights, and a consistent bedtime. If fatigue is severe, ask about physical therapy or medications that can help. And remember, you're not lazyyou're healing while on a serious therapy.
Hot flashes
Layer up with breathable fabrics, keep a fan nearby, and sip cold water. Some people use a cooling pillow or mattress pad. If hot flashes are stealing your sleep or your patience, talk to your clinician; there are medical options that can dial them down.
Muscle and joint pain
Think gentle before intense. Daily stretching, heat in the morning, and ice after activity can soothe sore spots. Low-impact exerciseswalking, swimming, tai chikeep you flexible and stronger. If over-the-counter anti-inflammatories are usually your go-to, check with your team first (because of bleeding risks and interactions). A physical therapy referral can be a game-changer, giving you a custom plan that respects your limits and builds strength safely.
Bowel changes
Diarrhea and constipation happen on both ends of the spectrum. For diarrhea, hydration is your best friendtry water, broth, or oral rehydration solutions. Short-term bland foods (think "BRAT"-style) can settle things, and your clinician might ok an anti-diarrheal. For constipation, introduce fiber gradually, add fruits like pears or prunes, and keep moving. If symptoms persist or you see blood, reach outdon't white-knuckle it.
Appetite and weight
When food tastes "meh," try small, frequent meals and easy protein wins: yogurt, eggs, nut butter on toast, protein smoothies. Keep favorite snacks in reach for quick calories. If weight is slipping or your appetite feels stuck in low gear, a registered dietitian can tailor ideas you'll actually enjoy. This is about nourishmentnot perfection.
Headaches
Hydrate, keep caffeine steady (not yo-yoing), prioritize sleep, and consider relaxation techniques. Track triggers: dehydration, skipped meals, stress, even certain foods. If headaches are severe, frequent, or paired with vision changes or confusion, that's a red flagcall your team. PRES is rare but serious, and early evaluation matters.
High blood pressure
Xtandi can bump up blood pressure. Home BP checks (same time each day, seated, feet flat, arm supported) are a smart move if your team suggests it. Share readings at visits. Keep salt sensible, stay active if cleared, and if medications need adjusting, don't be shy about asking for a clear plan. If you already have heart risks, ask whether a cardiology check-in makes sense early on.
Bleeding problems
Watch for easy bruising, nosebleeds, or black, tarry stools. If you take aspirin, NSAIDs, or blood thinners, ask your clinician to review whether anything should be paused or adjusted. If bleeding is heavy, persistent, or you feel lightheaded, call nowsafety first.
Falls and fractures
Hormone therapy can thin bones, and Xtandi may raise fall risk, so let's stack the odds in your favor. Do a home safety sweep: remove clutter, secure rugs, add night lights, and keep paths clear. Balance exercises, vitamin D and calcium (if appropriate), and a DEXA scan to check bone density can help. Ask about bone-protective medications if your fracture risk is higher. A few tweaks can mean more confidence on your feet.
Serious risks
These risks are not common, but knowing the signs helps you respond quickly and reduce harm.
Seizure risk
Seizures are rare on Xtandi, but risk is higher if you have a seizure history, brain lesions, a stroke history, or you're on certain interacting medications. Play it safe: avoid driving or operating heavy machinery until you know how you respond to Xtandi and your clinician gives the green light. Be upfront about alcohol use and any recreational substancesno judgment, just safety. If you experience anything that feels like a seizure or spell (sudden loss of awareness, jerking), seek emergency help.
PRES: subtle but serious
Posterior Reversible Encephalopathy Syndrome can present with sudden severe headache, confusion, vision changes, and sometimes seizures. "Reversible" is in the name because fast treatment can help, but timing matters. If you notice these symptoms, don't waitgo for urgent evaluation.
Heart events
Some people on Xtandi may be at higher risk of heart issues, particularly if they already have heart disease or multiple risk factors. It's wise to know your baseline: blood pressure, cholesterol, diabetes status, weight, smoking status. Ask for a simple symptom checklist: what kind of chest pain matters, when shortness of breath is urgent, and how to differentiate "normal" fatigue from something concerning. Lifestyle tweaksmovement, smart salt choices, stress controlstill matter here, and medication adjustments can protect you while you stay on treatment.
Severe allergic reactions
Hives, wheezing, swelling of your face, lips, tongue, or throat, or sudden trouble breathing are medical emergencies. Stop Xtandi and get help immediately. If you're unsure whether it's "severe enough," go anyway; it's better to be told you're okay than to wait on something dangerous.
Safety checks
Because Xtandi interacts with certain drugs, bring every medication and supplement to your visitprescription, over-the-counter, vitamins, and herbals (yes, St. John's wort counts). Enzalutamide can affect how your body processes other medicines, and vice versa, so transparency is your superpower here.
Expect a monitoring plan: PSA checks to gauge response, regular blood pressure readings, and periodic labs for blood counts and liver function. Your team may also review fall risk and bone health over time. Keep a small notebook or phone note with your weekly symptom highlights: energy level, mood, BP values, bowel habits, any falls, headaches, or chest symptoms. It'll make your visits sharper and more satisfying.
