Does Xtandi (Enzalutamide) need to be held prior to dental work?

Enzalutamide (Xtandi) Does Not Need to Be Held Prior to Dental Work

Enzalutamide (Xtandi) does not need to be held prior to dental procedures, as there is no evidence suggesting it increases the risk of complications during dental work.

Rationale for Continuing Enzalutamide During Dental Procedures

Enzalutamide is an androgen receptor inhibitor used in the treatment of castration-resistant prostate cancer. Unlike some medications that affect bone metabolism or coagulation, enzalutamide does not:

• Interfere with bone healing
• Increase bleeding risk
• Contribute to medication-related osteonecrosis of the jaw (MRONJ)

Key Considerations:

1. Mechanism of Action: Enzalutamide blocks androgen receptor signaling pathways 1, 2, but does not affect bone metabolism in the way bisphosphonates or denosumab do.

2. Risk Assessment: Clinical guidelines on medication-related osteonecrosis of the jaw (MRONJ) specifically identify bisphosphonates (BMAs) and denosumab as medications of concern 3, but do not mention enzalutamide.

3. Prostate Cancer Treatment Guidelines: The NCCN guidelines for prostate cancer mention concerns about osteonecrosis of the jaw with zoledronic acid and denosumab, but not with enzalutamide 3.

Medications That DO Require Special Consideration for Dental Work

Bisphosphonates and Denosumab

These medications are associated with MRONJ and require special considerations:

• Dental evaluation before starting therapy 3, 4
• Avoidance of invasive dental procedures during therapy 3
• Potential temporary discontinuation before dental surgery (though evidence is insufficient) 3

Anticoagulants/Antithrombotics

Guidelines recommend:

• Continuing vitamin K antagonists (VKAs) during minor dental procedures 3
• Using pro-hemostatic agents (e.g., tranexamic acid mouthwash) when continuing VKAs 3

Dental Procedure Recommendations for Patients on Enzalutamide

Since enzalutamide does not pose specific risks for dental procedures:

1. Standard dental protocols can be followed
2. No need to hold enzalutamide before, during, or after dental work
3. Regular oral hygiene practices should be maintained

General Dental Care Recommendations for Cancer Patients

While enzalutamide doesn't need to be held, good dental practices are still important:

• Maintain excellent oral hygiene
• Regular dental check-ups every 6 months
• Prompt reporting of any oral symptoms (pain, swelling, delayed healing)
• Use of prescription-strength fluoride for patients with radiation-induced salivary hypofunction 3

Important Caveat

If the patient is also taking bisphosphonates or denosumab for bone metastases (common in advanced prostate cancer), then special dental precautions would be needed due to those medications, not due to enzalutamide.

In summary, enzalutamide therapy can be safely continued during dental procedures without interruption or special precautions beyond standard dental care.