Apalutamide Interactions
Acetylsalicylic acid
No clinically significant drug interactions identified.
Alendronate
No clinically significant drug interactions identified.
Allopurinol
No clinically significant drug interactions identified.
Alprazolam
Caution - decreased level of alprazolam due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing alternative agent.
Amiodarone
Avoid combination - decreased level of amiodarone due to 3A4/P-gp/2C19 induction. Monitor for efficacy - higher doses than anticipated may be required. Additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Amitriptyline
Caution - potential decreased level of amitriptline due to 3A4/2C19 induction. Monitor for efficacy - higher doses than anticipated may be required. Additive risk of QT prolongation (dose dependent). Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Amlodipine
Caution - decreased level of amlodipine due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Amoxicillin
No clinically significant drug interactions identified.
Amoxicillin/clavulanate
No clinically significant drug interactions identified.
Amphetamine
No clinically significant drug interactions identified.
Apixaban
Avoid combinaton - decreased level of apixaban due to 3A4 induction and P-gp/BCRP/2C19 induction. Choose an alternative agent.
Aripiprazole (IM)
Avoid combinaton - decreased level of aripiprazole IM depot formulations due to 3A4 induction. Consider choosing an alternative agent.
Aripiprazole (PO)
Caution - decreased level of aripiprazole due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required, depending on the indication. Consider choosing an alternative agent.
Atenolol
No clinically significant drug interactions identified.
Atomoxetine
No clinically significant drug interactions identified.
Atorvastatin
Caution - decreased level of atovastatin due to 3A4 induction and BCRP/Pgp induction. Monitor for efficacy - higher doses than anticipated may be required.
Azithromycin
Caution - additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Baclofen
No clinically significant drug interactions identified.
Bisoprolol
Caution - decreased level of bisoprolol due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing alternative agent.
Buprenorphine/naloxone
Caution - decreased level of buprenorphine/naloxone due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Bupropion
No clinically significant drug interactions identified.
Buspirone
Avoid combination - decreased level of buspirone due to 3A4 induction. Choose an alternative agent.
Calcium
No clinically significant drug interactions identified.
Canagliflozin
No clinically significant drug interactions identified.
Candesartan
No clinically significant drug interactions identified.
Carbamazepine
Caution - decreased level of carbamazepine due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Carvedilol
No clinically significant drug interactions identified.
Cephalexin
No clinically significant drug interactions identified.
Cetirizine
No clinically significant drug interactions identified.
Chlorthalidone
No clinically significant drug interactions identified.
Cholecalciferol
No clinically significant drug interactions identified.
Ciprofloxacin
Caution - potential decreased level of ciprofloxacin due to Pgp induction. Monitor for ciprofloxacin efficacy. Additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Citalopram
Avoid combinaton - decreased effiacy of citalopram due to 2C19/3A4 induction. Also additive risk of QT prolongation. Choose an alternative agent.
Clarithromycin
Avoid combinaton - decreased level of clarithromycin due to 3A4 induction. Potential increased risk of apalutamide toxicity due to 3A4 inhibition. Also additive risk of QT prolongation. Choose an alternative agent.
Clindamycin
Caution - decreased level of clindamycin due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Clomipramine
Caution - additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Clonazepam
Caution - decreased level of clonazepam due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Clonidine
No clinically significant drug interactions identified.
Clopidogrel
Avoid combinaton - increased level of active metabolite of clopidogrel (prodrug) due to 2C19 induction. Increased risk of bleeding. Choose an alternative agent.
Codeine
Caution - decreased level of codeine due to 3A4 induction. This results in an increased level of inactive metabolite "norcodeine", as opposed to its active metabolite of morphine through 2D6 metabolism. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Colchicine
Caution - decreased level of colchicine due to 3A4/P-gp induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Cyclobenzaprine
No clinically significant drug interactions identified.
Dabigatran
Caution - decreased level of dabigaban due to P-gp induction. Consider choosing an alternative agent.
Dapagliflozin
No clinically significant drug interactions identified.
