Nubeqa Side Effects: The Good, The Bad, and What to Actually Expect

If you’ve just been prescribed Nubeqa (darolutamide) for prostate cancer, you’re probably wondering: What am I actually going to feel? Will I be able to work? Exercise? Live my normal life?

Here’s the good news: Nubeqa is generally considered one of the better-tolerated androgen receptor inhibitors for prostate cancer. But “better-tolerated” doesn’t mean “no side effects.” Let’s break down exactly what to expect — the good, the bad, and what actually matters.

“Many of our patients are pleasantly surprised by how well they tolerate Nubeqa compared to what they expected,” says Julia Kravtsova, PharmD, Head Patient Navigator at QuickRx Specialty Pharmacy. “But knowledge is power — understanding potential side effects helps patients recognize issues early and manage them effectively.”

The Most Common Nubeqa Side Effects (What You’ll Probably Notice)

Clinical trials involving thousands of patients give us a clear picture of what most people experience. Here’s the reality:

Fatigue and Weakness (16% of patients)

This is the side effect patients ask about most. About 1 in 6 patients report feeling more tired than usual or experiencing general weakness. The fatigue from Nubeqa is typically:

• Mild to moderate in most cases
• More noticeable in the first few weeks of treatment
• Often manageable with lifestyle adjustments
• Not the “crushing exhaustion” some cancer treatments cause

What helps: Planning rest periods throughout your day, light exercise (counterintuitive but true), and maintaining a consistent sleep schedule can all help manage fatigue.

Urinary Tract Infections (12% of patients)

UTIs are more common in prostate cancer patients in general, and Nubeqa may slightly increase this risk. Signs to watch for:

• Burning or pain when urinating
• Feeling the need to urinate more often or urgently
• Cloudy or strong-smelling urine
• Lower abdominal or pelvic discomfort
• Fever (if the infection is more serious)

What helps: Stay well-hydrated, don’t delay bathroom trips, and contact your doctor promptly if you notice UTI symptoms — early treatment prevents complications.

Skin Rash (4% of patients)

Some patients develop rashes while taking Nubeqa. These are usually mild and may appear as:

• Red, itchy patches on the skin
• Dry or flaky skin
• General skin irritation

What helps: Gentle, fragrance-free moisturizers and avoiding harsh soaps. If rash is severe or spreading, contact your healthcare team.

Pain in Arms and Legs (6% of patients)

Persistent limb pain is reported by some patients. This may feel like:

• Aching or soreness in the extremities
• Muscle discomfort
• Joint stiffness

What helps: Gentle stretching, light movement, and over-the-counter pain relievers (ask your doctor which are safe to use with Nubeqa).

Changes in Lab Values

Your doctor will monitor your blood work regularly because Nubeqa can affect:

• Liver enzymes: Elevated ALT (28% of patients), AST (23-32%), and bilirubin (16-17%)
• Neutrophils: Decreased white blood cell counts (16-20% of patients)

These changes are usually detected through routine blood tests before you notice any symptoms, which is why regular monitoring is so important.

Get Inmediate Copay Assistance

917-830-2525

Serious Warnings: The Side Effects That Need Immediate Attention

While most Nubeqa side effects are manageable, there are serious warnings you need to know about. These are rare but require immediate medical attention.

Ischemic Heart Disease (3-4% of patients)

This is the most serious cardiovascular concern with Nubeqa. Ischemic heart disease, including heart attacks, has occurred in some patients — and in rare cases, it has been fatal.

What you need to know:

• Androgen deprivation therapy (which you’re likely also receiving) may increase cardiovascular risk
• Your doctor should optimize your cardiovascular risk factors before starting Nubeqa
• Patients with existing heart conditions need extra monitoring
• Grade 3 or 4 cardiovascular events mean Nubeqa should be discontinued

Seizures (Less than 1% of patients)

Seizures have been reported in patients taking Nubeqa, including grades 1 to 3 events. In clinical studies, seizures occurred anywhere from 38 to 1,754 days after starting treatment.

Important considerations:

• It’s unknown whether anti-seizure medications can prevent Nubeqa-related seizures
• Avoid activities where sudden loss of consciousness could cause serious harm (driving, operating heavy machinery)
• If you have a history of seizures, discuss this carefully with your oncologist

Embryo-Fetal Toxicity

Based on how Nubeqa works, it can cause fetal harm and pregnancy loss. If your partner could become pregnant:

• Use effective contraception during treatment
• Continue contraception for 1 week after your last dose

Practical Tips for Managing Nubeqa Side Effects

“Being proactive about side effect management makes a huge difference in quality of life during treatment,” notes Julia Kravtsova, PharmD. “Small adjustments to daily routines can help patients stay on track with their medication.”

