Erleada

Overview

apalutamide

antiandrogen

• CYP2C8 substrate
• CYP3A4 substrate
• CYP2C9 inducer, weak
• CYP2C19 inducer, strong
• CYP3A4 inducer, strong
• BCRP inducer
• OATP1B1 inducer
• P-gp inducer
• lowers seizure threshold
• prolongs QT interval (known)

Contraindicated

• artemether/lumefantrine
Erleada (apalutamide)

+

artemether/ lumefantrine

1 interaction

Contraindicated

apalutamide + artemether/ lumefantrine

contraindicated: combo may decr. artemether/lumefantrine levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• atazanavir
Erleada (apalutamide)

+

atazanavir

1 interaction

Contraindicated

apalutamide + atazanavir

contraindicated: combo may decr. atazanavir levels, efficacy; may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced, P-gp-mediated transport induced; hepatic metab. inhibited)

• cisapride
Erleada (apalutamide)

+

cisapride

1 interaction

Contraindicated

apalutamide + cisapride

contraindicated: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• domperidone
Erleada (apalutamide)

+

domperidone

1 interaction

Contraindicated

apalutamide + domperidone

contraindicated: combo may decr. domperidone levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• doravirine
Erleada (apalutamide)

+

doravirine

1 interaction

Contraindicated

apalutamide + doravirine

contraindicated; D/C apalutamide at least 4wk before starting doravirine: combo may decr. doravirine levels, efficacy (hepatic metab. induced)

• dronedarone
Erleada (apalutamide)

+

dronedarone

1 interaction

Contraindicated

apalutamide + dronedarone

contraindicated: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. dronedarone levels, efficacy (additive effects; hepatic metab. induced)

• elbasvir
Erleada (apalutamide)

+

elbasvir

1 interaction

Contraindicated

apalutamide + elbasvir

contraindicated: combo may decr. elbasvir levels, efficacy (hepatic metab. induced)

• fostemsavir
Erleada (apalutamide)

+

fostemsavir

1 interaction

Contraindicated

apalutamide + fostemsavir

contraindicated: combo may decr. temsavir levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• grazoprevir
Erleada (apalutamide)

+

grazoprevir

1 interaction

Contraindicated

apalutamide + grazoprevir

contraindicated: combo may decr. grazoprevir levels, efficacy (hepatic metab. induced)

• isavuconazonium
Erleada (apalutamide)

+

isavuconazonium

1 interaction

Contraindicated

apalutamide + isavuconazonium

contraindicated: combo may decr. isavuconazole levels, efficacy (hepatic metab. induced)

• lenacapavir
Erleada (apalutamide)

+

lenacapavir

1 interaction

Contraindicated

apalutamide + lenacapavir

HIV INFECTION: contraindicated; HIV PRE-EXPOSURE PROPHYLAXIS: start apalutamide at least 2 days after lenacapavir initiation; on day apalutamide is initiated, give supplemental lenacapavir 927 mg SC x1 and 600 mg PO x1, then give 600 mg PO x1 the day after apalutamide initiation; if apalutamide use >6mo, continue supplemental SC and PO doses every 6mo from apalutamide initiation; consider alternative if already receiving apalutamide, dosing regimen not established: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced, UGT possibly induced)

• levoketoconazole
Erleada (apalutamide)

+

levoketoconazole

1 interaction

Contraindicated

apalutamide + levoketoconazole

contraindicated: combo may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects; may decr. levoketoconazole levels, efficacy (hepatic metab. inhibited, additive effects; hepatic metab. induced)

• lonafarnib
Erleada (apalutamide)

+

lonafarnib

1 interaction

Contraindicated

apalutamide + lonafarnib

contraindicated: combo may decr. lonafarnib levels, efficacy; may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced; hepatic metab. inhibited, additive effects)

• lopinavir/ritonavir
Erleada (apalutamide)

+

lopinavir/ ritonavir

1 interaction

Contraindicated

apalutamide + lopinavir/ ritonavir

contraindicated: combo may decr. lopinavir/ritonavir levels, efficacy; may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced, P-gp-mediated transport induced; hepatic metab. inhibited, additive effects)

• lorlatinib
Erleada (apalutamide)

+

lorlatinib

1 interaction

Contraindicated

apalutamide + lorlatinib

contraindicated; D/C apalutamide x3 half-lives before starting lorlatinib: combo may decr. lorlatinib levels, efficacy; may incr. risk of hepatotoxicity (hepatic metab. induced; pregnane X receptor possibly activated)

• lurasidone
Erleada (apalutamide)

+

lurasidone

1 interaction

Contraindicated

apalutamide + lurasidone

contraindicated: combo may decr. lurasidone levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• mavacamten
Erleada (apalutamide)

+

mavacamten

1 interaction

Contraindicated

apalutamide + mavacamten

contraindicated: combo may decr. mavacamten levels, efficacy (hepatic metab. induced)

• nirmatrelvir
Erleada (apalutamide)

+

nirmatrelvir

1 interaction

Contraindicated

apalutamide + nirmatrelvir

contraindicated: combo may decr. nirmatrelvir levels, efficacy (hepatic metab. induced)

• pacritinib
Erleada (apalutamide)

+

pacritinib

1 interaction

Contraindicated

apalutamide + pacritinib

contraindicated: combo may decr. pacritinib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• pimozide
Erleada (apalutamide)

+

pimozide

1 interaction

Contraindicated

apalutamide + pimozide

contraindicated: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• posaconazole
Erleada (apalutamide)

+

posaconazole

1 interaction

Contraindicated

apalutamide + posaconazole

contraindicated: combo may decr. posaconazole levels, efficacy; may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (P-gp-mediated transport induced; hepatic metab. inhibited, additive effects)

• praziquantel
Erleada (apalutamide)

+

praziquantel

1 interaction

Contraindicated

apalutamide + praziquantel

contraindicated: combo may decr. praziquantel levels, efficacy (hepatic metab. induced)

• ranolazine
Erleada (apalutamide)

+

ranolazine

1 interaction

Contraindicated

apalutamide + ranolazine

contraindicated: combo may decr. ranolazine levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced, P-gp-mediated transport induced; additive effects)

• ritonavir
Erleada (apalutamide)

+

ritonavir

1 interaction

Contraindicated

apalutamide + ritonavir

contraindicated: combo may decr. ritonavir levels, efficacy; may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced, P-gp-mediated transport induced; hepatic metab. inhibited)

• thioridazine
Erleada (apalutamide)

+

thioridazine

1 interaction

Contraindicated

apalutamide + thioridazine

contraindicated: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• tipranavir
Erleada (apalutamide)

+

tipranavir

1 interaction

Contraindicated

apalutamide + tipranavir

contraindicated: combo may decr. tipranavir levels, efficacy; may incr. apalutamide levels, risk of adverse effects (hepatic metab. induced, P-gp-mediated transport induced; hepatic metab. inhibited)

Avoid/Use Alternative

• abemaciclib
Erleada (apalutamide)

+

abemaciclib

1 interaction

Avoid/Use Alternative

apalutamide + abemaciclib

avoid combo: combo may decr. abemaciclib levels, efficacy (hepatic metab. induced)

• abiraterone acetate
Erleada (apalutamide)

+

abiraterone acetate

2 interactions

Avoid/Use Alternative

apalutamide + abiraterone acetate

if abiraterone coformulated w/ niraparib, avoid combo; otherwise, use alternative or incr. abiraterone dosing frequency to bid: combo may decr. abiraterone levels, efficacy (hepatic metab. induced)

• abrocitinib
Erleada (apalutamide)

+

abrocitinib

2 interactions

Avoid/Use Alternative

apalutamide + abrocitinib

avoid combo: combo may decr. abrocitinib and active metabolite levels, efficacy (hepatic metab. induced)

• acalabrutinib
Erleada (apalutamide)

+

acalabrutinib

1 interaction

Avoid/Use Alternative

apalutamide + acalabrutinib

use alternative or incr. acalabrutinib dose to 200 mg bid: combo may decr. acalabrutinib levels, efficacy (hepatic metab. induced)

• acoramidis
Erleada (apalutamide)

+

acoramidis

3 interactions

Avoid/Use Alternative

apalutamide + acoramidis

avoid combo: combo may decr. acoramidis levels, efficacy (UGT possibly induced)

• adagrasib
Erleada (apalutamide)

+

adagrasib

3 interactions

Avoid/Use Alternative

apalutamide + adagrasib

avoid combo: combo may decr. adagrasib levels, efficacy; may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced; hepatic metab. inhibited, additive effects)

• aldesleukin
Erleada (apalutamide)

+

aldesleukin

2 interactions

Avoid/Use Alternative

apalutamide + aldesleukin

avoid combo: combo may incr. risk of seizures (additive effects)

• alfentanil
Erleada (apalutamide)

+

alfentanil

1 interaction

Avoid/Use Alternative

apalutamide + alfentanil

use alternative or consider alfentanil dose adjustment: combo may decr. alfentanil levels, efficacy (hepatic metab. induced)

• alpelisib
Erleada (apalutamide)

+

alpelisib

3 interactions

Avoid/Use Alternative

apalutamide + alpelisib

avoid combo: combo may decr. alpelisib levels, efficacy (hepatic metab. induced)

• amifampridine
Erleada (apalutamide)

