Apalutamide Interactions
Levetiracetam
No clinically significant drug interactions identified.
Levodopa/carbidopa
No clinically significant drug interactions identified.
Levofloxacin
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.
Levothyroxine
Caution - risk of hypothyroidism due to additive effects. Monitor TSH. May require dose increase of levothyroxine.
Linagliptin
Avoid combination - decreased level of linagliptin due to 3A4 induction. Choose an alternative agent.
Liraglutide
No clinically significant drug interactions identified.
Lisdexamphetamine
No clinically significant drug interactions identified.
Lisinopril
No clinically significant drug interactions identified.
Loperamide
No clinically significant drug interactions identified.
Lorazepam
No clinically significant drug interactions identified.
Losartan
Caution - decreased level of losartan due to 3A4/2C9 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Memantine
No clinically significant drug interactions identified.
Metformin
No clinically significant drug interactions identified.
Methadone
Avoid combination - decreased level of methadone due to 3A4 induction. Also additive risk of QT prolongation. Choose an alternative agent.
Methylphenidate
No clinically significant drug interactions identified.
Metoclopramide
No clinically significant drug interactions identified.
Metoprolol
No clinically significant drug interactions identified.
Metrondiazole
No clinically significant drug interactions identified.
Mirabegron
Caution - decreased level of mirabegron 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.
Mirtazapine
Caution - decreased level of mirtazepine 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.
Misoprostol
No clinically significant drug interactions identified.
Montelukast
No clinically significant drug interactions identified.
Moxifloxacin
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.
Naltrexone
No clinically significant drug interactions identified.
Naproxen
No clinically significant drug interactions identified.
Nifedipine XL
Avoid combinaton - decreased level of nifedipine due to 3A4 induction. Choose an alternative agent.
Nirapirib
Avoid combinaton - decreased level of niraparib due to induction of BCRP/Pgp. Also potential risk of increased niraparib toxicity (unknown mechanism). Choose an alternative agent.
Nitrofurantoin
No clinically significant drug interactions identified.
Nortriptyline
Caution - potential decreased level of nortriptline 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.
Olanzapine
No clinically significant drug interactions identified.
Olaparib
Avoid combinaton - decreased level of olaparib due to 3A4 induction. Choose an alternative agent.
Omeprazole
Avoid combinaton - decreased level of omeprazole due to 2C19 induction. Choose an alternative agent.
Ondansetron
Caution - only for short courses of therapy. Potential decreased level of ondansetron due to 3A4/Pgp induction. Higher doses of ondansetron than anticipated may be required for 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.
Orlistat
No clinically significant drug interactions identified.
Oxazepam
No clinically significant drug interactions identified.
Oxybutynin
No clinically significant drug interactions identified.
Oxycodone
Avoid combinaton - decreased level of oxycodone due to 3A4 induction. Choose an alternative agent.
Pantoprazole
No clinically significant drug interactions identified.
Paroxetine
No clinically significant drug interactions identified.
Penicillin
No clinically significant drug interactions identified.
Perindopril
No clinically significant drug interactions identified.
Perinodopril
No clinically significant drug interactions identified.
Phenobarbital
Caution - decreased level of phenobarbital due to 3A4/2C19 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Phenytoin
Caution - decreased level of phenytoin due to 2C9/2C19/3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Pioglitazone
No clinically significant drug interactions identified.
Pravastatin
No clinically significant drug interactions identified.
Prazosin
No clinically significant drug interactions identified.
Prednisone
Caution - decreased level of prednisone due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required.
Pregabalin
No clinically significant drug interactions identified.
Prochlorperazine
No clinically significant drug interactions identified.
Propranolol
No clinically significant drug interactions identified.
Quetiapine
Avoid combinaton - decreased level of quetiapine due to 3A4 induction. Also additive risk of QT prolongation. Choose an alternative agent.
Rabeprazole
No clinically significant drug interactions identified.
Ramipril
No clinically significant drug interactions identified.
Ranitidine
No clinically significant drug interactions identified.
