Medical Oncologist
Enzalutamide side effects
Dizziness, Falls and Seizure Risk — on Enzalutamide
Dizziness is a common side effect of enzalutamide and is often manageable at home. Seizures are uncommon, but the risk is real enough that it carries a specific warning in the FDA prescribing information. Knowing which symptoms need emergency care — and which need home care — is the most useful thing on this page.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed August 2026
- Dizziness is common — Light-headedness and unsteadiness affect many people on enzalutamide, especially early in treatment.
- Seizure risk is real — The FDA prescribing information for enzalutamide carries a specific warning about seizure risk during treatment.
- Do not drive — The prescribing information advises against driving and operating machinery until your oncologist says otherwise.
- Report any fall — Even a fall where you feel fine needs to be mentioned to your team — do not assume it does not matter.
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Enzalutamide carries a known seizure risk, listed in the FDA prescribing information. Seizures are uncommon but serious — if one occurs, call emergency services immediately and do not restart the medicine without specialist advice. Dizziness and unsteadiness are more common and often manageable at home, but any fall with injury needs same-day review.
How can you reduce the risk of dizziness and falls at home?
- Rise slowly from bed or a chair — pause for a few seconds before walking.
- Hold handrails on stairs and when getting in or out of a car.
- Keep the path to the bathroom lit at night.
- Do not drive or use heavy machinery while on enzalutamide.
- Tell your team about every medicine, supplement, and herbal or ayurvedic preparation you take.
- Avoid alcohol during treatment.
- Wear flat, supportive footwear — not loose slippers.
- Tell whoever you live with about this side effect so they can help if needed.
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Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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How serious is dizziness on enzalutamide?
| Symptom | Manageable at home | Call your oncology team today |
|---|---|---|
| Dizziness | Passes within seconds of sitting or lying down | Lasts more than a minute, is getting worse, or feels new and different from before |
| Unsteadiness when walking | Mild; able to hold a wall and walk safely | Cannot walk safely on your own, or noticeably worsening day on day |
| After a fall | No injury; you feel clear and alert | Any head impact, new pain, or confusion after the fall — go to emergency |
| Shaking or jerking | — | Always an emergency — call 108 immediately, do not wait |
| Typically starts | Dizziness: often within the first weeks of treatment, may ease over time | Seizure risk is present throughout treatment — report any unusual episode at any stage |
Is it safe to drive on enzalutamide?
The FDA prescribing information for enzalutamide specifically advises against driving, operating heavy machinery, or other activities requiring full alertness during treatment.
Do not drive until your oncologist has explicitly told you it is safe. Do not assume that feeling well means it is fine — the possibility of a sudden seizure is what makes this a clinical decision, not a personal one.
If driving is essential to your work or daily life, raise this with your oncologist. Tell them what you need to do and let them advise you. Do not make this decision on your own.
What will your team do if you report dizziness or a fall?
Tell your oncologist at your next visit about any dizziness, unsteadiness, or fall — or call sooner if it is affecting daily life. Do not wait and hope it settles.
Your team will review whether any of your other medicines are adding to the problem. Blood pressure medicines, sleeping tablets, and some pain medicines can increase dizziness when combined with enzalutamide.
Depending on what they find, they may adjust the timing of your dose, refer you to physiotherapy for a fall-prevention programme, or review whether a contributing medicine can be changed. You are not expected to manage this on your own.
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Common questions
Frequently asked questions
What should I do if I think I had a seizure on enzalutamide?
Call 108 immediately and go to the nearest emergency department — do not drive yourself. If you are unsure whether it was a seizure, treat it as one and go anyway. Tell the emergency team you are taking enzalutamide. Do not take your next dose until your oncologist has reviewed the episode and specifically told you it is safe to continue. If you live alone, ask a family member or neighbour to stay with you until you have been assessed.
How common are seizures on enzalutamide?
Seizures on enzalutamide are uncommon, but the risk is real enough that the FDA's prescribing information carries a specific warning about it. Your individual risk depends on factors your oncologist should have considered before prescribing — including whether you have had seizures before, whether you have brain metastases, and what other medicines you take. If any of these apply to you and were not discussed, ask at your next visit. The low overall risk is not a reason to ignore unusual episodes.
Can enzalutamide be restarted after a seizure?
Do not restart enzalutamide after a seizure without a specific decision from your oncologist. NCCN guidance recommends permanently discontinuing enzalutamide following a seizure. Whether treatment continues, pauses, or stops depends on the full clinical picture — your oncologist will weigh the seizure risk against how well the drug is working for your cancer. That decision belongs with your treating team; do not make it yourself.
Will the dizziness improve over time?
For many people, dizziness and light-headedness ease after the first few weeks as the body adjusts to enzalutamide. It does not always disappear completely, and it may be more noticeable when you stand up quickly or when you are tired. Tell your team if it is interfering with daily life — there are practical steps, and sometimes clinical ones, that can help. Do not assume you simply have to live with it.
What medicines or conditions raise the seizure risk on enzalutamide?
The risk is higher if you have a history of seizures, brain metastases, or a recent stroke. Some medicines also increase it — including certain antidepressants, antipsychotics, and other drugs that lower the seizure threshold. Tell your oncology team about every medicine you take, including over-the-counter tablets, herbal preparations, and ayurvedic formulations. Your team should have assessed this before starting treatment, but a complete and current medicines list at every visit keeps that assessment up to date.