Casodex Is an Antiandrogen Medication Used to Treat Metastatic Prostate Cancer

Casodex (Bicalutamide) is a prescription medication that blocks testosterone from fueling prostate cancer cell growth, used alongside hormone therapy for metastatic prostate cancer treatment.

If you or someone you care about has been prescribed Casodex, you probably have questions. What does it do? How do you take it? What are the risks? This guide covers everything you need to know about Casodex in 2026 — in plain language.

What Is Casodex?

Here are the basics:

• Brand name: Casodex
• Generic name: Bicalutamide
• Drug class: Nonsteroidal antiandrogen (NSAA)
• Manufacturer: AstraZeneca (brand). Multiple manufacturers produce the generic.
• FDA approval: Approved for the treatment of metastatic prostate cancer in combination with a luteinizing hormone-releasing hormone (LHRH) analog
• Controlled substance: No — Casodex is not a controlled substance and has no DEA schedule
• Available forms: 50 mg oral tablet
• Generic available: Yes — generic Bicalutamide is widely available and significantly cheaper than brand-name Casodex

What Is Casodex Used For?

FDA-Approved Use

Casodex is FDA-approved for one specific indication:

Treatment of metastatic prostate cancer in combination with an LHRH analog (such as Leuprolide/Lupron or Goserelin/Zoladex).

This combination is called combined androgen blockade (CAB). The LHRH analog reduces testosterone production, while Casodex blocks any remaining testosterone from reaching cancer cells. Together, they provide more complete androgen suppression than either drug alone.

Off-Label Uses

While not FDA-approved for these uses, doctors sometimes prescribe Bicalutamide off-label for:

• Hirsutism (excess hair growth) in women
• Female pattern hair loss (androgenetic alopecia)
• Acne in women
• Feminizing hormone therapy for transgender women
• Polycystic ovary syndrome (PCOS)
• Frontal fibrosing alopecia
• Hidradenitis suppurativa

Off-label uses are prescribed based on clinical evidence and physician judgment, though they aren't included in the FDA-approved labeling.

How Is Casodex Taken?

Taking Casodex is straightforward:

• Dose: One 50 mg tablet, once daily
• Timing: Take it at the same time each day
• With food? Casodex can be taken with or without food
• How to take it: Swallow the tablet whole with water
• When to start: Begin on the same day as your LHRH analog therapy
• Duration: Casodex is taken for as long as your doctor recommends — typically as an ongoing treatment

If you miss a dose, take it as soon as you remember. If it's almost time for your next dose, skip the missed one and continue your regular schedule. Don't take two doses at once.

Who Should Not Take Casodex?

Casodex is not appropriate for everyone. You should not take Casodex if:

• You are allergic to Bicalutamide or any ingredient in the tablet
• You are a woman who is pregnant or may become pregnant — Bicalutamide can cause serious harm to an unborn baby
• You have severe liver problems — use with caution in moderate-to-severe hepatic impairment

Before starting Casodex, tell your doctor about:

• All medications you take, including over-the-counter drugs and supplements (see our drug interactions guide)
• Any history of liver disease
• Whether you take blood thinners like Warfarin

Important Safety Monitoring

Your doctor should order liver function tests (LFTs) before you start Casodex and monitor them regularly during treatment. While rare, Casodex can cause serious liver injury — and early detection through regular blood tests is critical. For more details, see our side effects guide.

Side Effects Overview

The most common side effects of Casodex (in combination with an LHRH analog) include:

• Hot flashes (53%)
• General pain (35%)
• Back pain (25%)
• Weakness (22%)
• Constipation (22%)
• Nausea (15%)
• Gynecomastia and breast pain

Serious but rare side effects include liver injury (hepatotoxicity), increased bleeding risk with blood thinners, interstitial lung disease, and photosensitivity. For a full breakdown, read our detailed guide on Casodex side effects.

How Much Does Casodex Cost?

Cost depends on whether you get brand or generic:

• Brand-name Casodex: $267–$325 for 30 tablets (50 mg)
• Generic Bicalutamide (retail, no coupon): Approximately $267 for 30 tablets
• Generic with a free coupon (GoodRx/SingleCare): As low as $19–$24 for 30 tablets
• Generic with GoodRx Gold: As low as $15 for 30 tablets

Insurance Coverage

Generic Bicalutamide is widely covered by most insurance plans, including Medicare Part D and Medicaid. It's typically placed on Tier 1 or Tier 2 (preferred generic), which means the lowest copay tier. Prior authorization is generally not required for the generic version.

Patient Assistance

AstraZeneca's AZ&Me Prescription Savings Program can provide Casodex at no cost to eligible uninsured or underinsured patients. Additional resources include NeedyMeds, RxAssist, and RxHope. For a complete guide to savings options, see how to save money on Casodex.

How Does Casodex Compare to Similar Medications?

Casodex belongs to the antiandrogen class. Here's how it compares to alternatives:

• Flutamide (Eulexin): Older antiandrogen, taken 3 times daily (vs. once daily for Casodex), higher risk of diarrhea and liver toxicity
• Nilutamide (Nilandron): Once-daily dosing like Casodex, but associated with visual disturbances and interstitial pneumonitis
• Enzalutamide (Xtandi): Second-generation antiandrogen, more potent, used for castration-resistant prostate cancer — but costs $15,000+ per month
• Apalutamide (Erleada): Second-generation antiandrogen for non-metastatic castration-resistant prostate cancer, also significantly more expensive

For more on alternatives, read our guide on alternatives to Casodex.

Final Thoughts

Casodex (Bicalutamide) has been a workhorse in prostate cancer treatment for decades. It's effective, well-tolerated by most patients, available as an affordable generic, and simple to take — one pill, once a day. While it does require regular liver monitoring and carries some side effects, it remains a standard part of combined androgen blockade therapy for metastatic prostate cancer.

If you've been prescribed Casodex, work closely with your oncologist or urologist to monitor your treatment. And if cost or availability is a concern, there are plenty of resources available to help — from discount coupons to pharmacy stock checkers.

Need help finding Casodex at a pharmacy near you? Visit Medfinder to search by zip code and find your medication today.