For Fatigue and Weakness

• Plan rest periods: Schedule short breaks throughout your day, especially during the first few weeks
• Light exercise: A short daily walk can actually boost energy levels
• Prioritize sleep: Aim for consistent bedtimes and wake times
• Ask for help: Don’t hesitate to delegate tasks when you’re feeling drained

For Taking Nubeqa Correctly

• Always take with food: This increases absorption by 2-2.5 times — take it with a meal or substantial snack
• Take twice daily, 12 hours apart: This maintains steady levels in your system (example: 8am and 8pm)
• Swallow tablets whole: Never crush, chew, or break the tablets
• If you miss a dose: Take it as soon as you remember unless it’s almost time for your next dose — never double up

For General Wellness During Treatment

• Stay hydrated (helps with fatigue and UTI prevention)
• Eat a balanced diet rich in fruits, vegetables, and lean proteins
• Keep a symptom journal to share with your healthcare team
• Don’t skip appointments or blood work

Drug Interactions: What Else Are You Taking?

Nubeqa interacts with your body’s complex systems, which means other substances can affect how well it works — or increase side effects. This is critically important.

Tell Your Doctor About:

• Prescription medications: Especially antibiotics, heart medications, and other cancer drugs
• Over-the-counter medications: Even common pain relievers and antacids
• Vitamins and supplements: Some can interfere with Nubeqa’s effectiveness
• Herbal products: St. John’s Wort and other herbs can be problematic

Specific Interactions to Know:

• Strong CYP3A4 inhibitors: Can increase Nubeqa levels in your blood (more side effects)
• Strong CYP3A4 inducers: Can decrease Nubeqa levels (less effective treatment)
• Rosuvastatin (Crestor): If you take this cholesterol medication, your dose should be limited to 5mg daily
• Hormonal contraceptives: Effectiveness may be reduced — use additional protection

“I always tell patients to bring a complete list of everything they take — prescription, over-the-counter, vitamins, supplements, everything,” says Julia Kravtsova, PharmD. “Even something that seems harmless could interact with Nubeqa.”

Need Nubeqa Copay Assistance?

Start Your Application

Frequently Asked Questions About Nubeqa Side Effects

How long do Nubeqa side effects last?

Most common side effects like fatigue tend to be most noticeable in the first few weeks of treatment and may improve as your body adjusts. However, some side effects may persist throughout treatment. If side effects are severe or intolerable, your doctor may adjust your dose from 600mg to 300mg twice daily.

Can I drive while taking Nubeqa?

Nubeqa can cause fatigue and, rarely, seizures. If you experience these side effects, avoid driving or operating heavy machinery. Discuss your specific situation with your doctor, especially during the early weeks of treatment.

Does Nubeqa cause hair loss?

Hair loss is not a commonly reported side effect of Nubeqa. Unlike some cancer treatments, darolutamide does not typically cause significant hair thinning or loss.

Can I drink alcohol while taking Nubeqa?

There’s no specific prohibition against alcohol with Nubeqa, but alcohol can worsen fatigue and may affect liver function. Discuss your alcohol consumption with your doctor, especially since Nubeqa can elevate liver enzymes.

What happens if I miss a dose of Nubeqa?

Take the missed dose as soon as you remember, unless it’s almost time for your next scheduled dose. In that case, skip the missed dose and continue your regular schedule. Never take two doses at once to make up for a missed dose.

Are Nubeqa side effects different when taken with docetaxel?

Yes, when Nubeqa is combined with docetaxel chemotherapy for metastatic castration-sensitive prostate cancer (mCSPC), additional side effects may include constipation, decreased appetite, and weight gain. Your oncology team will monitor you closely during combination therapy.

How does Nubeqa compare to other prostate cancer medications for side effects?

Nubeqa is generally considered to have a favorable side effect profile compared to some other androgen receptor inhibitors. It has low blood-brain barrier penetration, which may result in fewer central nervous system side effects. However, individual responses vary — discuss your options with your oncologist.

Does Nubeqa affect kidney function?

While Nubeqa doesn’t directly harm the kidneys, patients with severe kidney impairment (eGFR 15-29) require a reduced dose of 300mg twice daily. Your doctor will monitor your kidney function and adjust dosing as needed.

Can Nubeqa cause weight gain?

Weight gain is more commonly reported when Nubeqa is used in combination with docetaxel chemotherapy. As a single agent, weight changes are less commonly reported.

Is there financial help available for Nubeqa?

Yes! QuickRx Specialty Pharmacy provides free copay assistance services to help patients afford Nubeqa. We help with manufacturer copay cards, patient assistance programs, and foundation grants depending on your insurance status. Call (917) 830-2525 to learn more.

References

1. Nubeqa (darolutamide) Prescribing Information. U.S. Food and Drug Administration.
2. National Cancer Institute. Prostate Cancer Treatment (PDQ) – Patient Version.
3. Mayo Clinic. Darolutamide (Oral Route) – Side Effects.
4. American Cancer Society. Hormone Therapy for Prostate Cancer.
5. Prostate Cancer Foundation. Patient Resources.
6. MedlinePlus. Darolutamide.
7. UpToDate Clinical Drug Information Database (LexiDrug). Darolutamide Monograph. Accessed January 2026.

This information is not intended to replace professional medical advice. Always consult your oncologist or pharmacist for guidance about your specific Nubeqa treatment. For questions about Nubeqa copay assistance, contact QuickRx Specialty Pharmacy at (917) 830-2525.