If you're sexually active with a partner who could become pregnant, use condoms plus a second form of contraception during therapy and for 3 months after stopping Xtandi. If your partner is pregnant, condoms are recommended to reduce exposure. Fertility can be affected; if family planning is on your mind, say it out loudyour team can help explore options.
Compare options
You might hear Xtandi compared with abiraterone (often given with prednisone). Broadly speaking, fatigue and cognitive effects (and seizure risk) lean toward Xtandi's side, while abiraterone may bring more steroid-related issues like fluid retention, low potassium, and blood pressure changes. Which is "better" depends on your health profile, your priorities, and how you tolerate each medicine. According to trustworthy patient guidance from Prostate Cancer UK, talking through these trade-offs upfront helps you avoid unnecessary switches later.
When is it time to change course? If PSA rises with new symptoms, if side effects become intolerable despite adjustments, or if imaging shows new metastases, it's a real conversation. It's also a moment to ask about clinical trialsyou deserve to know your full menu of options.
Real-life tips
Here's what day-to-day success can look like on Xtandi.
A story many patients relate to: "Jim" started Xtandi with a full-time job and grandkid soccer games on weekends. Week 2 hit with heavy fatigue. He felt guilty cutting backuntil his physical therapist reframed it: protect your best hours. Jim now stacks chores in the morning, takes a midday walk, and saves his energy for the Saturday game. He still gets tired, but he doesn't miss the moments that matter.
"Luis" struggled with rising blood pressure during month one. He set a daily alarm for a quick BP check, cut back on ultra-salty snacks, and had his primary care doctor tweak a med. Within two weeks, his readings settledand so did his worry. Sometimes the smallest systems give the biggest peace of mind.
"Mark" took a weekend to fall-proof the house after a near-miss trip. Out went the loose rug and cluttered hallway; in came night lights and a grab bar near the shower. He jokes that his home is now "airport-runway-ready"and he hasn't had a fall since.
What routine could give you back a sense of control this week? A five-minute symptom log at night? A gentle walk with a neighbor? Moving the throw rug that always catches your foot?
Helpful sources
Want deeper dives as you go? According to the official safety pages for Xtandi and patient overviews from established resources like the Mayo Clinic and Drugs.com, the side effect profile and precautions described here are well-supported by clinical data and real-world experience. You might find it useful to explore the official Xtandi side effects overview and the patient-friendly Enzalutamide guidance from Prostate Cancer UK in the middle of your treatment journey, not just at the start.
Stay prepared
Quick reference for red flags: call your doctor for new chest pain, shortness of breath, severe headache, confusion, vision changes, persistent bleeding, fainting, or uncontrollable diarrhea. Go to the ER for a seizure, severe trouble breathing or swelling of the face or throat, crushing chest pain, or signs of stroke. If you experience a serious event, your team can also help you report it to FDA MedWatch; it's one way patients help make treatments safer for everyone.
Bringing it home
Xtandi can deliver real benefits for prostate cancerbut like any powerful treatment, it comes with risks. Knowing the most common Xtandi side effects (fatigue, hot flashes, bowel changes, headaches, blood pressure increases) and the rare but serious ones (seizure, PRES, heart events, severe allergy, fractures) helps you act early and stay safer. Keep a simple symptom log, check your blood pressure if advised, and share changes with your care team promptly. Never stop or change your dose without talking to your doctor.
Most of all, remember you're not alone. Side effects are problems to solve, not personal failures. If red-flag symptoms show upseizure, chest pain, severe headache with confusion or vision changes, or trouble breathingseek urgent care. And for everything else, bring your questions and your notes to your next visit. What's one step you can take today to feel a little better tomorrow? I'm rooting for youand I'm glad you're here, taking charge of your care.
FAQs
What are the most common Xtandi side effects?
Typical side effects include fatigue, hot flashes, muscle or joint aches, headaches, bowel changes, decreased appetite, and increased blood pressure.
When should I seek emergency care while on Xtandi?
Go to the ER immediately for seizures, severe breathing difficulty, swelling of the face/throat, crushing chest pain, or stroke signs. Call your doctor for new chest pain, shortness of breath, severe headache with vision changes, persistent bleeding, or fainting.
How can I manage fatigue caused by Xtandi?
Schedule activities during peak energy times, take short power naps, stay lightly active with walks or resistance bands, and maintain a consistent sleep routine. Ask your doctor about physical therapy if fatigue is severe.
Does Xtandi increase my risk of falls or fractures?
Yes, especially when combined with hormone therapy that lowers bone density. Safe home tips, balance exercises, calcium/vitamin D, and periodic bone density scans can reduce the risk.
Are seizures a common problem with Xtandi?
Seizures are rare but can occur, mainly in people with a history of seizures, brain lesions, or interacting medications. Report any sudden loss of awareness or jerking movements right away.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
Add Comment