Degarelix
No clinically significant drug interactions identified.
Denosumab
No clinically significant drug interactions identified.
Desipramine
Caution - additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Desvenlafaxine
No clinically significant drug interactions identified.
Dexamethasone
Caution - decreased level of dexamethadone due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Dexlansoprazole
Avoid combinaton - decreased level of dexlansoprazole due to 2C19 induction. Choose an alternative agent.
Dextroamphetamine
No clinically significant drug interactions identified.
Diazepam
Caution - decreased level of diazepam due to 3A4/2C19/2C9 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Diclofenac
No clinically significant drug interactions identified.
Digoxin
Caution - decreased level of digoxin due to P-gp induction. If concurrent use cannot be avoided, measure baseline serum digoxin level and monitor closely throughout treatment. Consider choosing an alternative agent.
Diltiazem
Avoid combinaton - decreased level of diltiazem due to 3A4 induction. Potential increased apalutamide toxicity due to 3A4 inhibition. Also additive risk of QT prolongation. Choose an alternative agent.
Dimenhydrinate
No clinically significant drug interactions identified.
Divalproex
No clinically significant drug interactions identified.
Docusate
No clinically significant drug interactions identified.
Domperidone
Caution - decreased level of domperidone due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Donepezil
Caution - additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Doxazosin
No clinically significant drug interactions identified.
Doxycycline
No clinically significant drug interactions identified.
Duloxetine
No clinically significant drug interactions identified.
Dutasteride
No clinically significant drug interactions identified.
Edoxaban
Caution - decreased level of edoxaban due to P-gp induction. Consider choosing an alternative agent.
Eletriptan
Caution - decreased level of eletriptan due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Empagliflozin
No clinically significant drug interactions identified.
Enalapril
No clinically significant drug interactions identified.
Escitalopram
Avoid combinaton - decreased effiacy of escitalopram due to 2C19/3A4 induction. Also additive risk of QT prolongation. Choose an alternative agent.
Esomeprazole
Avoid combinaton - decreased level of esomeprazole due to 2C19 induction. Choose an alternative agent.
Ezetimibe
No clinically significant drug interactions identified.
Famotidine
Caution - additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Fenofibrate
No clinically significant drug interactions identified.
Finasteride
No clinically significant drug interactions identified.
Fluconazole
Caution - only for short courses of therapy. Additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Fluoxetine
Caution - additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Folic acid
No clinically significant drug interactions identified.
Fosfomycin
No clinically significant drug interactions identified.
Furosemide
No clinically significant drug interactions identified.
Gabapentin
No clinically significant drug interactions identified.
Galantamine
No clinically significant drug interactions identified.
Gliclazide
No clinically significant drug interactions identified.
Glyburide
No clinically significant drug interactions identified.
Goserelin
No clinically significant drug interactions identified.
Guanfacine
Avoid combination - decreased level of guanfacine due to 3A4 induction. If concurrent use cannot be avoided, dose increase of guanfacine recommended. Choose an alternative agent.
Hydralazine
No clinically significant drug interactions identified.
Hydrochlorothiazide
No clinically significant drug interactions identified.
Hydromorphone
No clinically significant drug interactions identified.
Hydroxychloroquine
Caution - additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Consider choosing an alternative agent.
Hydroxyzine
No clinically significant drug interactions identified.
Ibuprofen
No clinically significant drug interactions identified.
Indapamide
No clinically significant drug interactions identified.
Indomethacin
No clinically significant drug interactions identified.
Irbesartan
No clinically significant drug interactions identified.
Isotretinoin
No clinically significant drug interactions identified.
Itraconazole
Avoid combination - decreased level of itraconazole due to 3A4 induction. Choose an alternative agent.
Ketorolac
No clinically significant drug interactions identified.
Labetalol
No clinically significant drug interactions identified.
Lansoprazole
Avoid combinaton - decreased level of lansoprazole due to 2C19 induction. Choose an alternative agent.
Leuprolide
No clinically significant drug interactions identified.
