Drug Interactions
Apalutamide Interactions
Acetylsalicylic acid
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.
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.
Apixaban
Avoid combinaton - decreased level of apixaban due to 3A4 induction and Pgp/BCRP/2C19 induction. Choose an alternative agent.
Atenolol
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.
Bisoprolol
Caution - decreased level of bisoprolol due to 3A4 induction. Monitor for efficacy - higher doses than anticipated may be required. Consider choosing alternative agent.
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.
Chlorthalidone
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.
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.
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.
Dabigatran
Avoid combinaton - decreased level of dabigatran due to Pgp induction. Choose an alternative agent.
Dapagliflozin
No clinically significant drug interactions identified.
Degarelix
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.
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.
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.
Doxycycline
No clinically significant drug interactions identified.
Duloxetine
No clinically significant drug interactions identified.
Dutasteride
No clinically significant drug interactions identified.
Edoxaban
Avoid combinaton - decreased level of edoxaban due to Pgp induction. Choose an alternative agent.
Empagliflozin
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.
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.
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.
Furosemide
No clinically significant drug interactions identified.
Gabapentin
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.
Hydrochlorothiazide
No clinically significant drug interactions identified.
Hydromorphone
No clinically significant drug interactions identified.
Ibuprofen
No clinically significant drug interactions identified.
Irbesartan
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.
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.
Lorazepam
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.
Metoclopramide
No clinically significant drug interactions identified.
Metoprolol
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.
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.
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.
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.
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.
Perinodopril
No clinically significant drug interactions identified.
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.
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.
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.
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/Pgp induction. Choose an alternative agent.
Rosuvastatin
Caution - decreased level of rosuvastatin due to 3A4/BCRP/2C9/OAT1B1 induction. Monitor for efficacy - higher doses than anticipated may be required.
Semaglutide
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.
Sulfamethoxazole-trimethoprim
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.
Terazocin
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.
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
