Can I Drink Alcohol While Taking Xtandi?

Prostate cancer affects a shocking 13% of men, but luckily it has a high successful treatment rate. Common treatments include active monitoring, radiation therapy, surgery, and hormone therapy. However, these treatments aren’t always effective. When prostate cancer progresses toward more advanced stages and nothing seems to be working, that’s when Xtandi can come in handy. 

Xtandi is an effective treatment for high-risk prostate cancer, but it can interact with many other drugs and substances. Avoiding these interactions can be a bit like walking through a minefield — trying hard not to trigger a reaction. Let’s better understand Xtandi’s interactions to clear a path for safe consumption. 

What Is Xtandi?

Xtandi is a prescription medication that’s used to treat certain types of advanced prostate cancer. It’s approved for two types of prostate cancer:

• Cancer that has spread to other parts of the body (metastatic cancer)

• Cancer that hasn’t spread to other parts of the body (nonmetastatic cancer)

Xtandi contains the drug enzalutamide, which belongs to a class of drugs called androgen receptor inhibitors. These drugs prevent the cancer from spreading by blocking the effects of androgens (male hormones). Those who are prescribed Xtandi should have already completed surgery to remove the testicles (orchiectomy), or have been taking another drug that lowers testosterone levels for full effectiveness of Xtandi. 

Clinical studies showed that in men with metastatic prostate cancer that no longer improved with medication or surgery, Xtandi (or enzalutamide) led to a 71% lower risk of the cancer spreading. In a group of men with nonmetastatic prostate cancer, Xtandi had an 83% lower risk of the cancer worsening in comparison to a group taking a placebo. Although Xtandi is an effective medication, it’s associated with potential side effects.

Xtandi Side Effects

Xtandi can cause a range of mild to severe side effects. Common side effects include:

• Fatigue
• Reduced appetite and weight loss
• Hot flashes
• Joint pain
• Dizziness
• Headaches 
• High blood pressure 

If these mild side effects worsen or don’t subside after a few weeks, talk to your doctor. Serious side effects are less common but can occur:

• Seizures. Although Xtandi is regarded as generally safe, seizures can occur (although they are uncommon). Clinical studies showed that 0.6% of those taking Xtandi experienced a seizure. Symptoms may include sudden loss of consciousness, convulsions, rapid eye movements, and drooling.
• Fatigue. Tiredness is a common side effect, but excessive tiredness can be a sign of something more serious. In rare instances, Xtandi can cause a neurological condition known as posterior reversible encephalopathy syndrome (PRES). Along with extreme fatigue, look out for other signs of PRES including high blood pressure, headache, vision disturbances, and confusion.
• Trouble urinating. Toxic byproducts of Xtandi are primarily eliminated through our urine. This increases the risk of urinary issues such as pain when urinating, frequent passing of urine, and blood in the urine.
• Ischemic heart disease (lack of blood flow to heart muscle). This can occur when a blockage forms in the arteries, stopping blood flow to the heart. Symptoms of ischemic heart disease include chest pain, fatigue, shortness of breath, heart palpitations, and dizziness.
• Falls and fractures. An increased risk of falls and fractures is common when taking Xtandi. Studies showed that falls occurred in 12% of those taking Xtandi versus 6% of those who took a placebo. Fractures caused by falls occurred in 13% of those taking Xtandi versus 6% of those taking the placebo.
• Severe allergic reaction. Mild allergic reactions can include symptoms such as skin rash, itchiness, and flushing. More severe allergic reactions can include swelling under the skin, swelling of the tongue, mouth, and throat, and trouble breathing.

If you’re experiencing any severe side effects, call 9-1-1 for emergency medical attention. Xtandi is already associated with many side effects, but when we add alcohol to the equation, things can get even more serious. 

Xtandi and Alcohol: Double Trouble

Xtandi, like all medications, is associated with side effects. However, mixing Xtandi and alcohol can be a whole different ball game.

In short, alcohol adds fuel to the risks of Xtandi. Mixing the two could lead to double the trouble. Here’s why:

1. Exacerbated Side Effects


Alcohol and Xtandi have many overlapping side effects:

• Balance and coordination issues. Both Xtandi and alcohol can make us dizzy. On top of that, alcohol impairs our balance and muscle movement, setting the stage for a tumble. With the increased risk of bone fractures while taking Xtandi, a fall is no small matter. 
• Aches and pains. A hangover headache and the morning-after neck and shoulder pain from a night of drinking are no walks in the park. Add headache and joint pain from Xtandi, and our body will be feeling pretty run-down. 
• Fatigue. Xtandi is known to cause tiredness and fatigue. As for alcohol, we know it can cause sleep disruptions, adding to our grogginess. 
• Blood pressure fluctuations. Xtandi can lead to high blood pressure. And alcohol? Well, alcohol throws a wrench into the mix. While we’re drinking, alcohol can temporarily cause our blood pressure to drop. However, in the long run, alcohol raises blood pressure — adding to the effects of Xtandi. 