+

amifampridine

2 interactions

Avoid/Use Alternative

apalutamide + amifampridine

consider alternative: combo may incr. risk of seizures (additive effects)

• amiodarone
Erleada (apalutamide)

+

amiodarone

1 interaction

Avoid/Use Alternative

apalutamide + amiodarone

use alternative or monitor ECG: combo may decr. amiodarone levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• apixaban
Erleada (apalutamide)

+

apixaban

3 interactions

Avoid/Use Alternative

apalutamide + apixaban

avoid combo: combo may decr. apixaban levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• apomorphine
Erleada (apalutamide)

+

apomorphine

3 interactions

Avoid/Use Alternative

apalutamide + apomorphine

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• apremilast
Erleada (apalutamide)

+

apremilast

3 interactions

Avoid/Use Alternative

apalutamide + apremilast

avoid combo: combo may decr. apremilast levels, efficacy (hepatic metab. induced)

• aprepitant
Erleada (apalutamide)

+

aprepitant

2 interactions

Avoid/Use Alternative

apalutamide + aprepitant

avoid combo: combo may decr. aprepitant levels, efficacy (hepatic metab. induced)

• aripiprazole bimonthly injection
Erleada (apalutamide)

+

aripiprazole bimonthly injection

2 interactions

Avoid/Use Alternative

apalutamide + aripiprazole bimonthly injection

avoid combo if concurrent use >14 days: combo may decr. aripiprazole levels, efficacy (hepatic metab. induced)

• aripiprazole lauroxil
Erleada (apalutamide)

+

aripiprazole lauroxil

1 interaction

Avoid/Use Alternative

apalutamide + aripiprazole lauroxil

ARISTADA INITIO: avoid combo; ARISTADA: if concurrent use >14 days, incr. aripiprazole lauroxil 441 mg qmo to 662 mg qmo; no dose adjustment at other doses: combo may decr. aripiprazole levels, efficacy (hepatic metab. induced)

• aripiprazole monthly injection
Erleada (apalutamide)

+

aripiprazole monthly injection

2 interactions

Avoid/Use Alternative

apalutamide + aripiprazole monthly injection

avoid combo if concurrent use >14 days: combo may decr. aripiprazole levels, efficacy (hepatic metab. induced)

• arsenic trioxide
Erleada (apalutamide)

+

arsenic trioxide

3 interactions

Avoid/Use Alternative

apalutamide + arsenic trioxide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• asenapine
Erleada (apalutamide)

+

asenapine

2 interactions

Avoid/Use Alternative

apalutamide + asenapine

avoid combo: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• atogepant
Erleada (apalutamide)

+

atogepant

1 interaction

Avoid/Use Alternative

apalutamide + atogepant

CHRONIC MIGRAINE: avoid combo; EPISODIC MIGRAINE: incr. atogepant dose to 30 or 60 mg/day: combo may decr. atogepant levels, efficacy (hepatic metab. induced)

• atrasentan
Erleada (apalutamide)

+

atrasentan

2 interactions

Avoid/Use Alternative

apalutamide + atrasentan

avoid combo: combo may decr. atrasentan levels, efficacy (hepatic metab. induced)

• avacopan
Erleada (apalutamide)

+

avacopan

2 interactions

Avoid/Use Alternative

apalutamide + avacopan

avoid combo: combo may decr. avacopan levels, efficacy (hepatic metab. induced)

• avanafil
Erleada (apalutamide)

+

avanafil

2 interactions

Avoid/Use Alternative

apalutamide + avanafil

avoid combo: combo may decr. avanafil levels, efficacy (hepatic metab. induced)

• avapritinib
Erleada (apalutamide)

+

avapritinib

1 interaction

Avoid/Use Alternative

apalutamide + avapritinib

avoid combo: combo may decr. avapritinib levels, efficacy (hepatic metab. induced)

• axitinib
Erleada (apalutamide)

+

axitinib

1 interaction

Avoid/Use Alternative

apalutamide + axitinib

avoid combo: combo may decr. axitinib levels, efficacy (hepatic metab. induced)

• azithromycin
Erleada (apalutamide)

+

azithromycin

2 interactions

Avoid/Use Alternative

apalutamide + azithromycin

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• berotralstat
Erleada (apalutamide)

+

berotralstat

2 interactions

Avoid/Use Alternative

apalutamide + berotralstat

avoid combo: combo may decr. berotralstat levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (P-gp-mediated transport induced; additive effects)

• bictegravir
Erleada (apalutamide)

+

bictegravir

2 interactions

Avoid/Use Alternative

apalutamide + bictegravir

use alternative: combo may decr. bictegravir levels, efficacy (hepatic metab. induced, UGT possibly induced)

• bortezomib
Erleada (apalutamide)

+

bortezomib

2 interactions

Avoid/Use Alternative

apalutamide + bortezomib

avoid combo: combo may decr. bortezomib levels, efficacy (hepatic metab. induced)

• bosutinib
Erleada (apalutamide)

+

bosutinib

1 interaction

Avoid/Use Alternative

apalutamide + bosutinib

avoid combo: combo may decr. bosutinib levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• buprenorphine
Erleada (apalutamide)

+

buprenorphine

2 interactions

Avoid/Use Alternative

apalutamide + buprenorphine

use alternative or monitor withdrawal sx, ECG: combo may decr. buprenorphine levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• buspirone
Erleada (apalutamide)

+

buspirone

2 interactions

Avoid/Use Alternative

apalutamide + buspirone

consider alternative or adjust buspirone dose: combo may decr. buspirone levels, efficacy (hepatic metab. induced)

• cabozantinib
Erleada (apalutamide)

+

cabozantinib

2 interactions

Avoid/Use Alternative

apalutamide + cabozantinib

use alternative or monitor ECG; incr. cabozantinib daily dose by 40 mg if medullary thyroid CA use; incr. cabozantinib dose by 20 mg if renal cell CA, hepatocellular CA, differentiated thyroid CA, or NET use: combo may decr. cabozantinib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• capivasertib
Erleada (apalutamide)

+

capivasertib

2 interactions

Avoid/Use Alternative

apalutamide + capivasertib

avoid combo: combo may decr. capivasertib levels, efficacy (hepatic metab. induced)

• capmatinib
Erleada (apalutamide)

+

capmatinib

1 interaction

Avoid/Use Alternative

apalutamide + capmatinib

avoid combo: combo may decr. capmatinib levels, efficacy (hepatic metab. induced)

• ceritinib
Erleada (apalutamide)

+

ceritinib

2 interactions

Avoid/Use Alternative

apalutamide + ceritinib

avoid combo: combo may decr. ceritinib levels, efficacy; may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced, P-gp-mediated transport induced; hepatic metab. inhibited, additive effects)

• chloroquine
Erleada (apalutamide)

+

chloroquine

2 interactions

Avoid/Use Alternative

apalutamide + chloroquine

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• citalopram
Erleada (apalutamide)

+

citalopram

2 interactions

Avoid/Use Alternative

apalutamide + citalopram

use alternative or monitor ECG: combo may decr. citalopram levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• clarithromycin
Erleada (apalutamide)

+

clarithromycin

2 interactions

Avoid/Use Alternative

apalutamide + clarithromycin

use alternative or monitor ECG: combo may decr. clarithromycin levels, efficacy; may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced; hepatic metab. inhibited, additive effects)

• clopidogrel
Erleada (apalutamide)

+

clopidogrel

1 interaction

Avoid/Use Alternative

apalutamide + clopidogrel

avoid combo: combo may incr. clopidogrel active metabolite levels, risk of bleeding (incl. life-threatening), other adverse effects (hepatic metab. induced, incr. conversion of clopidogrel to active metabolite)

• clozapine
Erleada (apalutamide)

+

clozapine

1 interaction

Avoid/Use Alternative

apalutamide + clozapine

use alternative or monitor ECG, electrolytes; consider clozapine dose adjustment: combo may decr. clozapine levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias, seizures (hepatic metab. induced; additive effects)

• cobicistat
Erleada (apalutamide)

+

cobicistat

2 interactions

Avoid/Use Alternative

apalutamide + cobicistat

avoid combo: combo may decr. cobicistat levels, efficacy; may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced; hepatic metab. inhibited)

• cobimetinib
Erleada (apalutamide)

+

cobimetinib

2 interactions

Avoid/Use Alternative

apalutamide + cobimetinib

avoid combo: combo may decr. cobimetinib levels, efficacy (hepatic metab. induced)

• codeine
Erleada (apalutamide)

+

codeine

2 interactions

Avoid/Use Alternative

apalutamide + codeine

use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)

• copanlisib
Erleada (apalutamide)

+

copanlisib

1 interaction

Avoid/Use Alternative

apalutamide + copanlisib

avoid combo: combo may decr. copanlisib levels, efficacy (hepatic metab. induced)

• crizotinib
Erleada (apalutamide)

+

crizotinib

1 interaction

Avoid/Use Alternative

apalutamide + crizotinib

avoid combo: combo may decr. crizotinib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• daridorexant
Erleada (apalutamide)

+

daridorexant

2 interactions

Avoid/Use Alternative

apalutamide + daridorexant

avoid combo: combo may decr. daridorexant levels, efficacy (hepatic metab. induced)

• darolutamide
Erleada (apalutamide)