Relugolix
Caution - decreased level of relugolix due to 3A4/P-gp induction. If concurrent use desired, increased dose of relugolix to 240mg once daily recommended. If apalutamide discontinued, reduce to 120mg once daily. Consider choosing an alternative agent.
Repaglinide
Caution - decreased level of repaglinide due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Risedronate
No clinically significant drug interactions identified.
Risperidone
Avoid combination - decreased level of risperidone due to 3A4/Pgp induction. Do not use for treatment of schizophrenia or bipolar disorder. For agitation, higher doses than anticipated may be needed for efficacy. Additive risk of QT prolongation. Baseline EKG if risk factors present (ie. older age, female, electrolyte abnormalities, low HR, cardiac comorbidities, etc). Choose an alternative agent.
Rivaroxaban
Avoid combinaton - decreased level of rivaroxaban due to 3A4 induction and BCRP/P-gp induction. Choose an alternative agent.
Rivastigmine
No clinically significant drug interactions identified.
Rizatriptan
No clinically significant drug interactions identified.
Ropinirole
No clinically significant drug interactions identified.
Rosuvastatin
Caution - decreased level of rosuvastatin due to 3A4/BCRP/2C9/OAT1B1 induction. Monitor for efficacy - higher doses than anticipated may be required.
Saxagliptin
Caution - decreased level of saxagliptin due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Semaglutide
No clinically significant drug interactions identified.
Senna
No clinically significant drug interactions identified.
Sertraline
Caution - decreased level of sertraline 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.
Sildenafil
Avoid combination (in pulmonary hypertension) - decreased level of sildenafil due to 3A4 induction. If use for erectile dysfunction, monitor for efficacy - higher doses than anticipated may be required.
Silodosin
No clinically significant drug interactions identified.
Simvastatin
Caution - decreased level of simvastatin due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required.
Sitagliptin
No clinically significant drug interactions identified.
Solifenacin
Caution - decreased level of solifenacin due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Spironolactone
No clinically significant drug interactions identified.
Sulfamethoxazole-trimethoprim
No clinically significant drug interactions identified.
Sumatriptan
No clinically significant drug interactions identified.
Tadalafil
Avoid combination (in pulmonary hypertension) - decreased level of tadalafil due to 3A4 induction. If use for erectile dysfunction, monitor for efficacy - higher doses than anticipated may be required.
Talazoparib
No clinically significant drug interactions identified.
Tamsulosin
No clinically significant drug interactions identified.
Telmisartan
No clinically significant drug interactions identified.
Temazepam
No clinically significant drug interactions identified.
Terazocin
No clinically significant drug interactions identified.
Terazosin
No clinically significant drug interactions identified.
Terbinafine
No clinically significant drug interactions identified.
Ticagrelor
Avoid combinaton - decreased level of ticagrelor due to 3A4 induction. Choose an alternative agent.
Tolterodine
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.
Topiramate
No clinically significant drug interactions identified.
Tramadol
Caution - decreased level of tramacet 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 alternative agent
Tramadol-acetaminophen
Caution - decreased level of tramacet 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 alternative agent
Trazodone
Avoid combinaton - decreased level of trazodone due to 3A4 induction. Also additive risk of QT prolongation. Choose an alternative agent.
Valacyclovir
No clinically significant drug interactions identified.
Valsartan
No clinically significant drug interactions identified.
Vardenafil
Caution - decreased level of vardenafil due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
Varenicline
No clinically significant drug interactions identified.
Venlafaxine
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.
Verapamil
Avoid combinaton - decreased level of verapamil due to 3A4 induction. Potential increased apalutamide toxicity due to 3A4 inhibition. Choose an alternative agent.
Vortioxetine
Avoid combination - decreased level of vortioxetine due to 3A4/2C9/2C19 induction. If concurrent use cannot be avoided, dose increase of vortioxetine recommended. Choose an alternative agent.
Warfarin
Caution - decreased level of warfarin due to 2C9 (major) induction and 2C19/3A4 induction. Monitor INR more closely after initiation of apalutamide therapy or dose changes. Titrate warfarin dose to target INR.
Zolmitriptan
No clinically significant drug interactions identified.
Zolpidem
Caution - decreased level of zolpidem due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing an alternative agent.
