Specific Foods and Beverages to Avoid While Taking Xtandi
While Xtandi (enzalutamide) can generally be taken with or without food, there are specific fruits and beverages that can interact with the medication, potentially altering its levels in the body and increasing the risk of side effects. These interactions involve a group of enzymes in the liver and gut responsible for drug metabolism, primarily CYP3A4.
Key Items to Avoid:
- Grapefruit and Grapefruit Juice: This is the most well-known dietary interaction with many medications, including Xtandi. Grapefruit contains furanocoumarins that inhibit the CYP3A4 enzyme, which helps process enzalutamide. By inhibiting this enzyme, grapefruit can cause higher-than-desired levels of Xtandi to build up in the bloodstream, increasing the risk of side effects like headaches, fatigue, and seizures.
- Seville Oranges: Often used to make marmalades, Seville oranges also contain high levels of the compounds that inhibit drug-metabolizing enzymes. For this reason, they should be avoided just like grapefruit. It is important for patients to check labels on jams and marmalades for this ingredient.
- Star Fruit (Carambola): Like grapefruit, star fruit can also interfere with the same enzymes, causing the concentration of the medication to rise. As with other interacting citrus, it is best to avoid star fruit completely during your treatment.
- St. John's Wort: This herbal supplement can have the opposite effect of grapefruit, potentially reducing the effectiveness of Xtandi by increasing the activity of drug-metabolizing enzymes. It is essential to inform your healthcare provider about all herbal products you are taking and to avoid St. John's wort while on enzalutamide.
Managing Common Side Effects with Dietary Choices
Beyond direct interactions, diet can play a significant role in mitigating some of the common side effects associated with Xtandi and overall cancer treatment. By adjusting your food and drink intake, you can help manage symptoms like hot flashes, fatigue, nausea, and diarrhea.
- For Hot Flashes: Patients experiencing hot flashes may find relief by avoiding certain triggers. Spicy foods, caffeinated beverages (coffee, tea, cola), and alcohol are known to worsen these symptoms. Instead, staying hydrated with cool, non-caffeinated fluids can help.
- For Diarrhea: To manage loose stools, a bland, low-fiber diet is often recommended. This means temporarily avoiding high-fiber foods such as raw fruits, vegetables, whole grains, and seeds. Certain ingredients like alcohol, caffeine, and artificial sweeteners should also be avoided as they can irritate the digestive system. Staying hydrated with non-caffeinated fluids is critical to prevent dehydration.
- For Nausea: Managing nausea involves eating small, frequent meals and avoiding foods that trigger the symptom. Patients are often advised to avoid spicy, fried, or strong-smelling foods. Bland foods and clear liquids are often better tolerated. Limiting caffeine and alcohol can also be helpful.
- For Taste Changes: Cancer treatment can sometimes cause a metallic taste or alter your sense of taste. To combat this, try using strong flavors and marinades to enhance food taste. Sometimes cold food is less bothersome than hot food. Eating poultry, fish, and eggs may be better if red meat tastes unpleasant.
Comparing Food Choices for Managing Xtandi Side Effects
| Issue | Foods/Drinks to Avoid | Recommended Alternatives/Tips |
|---|---|---|
| Drug Interaction Risk | Grapefruit, Seville Oranges, Star Fruit, St. John's Wort | Wide variety of other fruits, vegetables, and herbal teas. Consult a pharmacist before taking any new supplements. |
| Hot Flashes | Spicy foods, alcohol, caffeine | Cool beverages, water, iced tea (decaf). Eat smaller, cooler meals. |
| Diarrhea | Spicy foods, high-fiber foods, artificial sweeteners, caffeine, alcohol, excessive dairy | Bland, low-fiber foods like bananas, applesauce, white rice, boiled chicken. Drink plenty of clear fluids. |
| Nausea | Spicy, fried, or strong-smelling foods, alcohol, caffeine | Small, frequent meals. Clear liquids. Bland foods like crackers, toast, or broth. Try cold foods. |
| Taste Changes | Foods with strong metallic or unpleasant tastes, disliked foods | Use marinades and seasonings. Try different types of protein like chicken or fish. Try cold or room-temperature foods. |
Making Safe Dietary Choices During Xtandi Treatment
The most critical food precaution is avoiding grapefruit, Seville oranges, and star fruit, as these have a direct and potentially harmful interaction with Xtandi's metabolism. For managing symptoms, dietary adjustments are a supportive measure rather than a direct drug-food interaction. Your oncology care team is your best resource for personalized nutritional guidance, especially regarding supplements and managing side effects.
It is important to remember that this information is for guidance, and individual tolerance to food and beverages can vary. Always discuss your diet with your doctor or a registered dietitian to ensure your choices are both safe and supportive of your overall treatment plan.
For more information on cancer treatment and managing side effects, visit the National Cancer Institute website or consult reputable sources like Oncolink.
Conclusion
While Xtandi is a powerful and crucial medication, understanding its potential dietary considerations is vital for both its efficacy and your quality of life. The most important rule is to completely avoid grapefruit, Seville oranges, star fruit, and St. John's wort to prevent dangerous drug interactions. For side effects like diarrhea, nausea, and hot flashes, adjusting your intake of spicy foods, caffeine, and alcohol can provide significant relief. Maintaining open communication with your healthcare team is the best way to tailor your diet to your specific needs while taking Xtandi.