+

darolutamide

2 interactions

Avoid/Use Alternative

apalutamide + darolutamide

avoid combo: combo may decr. darolutamide levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• dasatinib
Erleada (apalutamide)

+

dasatinib

2 interactions

Avoid/Use Alternative

apalutamide + dasatinib

use alternative or consider incr. dasatinib dose; monitor ECG, electrolytes: combo may decr. dasatinib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• defactinib
Erleada (apalutamide)

+

defactinib

2 interactions

Avoid/Use Alternative

apalutamide + defactinib

avoid combo: combo may decr. defactinib levels, efficacy (hepatic metab. induced)

• deflazacort
Erleada (apalutamide)

+

deflazacort

1 interaction

Avoid/Use Alternative

apalutamide + deflazacort

avoid combo: combo may decr. deflazacort active metabolite levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• desipramine
Erleada (apalutamide)

+

desipramine

1 interaction

Avoid/Use Alternative

apalutamide + desipramine

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• desogestrel (contraceptive)
Erleada (apalutamide)

+

desogestrel (contraceptive)

2 interactions

Avoid/Use Alternative

apalutamide + desogestrel (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. desogestrel levels, contraceptive efficacy (hepatic metab. induced)

• deuruxolitinib
Erleada (apalutamide)

+

deuruxolitinib

2 interactions

Avoid/Use Alternative

apalutamide + deuruxolitinib

avoid combo: combo may decr. deuruxolitinib levels, efficacy (hepatic metab. induced)

• dexamethasone
Erleada (apalutamide)

+

dexamethasone

1 interaction

Avoid/Use Alternative

apalutamide + dexamethasone

if multiple myeloma use, consider alternative; otherwise, consider incr. dexamethasone dose: combo may decr. dexamethasone levels, efficacy (hepatic metab. induced)

• dexmedetomidine injection
Erleada (apalutamide)

+

dexmedetomidine injection

2 interactions

Avoid/Use Alternative

apalutamide + dexmedetomidine injection

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• diazoxide
Erleada (apalutamide)

+

diazoxide

2 interactions

Avoid/Use Alternative

apalutamide + diazoxide

avoid combo if also combined w/ moderate or strong CYP1A2 inducer; otherwise, caution advised: combo may decr. diazoxide levels, efficacy (hepatic metab. induced)

• dienogest (contraceptive)
Erleada (apalutamide)

+

dienogest (contraceptive)

1 interaction

Avoid/Use Alternative

apalutamide + dienogest (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. dienogest levels, contraceptive efficacy (hepatic metab. induced)

• dihydrocodeine
Erleada (apalutamide)

+

dihydrocodeine

1 interaction

Avoid/Use Alternative

apalutamide + dihydrocodeine

use alternative or monitor withdrawal sx: combo may decr. dihydrocodeine and active metabolite dihydromorphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite dihydromorphine)

• diltiazem
Erleada (apalutamide)

+

diltiazem

1 interaction

Avoid/Use Alternative

apalutamide + diltiazem

use alternative: combo may decr. diltiazem levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• disopyramide
Erleada (apalutamide)

+

disopyramide

2 interactions

Avoid/Use Alternative

apalutamide + disopyramide

use alternative or monitor ECG, disopyramide levels: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. disopyramide levels, efficacy (additive effects; hepatic metab. induced)

• dofetilide
Erleada (apalutamide)

+

dofetilide

2 interactions

Avoid/Use Alternative

apalutamide + dofetilide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• dolutegravir
Erleada (apalutamide)

+

dolutegravir

1 interaction

Avoid/Use Alternative

apalutamide + dolutegravir

avoid combo: combo may decr. dolutegravir levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced, BCRP-mediated transport induced, UGT possibly induced)

• dordaviprone
Erleada (apalutamide)

+

dordaviprone

1 interaction

Avoid/Use Alternative

apalutamide + dordaviprone

avoid combo: combo may decr. dordaviprone levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• droperidol
Erleada (apalutamide)

+

droperidol

2 interactions

Avoid/Use Alternative

apalutamide + droperidol

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• drospirenone (contraceptive)
Erleada (apalutamide)

+

drospirenone (contraceptive)

2 interactions

Avoid/Use Alternative

apalutamide + drospirenone (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. drospirenone levels, contraceptive efficacy (hepatic metab. induced)

• duvelisib
Erleada (apalutamide)

+

duvelisib

2 interactions

Avoid/Use Alternative

apalutamide + duvelisib

avoid combo: combo may decr. duvelisib levels, efficacy (hepatic metab. induced)

• edoxaban
Erleada (apalutamide)

+

edoxaban

1 interaction

Avoid/Use Alternative

apalutamide + edoxaban

consider alternative: combo may decr. edoxaban levels, efficacy (P-gp-mediated transport induced)

• elacestrant
Erleada (apalutamide)

+

elacestrant

2 interactions

Avoid/Use Alternative

apalutamide + elacestrant

avoid combo: combo may decr. elacestrant levels, efficacy (hepatic metab. induced)

• elexacaftor/tezacaftor/ivacaftor
Erleada (apalutamide)

+

elexacaftor/ tezacaftor/ ivacaftor

2 interactions

Avoid/Use Alternative

apalutamide + elexacaftor/ tezacaftor/ ivacaftor

avoid combo: combo may decr. elexacaftor/tezacaftor/ivacaftor levels, efficacy (hepatic metab. induced)

• eliglustat
Erleada (apalutamide)

+

eliglustat

2 interactions

Avoid/Use Alternative

apalutamide + eliglustat

avoid combo: combo may decr. eliglustat levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• elvitegravir
Erleada (apalutamide)

+

elvitegravir

1 interaction

Avoid/Use Alternative

apalutamide + elvitegravir

avoid combo: combo may decr. elvitegravir levels, efficacy (hepatic metab. induced)

• encorafenib
Erleada (apalutamide)

+

encorafenib

1 interaction

Avoid/Use Alternative

apalutamide + encorafenib

avoid combo: combo may decr. levels of both drugs, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• ensartinib
Erleada (apalutamide)

+

ensartinib

1 interaction

Avoid/Use Alternative

apalutamide + ensartinib

avoid combo: combo may decr. ensartinib levels, efficacy (hepatic metab. possibly induced)

• entrectinib
Erleada (apalutamide)

+

entrectinib

2 interactions

Avoid/Use Alternative

apalutamide + entrectinib

avoid combo: combo may decr. entrectinib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• enzalutamide
Erleada (apalutamide)

+

enzalutamide

2 interactions

Avoid/Use Alternative

apalutamide + enzalutamide

use alternative or incr. enzalutamide dose to 240 mg/day: combo may decr. levels of both drugs, efficacy (hepatic metab. induced)

• ephedra
Erleada (apalutamide)

+

ephedra

2 interactions

Avoid/Use Alternative

apalutamide + ephedra

avoid combo: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• erdafitinib
Erleada (apalutamide)

+

erdafitinib

1 interaction

Avoid/Use Alternative

apalutamide + erdafitinib

avoid combo: combo may decr. erdafitinib levels, efficacy (hepatic metab. induced)

• eribulin
Erleada (apalutamide)

+

eribulin

1 interaction

Avoid/Use Alternative

apalutamide + eribulin

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• erlotinib
Erleada (apalutamide)

+

erlotinib

2 interactions

Avoid/Use Alternative

apalutamide + erlotinib

use alternative or incr. erlotinib dose by 50 mg/day q2wk up to 450 mg/day: combo may decr. erlotinib levels, efficacy (hepatic metab. induced)

• erythromycin
Erleada (apalutamide)

+

erythromycin

2 interactions

Avoid/Use Alternative

apalutamide + erythromycin

use alternative or monitor ECG: combo may decr. erythromycin levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced, P-gp-mediated transport induced; additive effects)

• estradiol (contraceptive)
Erleada (apalutamide)

+

estradiol (contraceptive)

2 interactions

Avoid/Use Alternative

apalutamide + estradiol (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. estradiol levels, contraceptive efficacy (hepatic metab. induced, P-gp-mediated transport induced, UGT possibly induced)

• ethinyl estradiol (contraceptive)
Erleada (apalutamide)

+

ethinyl estradiol (contraceptive)

2 interactions

Avoid/Use Alternative

apalutamide + ethinyl estradiol (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. ethinyl estradiol levels, contraceptive efficacy (hepatic metab. induced, P-gp-mediated transport induced, UGT possibly induced)

• ethynodiol (contraceptive)
Erleada (apalutamide)

+

ethynodiol (contraceptive)

1 interaction

Avoid/Use Alternative

apalutamide + ethynodiol (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. ethynodiol and active metabolite levels, contraceptive efficacy (hepatic metab. induced)

• etonogestrel (contraceptive)
Erleada (apalutamide)

+

etonogestrel (contraceptive)

1 interaction

Avoid/Use Alternative

apalutamide + etonogestrel (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. etonogestrel levels, contraceptive efficacy (hepatic metab. induced)

• everolimus
Erleada (apalutamide)

+

everolimus

2 interactions

Avoid/Use Alternative

apalutamide + everolimus

BREAST CA, PNET, RENAL CELL CA, RENAL ANGIOMYOLIPOMA W/ TSC: use alternative or double everolimus dose using increments of 5 mg or less; TSC-ASSOC. SEGA or TSC-ASSOC. PARTIAL-ONSET SEIZURES: double everolimus dose using increments of 5 mg or less; monitor everolimus levels; TRANSPLANT: use alternative or monitor everolimus levels: combo may decr. everolimus levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• felodipine
Erleada (apalutamide)