As we can see, alcohol adds fuel to the fire — worsening side effects. But there’s even more to consider!

2. Overworking the Liver


Both Xtandi and alcohol are processed by the liver. When we drink, our liver prioritizes getting rid of the toxins from alcohol (for good reason). However, since our liver is in overdrive with having to deal with more than one thing at a time, it gives the toxins more time to linger. This can lead to increased side effects and hangover symptoms. 

Putting our liver into overdrive not only leads to negative short-term effects, but also causes long-term liver damage. Over time, constant stress can lead to liver dysfunction and disease. To learn more about how quickly this can happen, check out “How Much Alcohol Causes Liver Damage?” 

3. Hormone Disruptions


Xtandi works by blocking the action of male hormones. This slows prostate cancer growth and promotes cancer cell death. Alcohol, on the other hand, imbalances our hormones, disrupting the mechanism of Xtandi.

In small amounts, alcohol can increase the production of testosterone (a type of androgen). Over time however, alcohol has the opposite effect on testosterone. While this may sound like it works in our favor (for the sake of inhibiting androgens to treat prostate cancer), fluctuations in our testosterone only lead to greater hormonal imbalance. In fact, research shows that hormonal imbalance is one of the causes of prostate cancer. Want to learn more about alcohol’s effects on our hormones? Check out “How Does Quitting Alcohol Help Your Hormones?”


4. Mental Health Issues


Another risk of mixing Xtandi and alcohol? Poor mental health. While Xtandi alone isn’t associated with mental health issues, prostate cancer is. Significant mental health problems such as depression, anxiety, fear of cancer recurrence, and self-esteem issues are prevalent among those diagnosed with prostate cancer.

Similarly, alcohol is also associated with a host of mental health issues. Alcohol hijacks chemical messengers (neurotransmitters in our brain) that influence our mood. While we may feel a temporary boost in mood when we’re drinking, the depressant aftereffects increase the risk of mental health conditions such as anxiety, depression, and mood disorders. To get a more in-depth look at alcohol’s psychological impacts, take a look at “Understanding Alcohol’s Effects on Mental Health.”


5. Increased Interactions


Lastly, Xtandi and alcohol both interact with many other substances. Xtandi is commonly used in conjunction with other treatments to help attack prostate cancer on all fronts. For example, high-energy radiation used to destroy cancer cells (radiation therapy) is often used with Xtandi. Physicians recommend avoiding alcohol during radiation therapy, as it can make the experience even more unpleasant. Recovery from prostate cancer can include much more than Xtandi, increasing the chances of negative interactions when we choose to drink. 

To make matters more complicated, alcohol affects our inhibitions and judgment. Recall the long list of interactions printed on the warning label of Xtandi? Or the reminder from the doctor not to mix certain medications with alcohol? Well, alcohol can make these directions a bit fuzzy in our minds — and as a result, we may end up mixing substances that have dangerous interactions. What else should we take into consideration when taking Xtandi?

Xtandi’s Interactions With Other Medications

In addition to clashing with alcohol, Xtandi interacts with many other medications. Let’s get a better idea of what they are and how alcohol further complicates things.

Buspirone

Buspirone is a medication used to treat anxiety disorders by balancing the hormones that control our mood. Xtandi speeds up the breakdown of buspirone, leading to lower levels of the medication in our body — and as a result, decreases the effectiveness of buspirone. 

Alcohol and buspirone are also not a good mix. Since there aren’t any direct interactions, you may be wondering, “Can you drink while taking buspirone?” The short answer is no. Mixing alcohol with buspirone can lead to worsened side effects such as dizziness, drowsiness, difficulty breathing, and confusion. Additionally, alcohol negatively impacts anxiety, indirectly impacting buspirone. In short, alcohol, buspirone, and Xtandi are an incompatible combination.

Benzodiazepines

Benzodiazepines are a class of depressant drugs used to treat anxiety, seizures, and other conditions. They work by slowing down activity in our brain and nervous system. Xtandi decreases levels of the benzodiazepines in our body, making them less effective and increasing the risk of benzodiazepine withdrawal. 

