Medical Oncologist
Enzalutamide (Xtandi)
Enzalutamide Side Effects: — The Complete List and Timeline
Most people on enzalutamide notice fatigue and hot flushes within the first few weeks. A small number develop more serious reactions. Knowing which symptoms to watch for, and when to call your team, helps you stay safe and keep treatment on track.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed August 2026
- Fatigue is the most common — Most patients report tiredness from the first few weeks. It usually becomes manageable but rarely disappears completely.
- Seizure risk is real but small — A small number of patients on enzalutamide develop a seizure. Tell your team if you have ever had one before, and ask about driving.
- Some effects build up slowly — High blood pressure and bone thinning develop gradually, which is why monitoring continues throughout your treatment.
- Most effects are manageable — The majority of side effects can be managed without stopping treatment. Your team needs to hear about them to help.
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Enzalutamide commonly causes fatigue, hot flushes, dizziness and high blood pressure. Most side effects begin within the first few weeks of starting. A small number of patients develop a seizure, which is a known risk listed in NCCN guidance. Most side effects can be managed without stopping treatment, so tell your team as soon as you notice something new.
What side effects are most likely in the first few weeks?
Fatigue is the most commonly reported side effect of enzalutamide. It often begins within the first few weeks and can range from mild tiredness to significant exhaustion.
Hot flushes are also very common, caused by the drug's hormonal effect on testosterone. They tend to ease for many patients over time, though they may not stop completely.
Dizziness is more common early in treatment. It is one reason your team may advise caution about driving before your seizure risk and early dizziness have both been assessed.
Tell your team about these symptoms at your next appointment, or sooner if they are making daily activities difficult.
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Radiation Oncologist
Radiation Oncologist
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Dr. Mohammed Imran
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Which side effects can develop slowly over months of treatment?
High blood pressure can develop or worsen during enzalutamide treatment. Your team will check it at clinic visits, and monitoring it at home gives earlier warning between appointments.
Bone thinning is a gradual risk from hormonal treatment for prostate cancer. Your team may arrange a bone density scan and discuss whether calcium, vitamin D or bone-protecting medicines are appropriate for you.
Some patients notice changes in memory or concentration, often called brain fog. This is a real side effect and worth reporting. It is not a sign that cancer has spread to the brain.
Gradual symptoms are easy to dismiss. Mention any slow-developing change at your next visit so your team can track the pattern.
Which enzalutamide side effects need a call and when do they typically start?
| Side effect | How common | Typically starts | Action needed |
|---|---|---|---|
| Fatigue | Very common | Within first few weeks | Tell your team if it limits daily activity |
| Hot flushes | Very common | Within first few weeks | Mention at next appointment; team can advise |
| Dizziness | Common | Early — first weeks | Call today if severe or if you have fallen |
| High blood pressure | Common | Weeks to months into treatment | Monitor at home; call if very high or you have symptoms |
| Falls | Common, especially in older adults | Any time; higher risk with dizziness | Call today; emergency if head injury or unable to get up |
| Headache | Common | Early weeks | Call today if sudden and severe — this is a red flag |
| Memory or concentration changes | Reported by many patients | Weeks to months in | Tell your team; worth noting when it happens and how |
| Musculoskeletal pain | Common | Can start any time | Tell your team if it limits movement or is worsening |
| Insomnia | Common | Often early | Mention at next appointment |
| Seizure | Uncommon but a known risk | Can happen at any time | Emergency: go to hospital immediately |
How can you manage the common side effects of enzalutamide?
What can I do about fatigue on enzalutamide?
Fatigue on enzalutamide is one of the most commonly reported reasons patients find treatment difficult, and it is worth taking seriously rather than pushing through. Gentle, regular activity — even a short walk each day — tends to help more than complete rest. Protecting your sleep and pacing activities through the day both make a difference. If fatigue is stopping you from managing daily tasks, tell your team: it can sometimes have a treatable cause such as anaemia or low thyroid function, and there are practical ways to manage it even when the drug itself is the cause.