+

felodipine

2 interactions

Avoid/Use Alternative

apalutamide + felodipine

use alternative: combo may decr. felodipine levels, efficacy (hepatic metab. induced)

• fenfluramine
Erleada (apalutamide)

+

fenfluramine

2 interactions

Avoid/Use Alternative

apalutamide + fenfluramine

use alternative or consider fenfluramine dose adjustment: combo may decr. fenfluramine levels, efficacy; may alter seizure control (hepatic metab. induced; antagonistic effects, apalutamide may decr. seizure threshold)

• fentanyl
Erleada (apalutamide)

+

fentanyl

1 interaction

Avoid/Use Alternative

apalutamide + fentanyl

use alternative or monitor withdrawal sx: combo may decr. fentanyl levels, efficacy (hepatic metab. induced)

• fexinidazole
Erleada (apalutamide)

+

fexinidazole

1 interaction

Avoid/Use Alternative

apalutamide + fexinidazole

avoid combo during and x7 days after fexinidazole tx; if possible, do not initiate fexinidazole until 5 half-lives after apalutamide D/C: combo may incr. fexinidazole active metabolite levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced, incr. conversion to active metabolites, additive effects)

• finerenone
Erleada (apalutamide)

+

finerenone

1 interaction

Avoid/Use Alternative

apalutamide + finerenone

avoid combo: combo may decr. finerenone levels, efficacy (hepatic metab. induced)

• flibanserin
Erleada (apalutamide)

+

flibanserin

2 interactions

Avoid/Use Alternative

apalutamide + flibanserin

avoid combo: combo may decr. flibanserin levels, efficacy (hepatic metab. induced)

• fluconazole
Erleada (apalutamide)

+

fluconazole

1 interaction

Avoid/Use Alternative

apalutamide + fluconazole

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• fosaprepitant
Erleada (apalutamide)

+

fosaprepitant

2 interactions

Avoid/Use Alternative

apalutamide + fosaprepitant

avoid combo: combo may decr. aprepitant levels, efficacy (hepatic metab. induced)

• foscarnet
Erleada (apalutamide)

+

foscarnet

2 interactions

Avoid/Use Alternative

apalutamide + foscarnet

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• fostamatinib
Erleada (apalutamide)

+

fostamatinib

1 interaction

Avoid/Use Alternative

apalutamide + fostamatinib

use alternative: combo may decr. fostamatinib active metabolite levels, efficacy (hepatic metab. induced)

• fruquintinib
Erleada (apalutamide)

+

fruquintinib

1 interaction

Avoid/Use Alternative

apalutamide + fruquintinib

avoid combo: combo may decr. fruquintinib levels, efficacy (hepatic metab. induced)

• gepirone
Erleada (apalutamide)

+

gepirone

2 interactions

Avoid/Use Alternative

apalutamide + gepirone

avoid combo: combo may decr. gepirone levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• gepotidacin
Erleada (apalutamide)

+

gepotidacin

1 interaction

Avoid/Use Alternative

apalutamide + gepotidacin

avoid combo: combo may decr. gepotidacin levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• gilteritinib
Erleada (apalutamide)

+

gilteritinib

1 interaction

Avoid/Use Alternative

apalutamide + gilteritinib

avoid combo: combo may decr. gilteritinib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced, P-gp-mediated transport induced; additive effects)

• glasdegib
Erleada (apalutamide)

+

glasdegib

2 interactions

Avoid/Use Alternative

apalutamide + glasdegib

avoid combo: combo may decr. glasdegib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• glecaprevir
Erleada (apalutamide)

+

glecaprevir

1 interaction

Avoid/Use Alternative

apalutamide + glecaprevir

avoid combo: combo may decr. glecaprevir levels, efficacy (hepatic metab. induced, BCRP-mediated transport induced, P-gp-mediated transport induced, hepatic transport induced)

• grapefruit
Erleada (apalutamide)

+

grapefruit

1 interaction

Avoid/Use Alternative

apalutamide + grapefruit

use alternative or monitor ECG w/ large amounts of grapefruit (>1L juice): combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• hydrocodone
Erleada (apalutamide)

+

hydrocodone

1 interaction

Avoid/Use Alternative

apalutamide + hydrocodone

use alternative or monitor withdrawal sx, ECG, electrolytes, especially if hydrocodone ER doses >160 mg/day: combo may decr. hydrocodone levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• ibrutinib
Erleada (apalutamide)

+

ibrutinib

2 interactions

Avoid/Use Alternative

apalutamide + ibrutinib

avoid combo: combo may decr. ibrutinib levels, efficacy (hepatic metab. induced)

• ibutilide
Erleada (apalutamide)

+

ibutilide

1 interaction

Avoid/Use Alternative

apalutamide + ibutilide

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• idelalisib
Erleada (apalutamide)

+

idelalisib

1 interaction

Avoid/Use Alternative

apalutamide + idelalisib

avoid combo: combo may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects; may decr. idelalisib levels, efficacy (hepatic metab. inhibited; hepatic metab. induced, P-gp-mediated transport induced)

• iohexol
Erleada (apalutamide)

+

iohexol

2 interactions

Avoid/Use Alternative

apalutamide + iohexol

avoid combo if intrathecal iohexol use: combo may incr. risk of seizures (additive effects)

• irinotecan
Erleada (apalutamide)

+

irinotecan

1 interaction

Avoid/Use Alternative

apalutamide + irinotecan

use alternative or D/C apalutamide at least 2wk prior to irinotecan start: combo may decr. irinotecan and active metabolite levels, efficacy (hepatic metab. induced)

• isoflurane
Erleada (apalutamide)

+

isoflurane

1 interaction

Avoid/Use Alternative

apalutamide + isoflurane

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• isradipine
Erleada (apalutamide)

+

isradipine

1 interaction

Avoid/Use Alternative

apalutamide + isradipine

consider alternative: combo may decr. isradipine levels, efficacy (hepatic metab. induced)

• istradefylline
Erleada (apalutamide)

+

istradefylline

1 interaction

Avoid/Use Alternative

apalutamide + istradefylline

avoid combo: combo may decr. istradefylline levels, efficacy (hepatic metab. induced)

• ivacaftor
Erleada (apalutamide)

+

ivacaftor

2 interactions

Avoid/Use Alternative

apalutamide + ivacaftor

avoid combo: combo may decr. ivacaftor levels, efficacy (hepatic metab. induced)

• ivosidenib
Erleada (apalutamide)

+

ivosidenib

2 interactions

Avoid/Use Alternative

apalutamide + ivosidenib

avoid combo: combo may decr. levels of both drugs, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• ixabepilone
Erleada (apalutamide)

+

ixabepilone

1 interaction

Avoid/Use Alternative

apalutamide + ixabepilone

use alternative or consider gradually incr. ixabepilone dose to 60 mg/m^2: combo may decr. ixabepilone levels, efficacy (hepatic metab. induced)

• ixazomib
Erleada (apalutamide)

+

ixazomib

1 interaction

Avoid/Use Alternative

apalutamide + ixazomib

avoid combo: combo may decr. ixazomib levels, efficacy (hepatic metab. induced)

• ketoconazole
Erleada (apalutamide)

+

ketoconazole

1 interaction

Avoid/Use Alternative

apalutamide + ketoconazole

avoid combo 2wk before and during ketoconazole tx if possible; monitor for breakthrough fungal infection; consider incr. ketoconazole dose; monitor ECG during and up to 1wk after ketoconazole tx: combo may decr. ketoconazole levels, efficacy; may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced; hepatic metab. inhibited)

• lazertinib
Erleada (apalutamide)

+

lazertinib

2 interactions

Avoid/Use Alternative

apalutamide + lazertinib

avoid combo: combo may decr. lazertinib levels, efficacy (hepatic metab. induced)

• ledipasvir
Erleada (apalutamide)

+

ledipasvir

1 interaction

Avoid/Use Alternative

apalutamide + ledipasvir

avoid combo: combo may decr. ledipasvir levels, efficacy (P-gp-mediated transport induced)

• lefamulin
Erleada (apalutamide)

+

lefamulin

1 interaction

Avoid/Use Alternative

apalutamide + lefamulin

use alternative or monitor ECG: combo may decr. lefamulin levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced, P-gp-mediated transport induced; additive effects)

• letermovir
Erleada (apalutamide)

+

letermovir

2 interactions

Avoid/Use Alternative

apalutamide + letermovir

avoid combo: combo may decr. letermovir levels, efficacy (hepatic metab. induced, hepatic transport induced, P-gp-mediated transport induced)

• levofloxacin
Erleada (apalutamide)

+

levofloxacin

2 interactions

Avoid/Use Alternative

apalutamide + levofloxacin

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• levonorgestrel (contraceptive)
Erleada (apalutamide)

+

levonorgestrel (contraceptive)

1 interaction

Avoid/Use Alternative

apalutamide + levonorgestrel (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. levonorgestrel levels, contraceptive efficacy (hepatic metab. induced)

• levonorgestrel (post-coital contraceptive)
Erleada (apalutamide)

+

levonorgestrel (post-coital contraceptive)

