During the treatment of enzalutamide, it is important to focus on managing the three major effects of hypertension, fall risk, and cognitive impairment. The following provides professional management recommendations from three aspects: monitoring plans, intervention measures, and medication adjustments, all of which must be implemented under the supervision of a doctor.

Hypertension management

1. Monitoring plan

Baseline blood pressure measurement, weekly monitoring during the initial stage of treatment, and monthly monitoring after stabilization. Dynamic blood pressure monitoring is superior to single measurement.

2. Graded intervention

Grade 1 hypertension (140-159/90-99mmHg) suggests lifestyle adjustments; Grade 2 or above or symptomatic hypertension requires initiation of antihypertensive treatment.

3. Drug selection

Preferably choose ACEI/ARB class and avoid using potent CYP2C8 inhibitors (such as gefilzil) in combination to avoid affecting enzalutamide metabolism.

Fall prevention

1. Risk assessment

Perform TimedUpandGo test before treatment to assess balance ability. Regularly review bone density.

2. Environmental renovation

Remove tripping hazards such as carpets at home, install anti slip mats and handrails in the bathroom, and ensure sufficient lighting at night.

3. Drug review

Avoid using sedatives (such as benzodiazepines) in combination with drugs that may cause orthostatic hypotension.

Coping with cognitive impairment

1. Early identification

Use the MoCA scale for regular screening, focusing on symptoms such as memory loss and executive dysfunction.

2. Non pharmacological intervention

The combination of cognitive training and physical exercise has the best effect. It is recommended to engage in 30 minute aerobic exercise three times a week.

3. Drug adjustment

Severe cognitive impairment requires assessment of potential reduction. Avoid using anticholinergic drugs (such as oxybutynin) in combination.

Note: Specific management strategies need to be individualized, and if serious side effects occur, immediate medical attention should be sought. Maintain regular communication with the attending physician during treatment.