Is the dizziness dangerous, and can I still drive?
Dizziness on enzalutamide increases the risk of falling, particularly when standing up quickly from sitting or lying. Rise slowly and hold on to something if you feel unsteady. On driving: enzalutamide carries both a seizure risk and commonly causes dizziness, and prescribing guidance advises patients to discuss driving with their doctor before continuing. Many teams advise not driving until early dizziness has settled and seizure risk has been individually assessed. A seizure on treatment means stopping driving and notifying the appropriate authority — your team will advise what is required in your state.
What helps with hot flushes on enzalutamide?
Hot flushes are caused by the hormonal effect of enzalutamide on testosterone levels and are among the most common side effects reported. Loose, light clothing, a fan at night, and avoiding triggers such as caffeine, spicy food and alcohol all help some patients. Regular moderate exercise can reduce the frequency and intensity of flushes over time. If hot flushes are disrupting sleep or daily life significantly, tell your team: there are medicines that can reduce them, and your team will advise which are safe to take alongside your cancer treatment.
How worried should I be about the risk of seizure?
Enzalutamide carries a known risk of seizure, and this is listed in prescribing information approved by the CDSCO. For most patients the risk is low. It is higher in patients who have had a seizure before, who have had a significant brain injury, or who take other medicines that lower the seizure threshold. Your team should have asked about these factors before prescribing. Tell them about any past seizure history, even one from many years ago. You should not drive until your team has assessed your individual risk. If a seizure occurs, it is a medical emergency: call an ambulance and do not leave the person alone.
What is brain fog on enzalutamide, and will it improve?
Some patients taking enzalutamide notice difficulty concentrating, forgetting words, or losing track of tasks. This is what many patients call brain fog, and it is a recognised side effect — not anxiety or imagination. It does not mean cancer has spread to the brain. Some causes of cognitive change are treatable, including anaemia, poor sleep and low thyroid function, and your team may check for these. Keeping a simple diary of when it happens and how it affects you helps your team assess whether it is changing over time. Tell your team rather than simply accepting it: this is worth investigating.
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Common questions
Frequently asked questions
Will the side effects of enzalutamide get better over time?
Most common side effects like fatigue and hot flushes are at their worst in the first few months and often become easier to manage as your body adjusts. Some effects, such as blood pressure changes and bone thinning, build up gradually and need monitoring throughout treatment. A few — including the risk of seizure — do not follow a predictable timeline. Regular monitoring appointments are designed to catch gradual changes early, even when you feel well between visits.
Can I still drive while taking enzalutamide?
The answer depends on your individual situation, and you should ask your oncologist directly before driving. Enzalutamide carries a known seizure risk, and dizziness is also common — both affect driving safety. Many teams advise against driving until early dizziness has settled and your seizure risk has been individually assessed. A history of seizure, or a seizure on treatment, means no driving and a legal requirement to notify the licensing authority. Do not assume the answer is yes without asking your team.
Does enzalutamide affect the liver?
Liver function changes can occur on enzalutamide, and your team will monitor this with blood tests during treatment. Most changes are mild and do not require stopping the drug. Tell your team the same day if you notice yellowing of the skin or whites of your eyes, dark urine, or pain under your right ribs — these suggest a more significant reaction and should not wait for your next scheduled appointment.
Can I take other medicines alongside enzalutamide?
Enzalutamide interacts with a large number of other medicines, and checking for interactions is important before starting anything new. This includes prescription medicines, over-the-counter medicines, vitamins and herbal supplements — St John's Wort in particular should not be taken alongside enzalutamide. Tell your oncology team and your other doctors about everything you take before starting anything new, and do not stop any existing medicine without asking first.
What should I do if I miss a dose of enzalutamide?
If you realise on the same day, take the missed dose as soon as you remember. If you only realise the next day, skip the missed dose and take the next one at the usual time — do not take two doses to make up for the one you missed. If you are unsure, your pharmacist or oncology nurse is the right person to ask. Your team's written instructions take priority over any general guidance, so follow those if they say something different.