1 interaction

Avoid/Use Alternative

apalutamide + levonorgestrel (post-coital contraceptive)

consider alternative: combo may decr. levonorgestrel levels, post-coital contraceptive efficacy (hepatic metab. induced)

• lumacaftor/ivacaftor
Erleada (apalutamide)

+

lumacaftor/ ivacaftor

2 interactions

Avoid/Use Alternative

apalutamide + lumacaftor/ ivacaftor

avoid combo: combo may decr. levels of both drugs, efficacy (hepatic metab. induced)

• lumateperone
Erleada (apalutamide)

+

lumateperone

1 interaction

Avoid/Use Alternative

apalutamide + lumateperone

avoid combo: combo may decr. lumateperone levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• lurbinectedin
Erleada (apalutamide)

+

lurbinectedin

1 interaction

Avoid/Use Alternative

apalutamide + lurbinectedin

avoid combo: combo may decr. lurbinectedin levels, efficacy (hepatic metab. induced)

• maraviroc
Erleada (apalutamide)

+

maraviroc

2 interactions

Avoid/Use Alternative

apalutamide + maraviroc

ADULTS: adjust maraviroc dose to 600 mg bid; if also combined w/ strong CYP3A4 inhibitor, adjust maraviroc dose to 150 mg bid; PEDS: avoid combo: combo may decr. maraviroc levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• maribavir
Erleada (apalutamide)

+

maribavir

1 interaction

Avoid/Use Alternative

apalutamide + maribavir

avoid combo: combo may decr. maribavir levels, efficacy (hepatic metab. induced)

• mavorixafor
Erleada (apalutamide)

+

mavorixafor

1 interaction

Avoid/Use Alternative

apalutamide + mavorixafor

avoid combo: combo may decr. mavorixafor levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• medroxyprogesterone (contraceptive)
Erleada (apalutamide)

+

medroxyprogesterone (contraceptive)

1 interaction

Avoid/Use Alternative

apalutamide + medroxyprogesterone (contraceptive)

use additional non-hormonal or alternative contraception: combo may decr. medroxyprogesterone levels, contraceptive efficacy (hepatic metab. induced)

• meperidine
Erleada (apalutamide)

+

meperidine

2 interactions

Avoid/Use Alternative

apalutamide + meperidine

use alternative or monitor withdrawal sx, ECG: combo may decr. meperidine levels, efficacy; may incr. normeperidine levels, risk of neurotoxicity; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced, incr. toxic metabolite formation; additive effects)

• midostaurin
Erleada (apalutamide)

+

midostaurin

2 interactions

Avoid/Use Alternative

apalutamide + midostaurin

avoid combo: combo may decr. midostaurin levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• mobocertinib
Erleada (apalutamide)

+

mobocertinib

1 interaction

Avoid/Use Alternative

apalutamide + mobocertinib

avoid combo: combo may decr. mobocertinib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• moxifloxacin
Erleada (apalutamide)

+

moxifloxacin

2 interactions

Avoid/Use Alternative

apalutamide + moxifloxacin

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• naldemedine
Erleada (apalutamide)

+

naldemedine

1 interaction

Avoid/Use Alternative

apalutamide + naldemedine

use alternative: combo may decr. naldemedine levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• neratinib
Erleada (apalutamide)

+

neratinib

2 interactions

Avoid/Use Alternative

apalutamide + neratinib

avoid combo: combo may decr. neratinib levels, efficacy (hepatic metab. induced)

• netupitant
Erleada (apalutamide)

+

netupitant

1 interaction

Avoid/Use Alternative

apalutamide + netupitant

avoid combo: combo may decr. netupitant levels, efficacy (hepatic metab. induced)

• nevirapine
Erleada (apalutamide)

+

nevirapine

1 interaction

Avoid/Use Alternative

apalutamide + nevirapine

avoid combo: combo may decr. nevirapine levels, efficacy (hepatic metab. induced)

• nicardipine
Erleada (apalutamide)

+

nicardipine

1 interaction

Avoid/Use Alternative

apalutamide + nicardipine

use alternative or monitor BP: combo may decr. nicardipine levels, efficacy (hepatic metab. induced)

• nifedipine
Erleada (apalutamide)

+

nifedipine

2 interactions

Avoid/Use Alternative

apalutamide + nifedipine

use alternative: combo may decr. nifedipine levels, efficacy (hepatic metab. induced)

• nintedanib
Erleada (apalutamide)

+

nintedanib

2 interactions

Avoid/Use Alternative

apalutamide + nintedanib

avoid combo: combo may decr. nintedanib levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• nirogacestat
Erleada (apalutamide)

+

nirogacestat

2 interactions

Avoid/Use Alternative

apalutamide + nirogacestat

avoid combo: combo may decr. nirogacestat levels, efficacy (hepatic metab. induced)

• nisoldipine
Erleada (apalutamide)

+

nisoldipine

1 interaction

Avoid/Use Alternative

apalutamide + nisoldipine

use alternative or monitor BP: combo may decr. nisoldipine levels, efficacy (hepatic metab. induced)

• norelgestromin (contraceptive)
Erleada (apalutamide)

+

norelgestromin (contraceptive)

1 interaction

Avoid/Use Alternative

apalutamide + norelgestromin (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. norelgestromin levels, contraceptive efficacy (hepatic metab. induced)

• norethindrone (contraceptive)
Erleada (apalutamide)

+

norethindrone (contraceptive)

1 interaction

Avoid/Use Alternative

apalutamide + norethindrone (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. norethindrone levels, contraceptive efficacy (hepatic metab. induced)

• norgestrel (contraceptive)
Erleada (apalutamide)

+

norgestrel (contraceptive)

2 interactions

Avoid/Use Alternative

apalutamide + norgestrel (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. norgestrel levels, contraceptive efficacy (hepatic metab. induced)

• oliceridine
Erleada (apalutamide)

+

oliceridine

2 interactions

Avoid/Use Alternative

apalutamide + oliceridine

use alternative or monitor withdrawal sx, ECG; consider oliceridine dose adjustment: combo may decr. oliceridine levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• omaveloxolone
Erleada (apalutamide)

+

omaveloxolone

2 interactions

Avoid/Use Alternative

apalutamide + omaveloxolone

avoid combo: combo may decr. omaveloxolone levels, efficacy (hepatic metab. induced)

• oxaliplatin
Erleada (apalutamide)

+

oxaliplatin

1 interaction

Avoid/Use Alternative

apalutamide + oxaliplatin

use alternative or monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ozanimod
Erleada (apalutamide)

+

ozanimod

2 interactions

Avoid/Use Alternative

apalutamide + ozanimod

consider alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• palovarotene
Erleada (apalutamide)

+

palovarotene

1 interaction

Avoid/Use Alternative

apalutamide + palovarotene

avoid combo: combo may decr. palovarotene levels, efficacy (hepatic metab. induced)

• pemigatinib
Erleada (apalutamide)

+

pemigatinib

2 interactions

Avoid/Use Alternative

apalutamide + pemigatinib

avoid combo: combo may decr. pemigatinib levels, efficacy (hepatic metab. induced)

• pentamidine
Erleada (apalutamide)

+

pentamidine

1 interaction

Avoid/Use Alternative

apalutamide + pentamidine

use alternative or monitor ECG; risk may be lower w/ nebulized pentamidine: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• pexidartinib
Erleada (apalutamide)

+

pexidartinib

1 interaction

Avoid/Use Alternative

apalutamide + pexidartinib

avoid combo: combo may decr. pexidartinib levels, efficacy (hepatic metab. induced)

• pirtobrutinib
Erleada (apalutamide)

+

pirtobrutinib

2 interactions

Avoid/Use Alternative

apalutamide + pirtobrutinib

avoid combo: combo may decr. pirtobrutinib levels, efficacy (hepatic metab. induced)

• pitolisant
Erleada (apalutamide)

+

pitolisant

2 interactions

Avoid/Use Alternative

apalutamide + pitolisant

avoid combo: combo may decr. pitolisant levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• ponesimod
Erleada (apalutamide)

+

ponesimod

2 interactions

Avoid/Use Alternative

apalutamide + ponesimod

use alternative or monitor HR, ECG: combo may incr. risk of bradycardia, AV block, QT prolongation, cardiac arrhythmias (additive effects)

• pralsetinib
Erleada (apalutamide)

+

pralsetinib

2 interactions

Avoid/Use Alternative

apalutamide + pralsetinib

if adding pralsetinib to ongoing apalutamide tx or 7 days after adding apalutamide to ongoing pralsetinib tx, use alternative or double current pralsetinib dose; monitor ECG, consider monitoring electrolytes: combo may decr. pralsetinib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• pretomanid
Erleada (apalutamide)

+

pretomanid

1 interaction

Avoid/Use Alternative

apalutamide + pretomanid

avoid combo: combo may decr. pretomanid levels, efficacy (hepatic metab. induced)

• procainamide
Erleada (apalutamide)

+

procainamide

1 interaction

Avoid/Use Alternative

apalutamide + procainamide

avoid combo: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• quetiapine
Erleada (apalutamide)

+

quetiapine

2 interactions

Avoid/Use Alternative

apalutamide + quetiapine

use alternative or monitor ECG; incr. quetiapine dose up to 5-fold of original dose if apalutamide use greater than 7-14 days: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. quetiapine levels, efficacy (additive effects; hepatic metab. induced)

