Nilutamide

Nilutamide is a nonsteroidal antiandrogen used in the treatment of advanced prostate cancer. It acts as a competitive antagonist of the androgen receptor, blocking the action of testosterone and dihydrotestosterone on prostate tumor cells.

Nilutamide is typically used as part of combination therapy with a luteinizing hormone-releasing hormone (LHRH) agonist to achieve medical castration in men with metastatic or locally advanced disease.

Oral administration is common, usually starting together with the LHRH analogue. The drug is extensively metabolized in the liver, and its effects persist for some time after discontinuation.

Adverse effects include hepatotoxicity, which can be severe and has led to stopping therapy in some cases. A disulfiram-like reaction with alcohol may occur, with flushing, tachycardia, and nausea. Visual disturbances such as impaired dark adaptation and changes in color vision can occur, particularly early in therapy. Other side effects include fatigue, nausea, rash, gynecomastia, and edema. Rare but serious events include interstitial pneumonitis and neutropenia.

Nilutamide was among the first-generation nonsteroidal antiandrogens. It has largely been superseded by newer agents such as bicalutamide due to better tolerability and safety profiles, but it remains available in some regions and may be chosen in specific clinical contexts.

See also: flutamide, bicalutamide.