Enzalutamide When You Are Older — or Have Other Health Conditions

Prescribing guidance does not recommend a lower dose based on age alone. Most older patients start at the same dose as younger patients. What changes is how closely your team monitors you — fatigue, dizziness, and blood pressure are watched more carefully. If side effects are significantly affecting your daily life, a dose discussion is appropriate. Tell your team if you are struggling, rather than stopping the medicine yourself.

A previous seizure does not automatically rule out enzalutamide, but it changes how the decision is made. NCCN guidance treats a seizure history as a significant risk factor requiring careful evaluation before starting. Your oncologist will usually involve a neurologist. The outcome of that evaluation — not a blanket rule — determines whether enzalutamide is appropriate for you and under what conditions. Disclose even a single episode, however long ago it happened.

Enzalutamide and warfarin can be used together, but enzalutamide significantly changes how warfarin is processed in the body, which alters your INR. Your INR will need to be checked more frequently when you start enzalutamide, and your warfarin dose will very likely need adjustment. Tell your anticoagulation clinic or GP as soon as enzalutamide is prescribed, so the monitoring is in place before your first dose.

It can. Hypertension is a recognised effect of enzalutamide and occurs in a proportion of patients who had well-controlled blood pressure before starting. Your team will monitor it at clinic visits. If you have a blood pressure monitor at home, check it between appointments and report any reading that is clearly higher than your usual range. If your BP rises, your existing medicine may need to be adjusted — this is straightforward when identified early.

Enzalutamide's effect on hormone levels can affect blood glucose control in some patients with diabetes. If you take tablets or insulin for diabetes, your readings may change after starting and your diabetes medicines may need adjustment. Tell your diabetic care team or GP that you are starting enzalutamide. Monitor your blood glucose as your team advises and report any readings that are unusual for you, particularly if they are consistently higher than before.

This concern is well-founded and worth raising directly with your team. Fatigue and dizziness from enzalutamide, combined with any reduction in bone density from prolonged hormonal treatment, increase the risk of a fall causing a fracture. Practical steps that help include removing trip hazards at home, using a walking aid if your balance feels off, and asking for a physiotherapy or falls-prevention referral. Tell your team at every visit if you have felt unsteady or had a fall since your last appointment.

Enzalutamide affects how the body processes a wide range of medicines, not just a few. Common ones include warfarin, some statins, antifungals, and medicines for anxiety, depression, or seizures. The safest approach is to bring a complete list of everything you take — prescription, over-the-counter, and supplements — to your oncologist before starting, and to share that you are on enzalutamide with any new doctor or pharmacist you see afterwards. Do not stop or change any medicine without checking with your oncology team first.

Mild to moderate kidney impairment does not require a dose adjustment according to prescribing guidance. For severe impairment, the available evidence is limited and your oncologist will weigh the expected benefit against what is known about safety in your specific situation. Make sure your team has your most recent kidney function results before the prescription is written. If you are on dialysis, your oncologist and kidney specialist should speak to each other before a decision is made.