• quinidine (antiarrhythmic)
Erleada (apalutamide)

+

quinidine (antiarrhythmic)

2 interactions

Avoid/Use Alternative

apalutamide + quinidine (antiarrhythmic)

use alternative or monitor ECG, quinidine levels: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. quinidine levels, efficacy (additive effects; hepatic metab. induced, P-gp-mediated transport induced)

• quinine
Erleada (apalutamide)

+

quinine

1 interaction

Avoid/Use Alternative

apalutamide + quinine

avoid combo: combo may decr. quinine levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced, P-gp-mediated transport induced; additive effects)

• quizartinib
Erleada (apalutamide)

+

quizartinib

1 interaction

Avoid/Use Alternative

apalutamide + quizartinib

avoid combo: combo may decr. quizartinib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• repotrectinib
Erleada (apalutamide)

+

repotrectinib

3 interactions

Avoid/Use Alternative

apalutamide + repotrectinib

avoid combo: combo may decr. repotrectinib levels, efficacy (hepatic metab. induced)

• revumenib
Erleada (apalutamide)

+

revumenib

2 interactions

Avoid/Use Alternative

apalutamide + revumenib

avoid combo: combo may decr. revumenib levels, efficacy; may incr. revumenib active metabolite levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced, incr. active metabolite formation, additive effects)

• ribociclib
Erleada (apalutamide)

+

ribociclib

1 interaction

Avoid/Use Alternative

apalutamide + ribociclib

use alternative or monitor ECG, electrolytes: combo may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects; may decr. ribociclib levels, efficacy (hepatic metab. inhibited, additive effects; hepatic metab. induced)

• rilpivirine
Erleada (apalutamide)

+

rilpivirine

1 interaction

Avoid/Use Alternative

apalutamide + rilpivirine

avoid combo: combo may decr. rilpivirine levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• rimegepant
Erleada (apalutamide)

+

rimegepant

1 interaction

Avoid/Use Alternative

apalutamide + rimegepant

avoid combo: combo may decr. rimegepant levels, efficacy (hepatic metab. induced)

• roflumilast
Erleada (apalutamide)

+

roflumilast

2 interactions

Avoid/Use Alternative

apalutamide + roflumilast

avoid combo: combo may decr. roflumilast levels, efficacy (hepatic metab. induced)

• rolapitant
Erleada (apalutamide)

+

rolapitant

1 interaction

Avoid/Use Alternative

apalutamide + rolapitant

avoid combo: combo may decr. rolapitant levels, efficacy (hepatic metab. induced)

• romidepsin
Erleada (apalutamide)

+

romidepsin

1 interaction

Avoid/Use Alternative

apalutamide + romidepsin

use alternative or monitor ECG: combo may incr. or decr. romidepsin levels, incr. risk of adverse effects or efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (mechanism unknown; additive effects)

• rucaparib
Erleada (apalutamide)

+

rucaparib

1 interaction

Avoid/Use Alternative

apalutamide + rucaparib

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• segesterone (contraceptive)
Erleada (apalutamide)

+

segesterone (contraceptive)

2 interactions

Avoid/Use Alternative

apalutamide + segesterone (contraceptive)

use additional non-hormonal or alternative contraception during and x28 days after apalutamide tx: combo may decr. segesterone levels, contraceptive efficacy (hepatic metab. induced)

• selpercatinib
Erleada (apalutamide)

+

selpercatinib

2 interactions

Avoid/Use Alternative

apalutamide + selpercatinib

avoid combo: combo may decr. selpercatinib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• selumetinib
Erleada (apalutamide)

+

selumetinib

1 interaction

Avoid/Use Alternative

apalutamide + selumetinib

avoid combo: combo may decr. selumetinib levels, efficacy (hepatic metab. induced)

• sertraline
Erleada (apalutamide)

+

sertraline

1 interaction

Avoid/Use Alternative

apalutamide + sertraline

use alternative or monitor ECG: combo may decr. sertraline levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• sevoflurane
Erleada (apalutamide)

+

sevoflurane

1 interaction

Avoid/Use Alternative

apalutamide + sevoflurane

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• sirolimus
Erleada (apalutamide)

+

sirolimus

2 interactions

Avoid/Use Alternative

apalutamide + sirolimus

use alternative or monitor sirolimus levels: combo may decr. sirolimus levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• sirolimus albumin-bound
Erleada (apalutamide)

+

sirolimus albumin-bound

2 interactions

Avoid/Use Alternative

apalutamide + sirolimus albumin-bound

avoid combo: combo may decr. sirolimus albumin-bound levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• sofosbuvir
Erleada (apalutamide)

+

sofosbuvir

2 interactions

Avoid/Use Alternative

apalutamide + sofosbuvir

avoid combo: combo may decr. sofosbuvir and active metabolite levels, efficacy (P-gp-mediated transport induced)

• solifenacin
Erleada (apalutamide)

+

solifenacin

1 interaction

Avoid/Use Alternative

apalutamide + solifenacin

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• sonidegib
Erleada (apalutamide)

+

sonidegib

1 interaction

Avoid/Use Alternative

apalutamide + sonidegib

avoid combo: combo may decr. sonidegib levels, efficacy (hepatic metab. induced)

• sorafenib
Erleada (apalutamide)

+

sorafenib

1 interaction

Avoid/Use Alternative

apalutamide + sorafenib

avoid combo: combo may decr. sorafenib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• sparsentan
Erleada (apalutamide)

+

sparsentan

1 interaction

Avoid/Use Alternative

apalutamide + sparsentan

avoid combo: combo may decr. sparsentan levels, efficacy (hepatic metab. induced)

• stiripentol
Erleada (apalutamide)

+

stiripentol

1 interaction

Avoid/Use Alternative

apalutamide + stiripentol

use alternative or consider stiripentol dose adjustment: combo may decr. stiripentol levels, efficacy; may alter seizure control (hepatic metab. possibly induced; antagonistic effects, apalutamide may decr. seizure threshold)

• sufentanil
Erleada (apalutamide)

+

sufentanil

1 interaction

Avoid/Use Alternative

apalutamide + sufentanil

use alternative or consider sufentanil dose adjustment: combo may decr. sufentanil levels, efficacy (hepatic metab. induced)

• suzetrigine
Erleada (apalutamide)

+

suzetrigine

2 interactions

Avoid/Use Alternative

apalutamide + suzetrigine

avoid combo: combo may decr. suzetrigine and active metabolite levels, efficacy (hepatic metab. induced)

• tadalafil
Erleada (apalutamide)

+

tadalafil

2 interactions

Avoid/Use Alternative

apalutamide + tadalafil

PULMONARY HTN: avoid combo; ERECTILE DYSFUNCTION and BENIGN PROSTATIC HYPERPLASIA: consider alternative: combo may decr. tadalafil levels, efficacy (hepatic metab. induced)

• tamoxifen
Erleada (apalutamide)

+

tamoxifen

1 interaction

Avoid/Use Alternative

apalutamide + tamoxifen

avoid combo: combo may decr. tamoxifen and active metabolite levels, efficacy (hepatic metab. induced)

• tasimelteon
Erleada (apalutamide)

+

tasimelteon

1 interaction

Avoid/Use Alternative

apalutamide + tasimelteon

avoid combo: combo may decr. tasimelteon levels, efficacy (hepatic metab. induced)

• tenofovir alafenamide
Erleada (apalutamide)

+

tenofovir alafenamide

1 interaction

Avoid/Use Alternative

apalutamide + tenofovir alafenamide

avoid combo: combo may decr. tenofovir levels, efficacy (P-gp-mediated transport induced)

• tetrabenazine
Erleada (apalutamide)

+

tetrabenazine

1 interaction

Avoid/Use Alternative

apalutamide + tetrabenazine

avoid combo: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• tezacaftor/ivacaftor
Erleada (apalutamide)

+

tezacaftor/ ivacaftor

1 interaction

Avoid/Use Alternative

apalutamide + tezacaftor/ ivacaftor

avoid combo: combo may decr. tezacaftor/ivacaftor levels, efficacy (hepatic metab. induced)

• tofacitinib
Erleada (apalutamide)

+

tofacitinib

2 interactions

Avoid/Use Alternative

apalutamide + tofacitinib

avoid combo: combo may decr. tofacitinib levels, efficacy (hepatic metab. induced)

• tolvaptan
Erleada (apalutamide)

+

tolvaptan

1 interaction

Avoid/Use Alternative

apalutamide + tolvaptan

avoid combo: combo may decr. tolvaptan levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• toremifene
Erleada (apalutamide)

+

toremifene

1 interaction

Avoid/Use Alternative

apalutamide + toremifene

avoid combo: combo may decr. toremifene levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• tretinoin
Erleada (apalutamide)

+

tretinoin

2 interactions

Avoid/Use Alternative

apalutamide + tretinoin

use alternative: combo may decr. tretinoin levels, efficacy (hepatic metab. induced)

• triazolam
Erleada (apalutamide)

+

triazolam

2 interactions

Avoid/Use Alternative

apalutamide + triazolam

consider alternative: combo may decr. triazolam levels, efficacy (hepatic metab. induced)

• tucatinib
Erleada (apalutamide)

+

tucatinib

1 interaction

Avoid/Use Alternative

apalutamide + tucatinib

avoid combo: combo may decr. tucatinib levels, efficacy; may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced; hepatic metab. inhibited)

