Bicadex Special Precautions

Initiation of treatment should be under the direct supervision of a specialist.
Bicalutamide is extensively metabolized in the liver. Data suggest that its elimination may be slower in subjects with severe hepatic impairment and this could lead to increased accumulation of bicalutamide. Therefore, bicalutamide should be used with caution in patients with moderate to severe hepatic impairment.
Periodic liver function testing should be considered due to the possibility of hepatic changes. The majority of changes are expected to occur within the first 6 months of bicalutamide therapy.
Severe hepatic changes and hepatic failure have been observed rarely with bicalutamide (see Adverse Reactions). Bicalutamide therapy should be discontinued if changes are severe.
A reduction in glucose tolerance has been observed in males receiving LHRH agonists. This may manifest as diabetes or loss of glycemic control in those with preexisting diabetes. Consideration should therefore be given to monitoring blood glucose in patients receiving bicalutamide in combination with LHRH agonists.
Bicalutamide has been shown to inhibit cytochrome P-450 (CYP3A4), as such caution should be exercised when co-administered with drugs metabolized predominantly by CYP3A4 (see Contraindications and Interactions).
Effects on the Ability to Drive or Operate Machinery: Bicalutamide is unlikely to impair the ability of patients to drive or operate machinery. However, it should be noted that occasionally, somnolence may occur. Any affected patients should exercise caution.