Do the depressant effects of benzodiazepines sound familiar? That’s because alcohol is also a depressant that causes similar effects on our central nervous system (CNS). Mixing the alcohol and benzodiazepines amplifies their dangers including exacerbated side effects, increased risk of overdose, and increased risk of dependence.

Sedative-Hypnotics

This class of drugs reduces anxiety and induces calming effects, which is helpful in treating insomnia or other sleep disorders. Xtandi impacts the effectiveness of sedative-hypnotics, as it promotes speedier breakdown of the drugs. 

Mixing alcohol and sedative-hypnotics is also a bad idea. Like benzodiazepines, sedative-hypnotics are also CNS depressants that act on the same system as alcohol. Drinking while taking sedative-hypnotics increases their depressant effects, risk of overdose, and risk of dependence.

Before starting Xtandi, it’s important to discuss with our physician which prescription medications, over-the-counter medications, and other substances we’re taking. Aside from the more obvious prescription medications, let’s see what else we need to make note of.

Xtandi and Other Interactions

Aside from prescription medications, Xtandi doesn’t mix well with several other substances:

• Cannabis. Xtandi is reported to reduce the effects of cannabis products. Cannabidiol (CBD) products, which are commonly used to aid with sickness and pain in cancer patients, may be less effective when mixed with Xtandi.
• Herbs and supplements. Saint-John’s-wort is an herbal supplement that may help treat depression and other conditions. However, it speeds up the breakdown of Xtandi, which can impact its effectiveness. Although there aren’t any other reported vitamin or supplement interactions, it’s beneficial to consult with a physician or pharmacist and track any negative side effects.
• Foods. There are no reported foods to avoid when taking Xtandi. However, we have individual differences in how we react to certain foods. Be sure to take note if you do experience any adverse effects.

To stay on the safe side, we should consult with our doctor if we’re taking or planning to take any of these substances.

How Long After Stopping Xtandi Can You Drink Alcohol?

The average half-life of Xtandi is 5.8 days or 6 to be safe. However, it takes about 5 half-lives for a medication to be completely eliminated from our system. It’s recommended to wait at least 30 days after stopping Xtandi to avoid the potential risks of mixing Xtandi and alcohol. 

Waiting for the elimination period to pass before drinking is helpful in reducing indirect interactions between Xtandi and alcohol, but it’s important to note that drinking is still detrimental to our health. In regards to recovering from prostate cancer, alcohol imbalances our hormones and puts a damper on immune function — leading to an increased risk of cancer recurrence and impacted recovery. Let’s explore some ways we can approach Xtandi and alcohol more safely and mindfully.

Exploring Safe Consumption

Understanding Xtandi and alcohol’s interactions is one way we can prioritize our safety. Implementing mindful consumption strategies can further promote our health and safety:

• Talk to your doctor. If we’ve been prescribed Xtandi and we’re choosing to drink, it’s important to consult clearly with our physician to make adjustments to our treatment plan as needed.
• Avoid alcohol. Alcohol not only exacerbates the side effects of Xtandi, but also indirectly affects our recovery from prostate cancer and our overall health. Opt for alcohol-free alternatives and avoid triggers for drinking.
• Take note of potential interactions. Make a list of the medications and supplements you’re taking. This helps you and your physician identify potential interactions with Xtandi and alcohol.
• Maintain hormone health. A main cause of prostate cancer is an imbalance of hormones. We can maintain optimal hormone health by getting adequate rest, eating a balanced diet, and reducing disruptive substances such as alcohol and nicotine.
• Seek support. The way alcohol hijacks our brain’s reward system can lead to alcohol dependence, which can be challenging to overcome. Luckily, there are plenty of support options such as family and friends, peer support groups, and behavioral therapies to help us develop a better relationship with alcohol.

Navigating prostate cancer and alcohol is no easy task. But remember that Reframe is here for you as you work towards a happier and healthier life. Be a part of our thriving community and connect with others who may share similar struggles. We can work together to support each other every step of the way!

Summing Up

Xtandi is an effective treatment for advanced prostate cancer, but navigating it safely can be a bit of a balancing act. It has interactions with other medications and substances, including alcohol. Drinking while taking Xtandi amplifies its side effects and opens the door to other potential risks. Luckily, we can minimize these risks by quitting or cutting back on alcohol. Exact the full effectiveness of Xtandi by avoiding interactions!