• ubrogepant
Erleada (apalutamide)

+

ubrogepant

1 interaction

Avoid/Use Alternative

apalutamide + ubrogepant

avoid combo: combo may decr. ubrogepant levels, efficacy (hepatic metab. induced)

• vandetanib
Erleada (apalutamide)

+

vandetanib

2 interactions

Avoid/Use Alternative

apalutamide + vandetanib

avoid combo: combo may decr. vandetanib levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• vanzacaftor/tezacaftor/deutivacaftor
Erleada (apalutamide)

+

vanzacaftor/ tezacaftor/ deutivacaftor

1 interaction

Avoid/Use Alternative

apalutamide + vanzacaftor/ tezacaftor/ deutivacaftor

avoid combo: combo may decr. vanzacaftor/tezacaftor/deutivacaftor levels, efficacy (hepatic metab. induced)

• velpatasvir
Erleada (apalutamide)

+

velpatasvir

1 interaction

Avoid/Use Alternative

apalutamide + velpatasvir

avoid combo: combo may decr. velpatasvir levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• venetoclax
Erleada (apalutamide)

+

venetoclax

2 interactions

Avoid/Use Alternative

apalutamide + venetoclax

avoid combo: combo may decr. venetoclax levels, efficacy (hepatic metab. induced)

• verapamil
Erleada (apalutamide)

+

verapamil

1 interaction

Avoid/Use Alternative

apalutamide + verapamil

use alternative: combo may decr. verapamil levels, efficacy (hepatic metab. induced)

• vinblastine
Erleada (apalutamide)

+

vinblastine

1 interaction

Avoid/Use Alternative

apalutamide + vinblastine

avoid combo: combo may decr. vinblastine levels, efficacy (hepatic metab. induced)

• vincristine
Erleada (apalutamide)

+

vincristine

1 interaction

Avoid/Use Alternative

apalutamide + vincristine

avoid combo: combo may decr. vincristine levels, efficacy (hepatic metab. induced)

• vorapaxar
Erleada (apalutamide)

+

vorapaxar

2 interactions

Avoid/Use Alternative

apalutamide + vorapaxar

avoid combo: combo may decr. vorapaxar levels, efficacy (hepatic metab. induced)

• zanubrutinib
Erleada (apalutamide)

+

zanubrutinib

3 interactions

Avoid/Use Alternative

apalutamide + zanubrutinib

avoid combo: combo may decr. zanubrutinib levels, efficacy (hepatic metab. induced)

• ziprasidone
Erleada (apalutamide)

+

ziprasidone

2 interactions

Avoid/Use Alternative

apalutamide + ziprasidone

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• zolpidem
Erleada (apalutamide)

+

zolpidem

1 interaction

Avoid/Use Alternative

apalutamide + zolpidem

avoid combo: combo may decr. zolpidem levels, efficacy (hepatic metab. induced)

• zuranolone
Erleada (apalutamide)

+

zuranolone

1 interaction

Avoid/Use Alternative

apalutamide + zuranolone

avoid combo: combo may decr. zuranolone levels, efficacy (hepatic metab. induced)

Monitor/Modify Tx

• afatinib
Erleada (apalutamide)

+

afatinib

1 interaction

Monitor/Modify Tx

apalutamide + afatinib

incr. afatinib dose by 10 mg/day: combo may decr. afatinib levels, efficacy (P-gp-mediated transport induced)

• albuterol
Erleada (apalutamide)

+

albuterol

1 interaction

Monitor/Modify Tx

apalutamide + albuterol

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• alfuzosin
Erleada (apalutamide)

+

alfuzosin

2 interactions

Monitor/Modify Tx

apalutamide + alfuzosin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• aminophylline
Erleada (apalutamide)

+

aminophylline

1 interaction

Monitor/Modify Tx

apalutamide + aminophylline

monitor theophylline levels: combo may decr. theophylline levels, efficacy (hepatic metab. induced, aminophylline converted to theophylline)

• amisulpride
Erleada (apalutamide)

+

amisulpride

1 interaction

Monitor/Modify Tx

apalutamide + amisulpride

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• amitriptyline
Erleada (apalutamide)

+

amitriptyline

1 interaction

Monitor/Modify Tx

apalutamide + amitriptyline

monitor amitriptyline levels, ECG: combo may decr. amitriptyline and active metabolite nortriptyline levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced, P-gp-mediated transport induced; additive effects)

• amlodipine
Erleada (apalutamide)

+

amlodipine

1 interaction

Monitor/Modify Tx

apalutamide + amlodipine

monitor BP: combo may decr. (lev)amlodipine levels, efficacy (hepatic metab. induced)

• arformoterol inhaled
Erleada (apalutamide)

+

arformoterol inhaled

1 interaction

Monitor/Modify Tx

apalutamide + arformoterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• asciminib
Erleada (apalutamide)

+

asciminib

2 interactions

Monitor/Modify Tx

apalutamide + asciminib

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• avatrombopag
Erleada (apalutamide)

+

avatrombopag

2 interactions

Monitor/Modify Tx

apalutamide + avatrombopag

CHRONIC IMMUNE THROMBOCYTOPENIA: if also combined w/ mod-strong CYP2C9 inducer, incr. start dose to 40 mg po qd and monitor platelets; otherwise, monitor platelets; CHRONIC LIVER DZ: monitor platelets: combo may decr. avatrombopag levels, efficacy (hepatic metab. induced)

• belumosudil
Erleada (apalutamide)

+

belumosudil

1 interaction

Monitor/Modify Tx

apalutamide + belumosudil

incr. belumosudil dose to 200 mg bid: combo may decr. belumosudil levels, efficacy (hepatic metab. induced)

• betamethasone
Erleada (apalutamide)

+

betamethasone

1 interaction

Monitor/Modify Tx

apalutamide + betamethasone

consider betamethasone dose adjustment: combo may decr. betamethasone levels, efficacy (hepatic metab. induced)

• bupropion
Erleada (apalutamide)

+

bupropion

2 interactions

Monitor/Modify Tx

apalutamide + bupropion

consider lower bupropion doses: combo may incr. risk of seizures (additive effects)

• butorphanol
Erleada (apalutamide)

+

butorphanol

1 interaction

Monitor/Modify Tx

apalutamide + butorphanol

monitor withdrawal sx: combo may decr. butorphanol levels, efficacy (hepatic metab. induced)

• calcitriol
Erleada (apalutamide)

+

calcitriol

1 interaction

Monitor/Modify Tx

apalutamide + calcitriol

monitor vitamin D levels: combo may decr. vitamin D levels, efficacy (hepatic metab. induced)

• cannabidiol
Erleada (apalutamide)

+

cannabidiol

1 interaction

Monitor/Modify Tx

apalutamide + cannabidiol

consider cannabidiol dose adjustment: combo may decr. cannabidiol and active metabolite levels, efficacy; may alter seizure control (hepatic metab. induced; antagonistic effects, apalutamide may decr. seizure threshold)

• carbamazepine
Erleada (apalutamide)

+

carbamazepine

2 interactions

Monitor/Modify Tx

apalutamide + carbamazepine

monitor carbamazepine levels: combo may decr. levels of both drugs, efficacy; may alter seizure control (hepatic metab. induced; antagonistic effects, apalutamide may decr. seizure threshold)

• carvedilol
Erleada (apalutamide)

+

carvedilol

1 interaction

Monitor/Modify Tx

apalutamide + carvedilol

monitor BP, HR: combo may decr. carvedilol levels, efficacy (P-gp-mediated transport induced)

• chloramphenicol
Erleada (apalutamide)

+

chloramphenicol

1 interaction

Monitor/Modify Tx

apalutamide + chloramphenicol

monitor ECG: combo may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• chlorpromazine
Erleada (apalutamide)

+

chlorpromazine

1 interaction

Monitor/Modify Tx

apalutamide + chlorpromazine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• cholecalciferol (vitamin D3)
Erleada (apalutamide)

+

cholecalciferol (vitamin D3)

1 interaction

Monitor/Modify Tx

apalutamide + cholecalciferol (vitamin D3)

monitor vitamin D levels: combo may decr. vitamin D levels, efficacy (hepatic metab. induced)

• ciprofloxacin
Erleada (apalutamide)

+

ciprofloxacin

1 interaction

Monitor/Modify Tx

apalutamide + ciprofloxacin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• clobazam
Erleada (apalutamide)

+

clobazam

1 interaction

Monitor/Modify Tx

apalutamide + clobazam

consider monitoring resp. rate: combo may incr. clobazam active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may alter seizure control (hepatic metab. induced, incr. active metabolite formation; antagonistic effects, apalutamide may decr. seizure threshold)

• clofazimine
Erleada (apalutamide)

+

clofazimine

1 interaction

Monitor/Modify Tx

apalutamide + clofazimine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• clomipramine
Erleada (apalutamide)

+

clomipramine

1 interaction

Monitor/Modify Tx

apalutamide + clomipramine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• cyclophosphamide
Erleada (apalutamide)

+

cyclophosphamide

2 interactions

Monitor/Modify Tx

apalutamide + cyclophosphamide

monitor CBC, renal, cardiac fxn: combo may incr. cyclophosphamide active metabolite levels, risk of serious infection, myelosuppression, nephrotoxicity, cardiotoxicity, other adverse effects (hepatic metab. possibly induced, incr. active metabolite formation)

