Cytomid

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What Is Cytomid?

Cytomid is an oral tablet from Cipla containing flutamide 250 mg. Flutamide is a non-steroidal anti-androgen that competitively blocks the androgen receptor in prostate cancer cells, inhibiting the proliferative effect of testosterone and dihydrotestosterone (DHT). It is used in advanced or metastatic prostate cancer, almost always combined with an LHRH agonist (goserelin, leuprorelin, triptorelin) for combined androgen blockade (CAB).

How Does Cytomid Work?

Prostate cancer growth is driven by androgen-receptor signalling. Standard androgen deprivation therapy (ADT) suppresses ovarian androgen production through LHRH agonists. However, the adrenal glands continue to produce ~10% of total body androgens, and the residual signal is enough to drive disease progression in many patients. Cytomid blocks the androgen receptor itself, so the residual adrenal androgens cannot signal — producing more complete androgen blockade.

• Competitive androgen-receptor antagonist — binds the AR and prevents testosterone / DHT from activating it.
• Short half-life (~5 hours) — requires three-times-daily dosing.
• Used to prevent “tumour flare” when starting LHRH agonist therapy — the initial LHRH-induced testosterone surge can transiently worsen disease, and pre-treatment with anti-androgen blocks this.

Toepassingen en Indicaties

• Combined androgen blockade (CAB) in advanced or metastatic prostate cancer (with LHRH agonist)
• Tumour flare prevention at LHRH agonist initiation (2–4 weeks pre-treatment)
• After biochemical recurrence as part of intermittent or continuous androgen deprivation regimens

Cytomid Dosage and How to Take

Standaard dosering: 250 mg three times daily (8-hourly).

1. Three times daily, 8 hours apart. Take with food to reduce GI upset.
2. Slik de tablet heel door met water.
3. Mandatory monitoring: baseline LFTs (AST, ALT) and PSA. Repeat LFTs monthly for the first 4 months, then every 3–6 months. PSA every 3 months. Stop and investigate if AST/ALT > 3× upper limit of normal.
4. Pre-LHRH-agonist tumour-flare prevention: start Cytomid 2–4 weeks before LHRH agonist initiation, continue for at least 1 month after.
5. Do not stop without oncologist instruction.

Side Effects of Cytomid

Vaak voorkomend:

• Gynaecomastia and breast tenderness (40–70% with monotherapy; less with CAB)
• Hot flushes
• Reduced libido and erectile dysfunction
• Fatigue, asthenia
• Diarrhoea (especially flutamide)
• Milde maag-darmklachten

Important — mandate monitoring:

• Hepatotoxiciteit — can be severe and unpredictable. Stop immediately for jaundice, dark urine, severe fatigue, or AST/ALT > 3× ULN. Most cases occur within first 4 months.
• Methaemoglobinaemia — cyanosis, headache, dyspnoea (flutamide-specific)
• Diarrhoea more common than with bicalutamide

Zeldzaam: haemolytic anaemia, photosensitivity, severe skin reactions.

Waarschuwingen en voorzorgsmaatregelen

• Zwangerschap en borstvoeding: not applicable (male-only indication) but anti-androgens are fetotoxic if taken in error during pregnancy.
• Leverfunctie: mandatory monthly LFTs for first 4 months. Stop for AST/ALT > 3× ULN.
• Diabetes: may worsen glycaemic control.
• Cardiovasculair: ADT in general is associated with increased cardiovascular events. Optimise modifiable risk factors.
• Gynaecomastia prophylaxis: low-dose tamoxifen 10–20 mg/day or prophylactic breast radiotherapy reduces incidence (specialist).
• Driving: caution — fatigue and dizziness may impair driving.

Geneesmiddelinteracties

Opslag

• Store at room temperature, 15–25°C, in original blister.
• Keep out of reach of children, women, and pets — anti-androgens are fetotoxic.

Gerelateerde alternatieven op MedsBase

Other oncology medications stocked alongside this product:

• Bdenza (enzalutamide 40 mg)
• Bicalumutide (bicalutamide 50 mg)

Browse all anti-cancer medications →

Veelgestelde vragen

Why is Cytomid usually combined with an LHRH agonist?

LHRH agonists (goserelin, leuprorelin) suppress testicular androgen production, but the adrenal glands continue producing ~10% of body androgens that can drive prostate cancer growth. Cytomid blocks the androgen receptor itself, so adrenal androgens cannot signal. The combination is called combined androgen blockade (CAB) and produces deeper androgen suppression than LHRH agonist alone in advanced disease.

What is “tumour flare” and why does Cytomid prevent it?

When LHRH agonist therapy starts, the pituitary is initially stimulated and testosterone surges for 1–2 weeks before downregulation kicks in. In patients with significant disease burden (bone metastases, urinary obstruction, spinal cord compression risk), this transient testosterone surge can worsen symptoms acutely. Starting Cytomid 2–4 weeks before the LHRH agonist blocks the receptor and prevents the flare.

How is gynaecomastia managed?

Breast tenderness and gynaecomastia affect 40–70% of patients on bicalutamide monotherapy at higher doses. Prophylaxis options: low-dose tamoxifen 10–20 mg/day (most evidence) or prophylactic breast radiotherapy as a single 8–12 Gy fraction before starting anti-androgen therapy. Discuss with the oncologist before starting if cosmetic concerns are significant.

What blood tests do I need?

Mandatory: baseline LFTs (AST, ALT) and PSA. Then LFTs monthly for the first 4 months, then every 3–6 months. PSA every 3 months. Stop Cytomid immediately and contact your oncologist if AST/ALT > 3× ULN, or for any jaundice, dark urine or severe fatigue.

Can I drink alcohol on Cytomid?

Limit alcohol — both alcohol and flutamide are hepatotoxic and the combination amplifies the risk of severe drug-induced liver injury. Occasional small amounts are usually tolerable; heavy or daily drinking should be avoided throughout treatment.

Why is Cytomid three times daily instead of once daily?

Flutamide has a short half-life (~5 hours) compared with bicalutamide (~6 days), so it requires three-times-daily dosing for stable androgen-receptor blockade. Bicalutamide's once-daily convenience is one reason it has largely replaced flutamide in modern practice.

Will Cytomid affect my heart?

Anti-androgen monotherapy has minimal direct cardiovascular effect, but the broader androgen deprivation therapy (LHRH agonist + anti-androgen) is associated with increased cardiovascular events including MI and stroke. Optimise cardiovascular risk factors: BP control, statin if hyperlipidaemic, smoking cessation, exercise, weight management.

Can I stop Cytomid if PSA stays low?

Discuss with your oncologist. In some intermittent-CAB protocols, CAB is held when PSA is suppressed below threshold and resumed when PSA rises — this can reduce side effects without compromising survival. Never stop unilaterally — PSA monitoring and timing of restart are critical.

Waarom bestellen bij MedsBase

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Related Anti-Cancer Medications

Other oncology medications stocked alongside this product:

• Bicalumutide (bicalutamide 50 mg)
• Bdenza (enzalutamide 40 mg)
• Endace (megestrol 40/160 mg)
• Tamilong (tamoxifen 10/20 mg)
• Xtane (exemestane 25 mg)

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