• cyclosporine
Erleada (apalutamide)

+

cyclosporine

2 interactions

Monitor/Modify Tx

apalutamide + cyclosporine

monitor cyclosporine levels: combo may decr. cyclosporine levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

• degarelix
Erleada (apalutamide)

+

degarelix

1 interaction

Monitor/Modify Tx

apalutamide + degarelix

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• desflurane
Erleada (apalutamide)

+

desflurane

1 interaction

Monitor/Modify Tx

apalutamide + desflurane

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• deutetrabenazine
Erleada (apalutamide)

+

deutetrabenazine

1 interaction

Monitor/Modify Tx

apalutamide + deutetrabenazine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• digoxin
Erleada (apalutamide)

+

digoxin

1 interaction

Monitor/Modify Tx

apalutamide + digoxin

monitor digoxin levels: combo may decr. digoxin levels, efficacy (P-gp-mediated transport induced)

• donepezil
Erleada (apalutamide)

+

donepezil

1 interaction

Monitor/Modify Tx

apalutamide + donepezil

monitor ECG: combo may decr. donepezil levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• doxercalciferol
Erleada (apalutamide)

+

doxercalciferol

1 interaction

Monitor/Modify Tx

apalutamide + doxercalciferol

monitor calcium, iPTH: combo may alter doxercalciferol and active metabolite levels, efficacy (hepatic metab. induced, net effect on vitamin D activation/inactivation unknown)

• epirubicin
Erleada (apalutamide)

+

epirubicin

1 interaction

Monitor/Modify Tx

apalutamide + epirubicin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• eravacycline
Erleada (apalutamide)

+

eravacycline

1 interaction

Monitor/Modify Tx

apalutamide + eravacycline

incr. eravacycline dose to 1.5 mg/kg IV q12h: combo may decr. eravacycline levels, efficacy (hepatic metab. induced)

• escitalopram
Erleada (apalutamide)

+

escitalopram

2 interactions

Monitor/Modify Tx

apalutamide + escitalopram

monitor ECG: combo may decr. escitalopram levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• ethosuximide
Erleada (apalutamide)

+

ethosuximide

2 interactions

Monitor/Modify Tx

apalutamide + ethosuximide

monitor ethosuximide levels: combo may decr. ethosuximide levels, efficacy; may alter seizure control (hepatic metab. induced; antagonistic effects, apalutamide may decr. seizure threshold)

• exemestane
Erleada (apalutamide)

+

exemestane

1 interaction

Monitor/Modify Tx

apalutamide + exemestane

incr. exemestane dose to 50 mg qd: combo may decr. exemestane levels, efficacy (hepatic metab. induced)

• fingolimod
Erleada (apalutamide)

+

fingolimod

1 interaction

Monitor/Modify Tx

apalutamide + fingolimod

monitor ECG overnight during fingolimod initiation/titration: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. fingolimod levels, efficacy (additive effects; hepatic metab. induced)

• fludrocortisone
Erleada (apalutamide)

+

fludrocortisone

1 interaction

Monitor/Modify Tx

apalutamide + fludrocortisone

consider fludrocortisone dose adjustment: combo may decr. fludrocortisone levels, efficacy (hepatic metab. induced)

• formoterol inhaled
Erleada (apalutamide)

+

formoterol inhaled

1 interaction

Monitor/Modify Tx

apalutamide + formoterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• fosphenytoin
Erleada (apalutamide)

+

fosphenytoin

1 interaction

Monitor/Modify Tx

apalutamide + fosphenytoin

monitor phenytoin levels: combo may decr. levels of both drugs, efficacy; may alter seizure control (hepatic metab. induced; antagonistic effects, apalutamide may decr. seizure threshold)

• gemfibrozil
Erleada (apalutamide)

+

gemfibrozil

2 interactions

Monitor/Modify Tx

apalutamide + gemfibrozil

monitor ECG: combo may incr. apalutamide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• gemtuzumab ozogamicin
Erleada (apalutamide)

+

gemtuzumab ozogamicin

2 interactions

Monitor/Modify Tx

apalutamide + gemtuzumab ozogamicin

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• goserelin
Erleada (apalutamide)

+

goserelin

1 interaction

Monitor/Modify Tx

apalutamide + goserelin

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• granisetron
Erleada (apalutamide)

+

granisetron

1 interaction

Monitor/Modify Tx

apalutamide + granisetron

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• guanfacine
Erleada (apalutamide)

+

guanfacine

1 interaction

Monitor/Modify Tx

apalutamide + guanfacine

consider incr. guanfacine ER dose up to double, consider incr. dose for immed.-release form: combo may decr. guanfacine levels, efficacy (hepatic metab. induced)

• histrelin
Erleada (apalutamide)

+

histrelin

2 interactions

Monitor/Modify Tx

apalutamide + histrelin

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• hydrocortisone
Erleada (apalutamide)

+

hydrocortisone

1 interaction

Monitor/Modify Tx

apalutamide + hydrocortisone

consider hydrocortisone dose adjustment: combo may decr. hydrocortisone levels, efficacy (hepatic metab. induced)

• hydroxyzine
Erleada (apalutamide)

+

hydroxyzine

1 interaction

Monitor/Modify Tx

apalutamide + hydroxyzine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ifosfamide
Erleada (apalutamide)

+

ifosfamide

2 interactions

Monitor/Modify Tx

apalutamide + ifosfamide

monitor CBC, renal, cardiac fxn; consider ifosfamide dose adjustment: combo may incr. ifosfamide active and toxic metabolite levels, risk of myelosuppression, serious infection, encephalopathy, nephrotoxicity, cardiotoxicity, other adverse effects (hepatic metab. induced, incr. metabolite formation)

• imipramine
Erleada (apalutamide)

+

imipramine

1 interaction

Monitor/Modify Tx

apalutamide + imipramine

monitor imipramine levels: combo may decr. imipramine levels, efficacy (hepatic metab. induced)

• iopamidol
Erleada (apalutamide)

+

iopamidol

1 interaction

Monitor/Modify Tx

apalutamide + iopamidol

caution advised if intrathecal iopamidol use; consider holding apalutamide at least 48h before and at least 24h after intrathecal iopamidol: combo may incr. risk of seizures (additive effects)

• lenvatinib
Erleada (apalutamide)

+

lenvatinib

2 interactions

Monitor/Modify Tx

apalutamide + lenvatinib

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• leuprolide
Erleada (apalutamide)

+

leuprolide

1 interaction

Monitor/Modify Tx

apalutamide + leuprolide

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• levalbuterol inhaled
Erleada (apalutamide)

+

levalbuterol inhaled

1 interaction

Monitor/Modify Tx

apalutamide + levalbuterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• levothyroxine
Erleada (apalutamide)

+

levothyroxine

2 interactions

Monitor/Modify Tx

apalutamide + levothyroxine

monitor thyroid fxn: combo may decr. thyroid hormone levels, efficacy (UGT possibly induced)

• liothyronine
Erleada (apalutamide)

+

liothyronine

2 interactions

Monitor/Modify Tx

apalutamide + liothyronine

monitor thyroid fxn: combo may decr. thyroid hormone levels, efficacy (UGT possibly induced)

• lofexidine
Erleada (apalutamide)

+

lofexidine

1 interaction

Monitor/Modify Tx

apalutamide + lofexidine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• methylprednisolone
Erleada (apalutamide)

+

methylprednisolone

1 interaction

Monitor/Modify Tx

apalutamide + methylprednisolone

consider methylprednisolone dose adjustment: combo may decr. methylprednisolone levels, efficacy (hepatic metab. induced)

• metronidazole
Erleada (apalutamide)

+

metronidazole

1 interaction

Monitor/Modify Tx

apalutamide + metronidazole

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• mirtazapine
Erleada (apalutamide)

+

mirtazapine

1 interaction

Monitor/Modify Tx

apalutamide + mirtazapine

monitor ECG; consider mirtazapine dose adjustment: combo may decr. mirtazapine levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced; additive effects)

• nateglinide
Erleada (apalutamide)

+

nateglinide

1 interaction

Monitor/Modify Tx

apalutamide + nateglinide

monitor glucose: combo may decr. nateglinide levels, efficacy (hepatic transport induced)

• nortriptyline
Erleada (apalutamide)

+

nortriptyline

1 interaction

Monitor/Modify Tx

apalutamide + nortriptyline

monitor nortriptyline levels: combo may decr. nortriptyline levels, efficacy (hepatic metab. induced)

• olodaterol inhaled
Erleada (apalutamide)

+

olodaterol inhaled

1 interaction

Monitor/Modify Tx

apalutamide + olodaterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• ondansetron
Erleada (apalutamide)

+

ondansetron

1 interaction

Monitor/Modify Tx

apalutamide + ondansetron

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. ondansetron levels, efficacy (additive effects; hepatic metab. induced)

• osilodrostat
Erleada (apalutamide)

+

osilodrostat

1 interaction

Monitor/Modify Tx

apalutamide + osilodrostat

monitor ECG, cortisol levels: combo may incr. risk of QT prolongation, cardiac arrhythmias; may decr. osilodrostat levels, efficacy (additive effects; hepatic metab. induced)

• palonosetron
Erleada (apalutamide)

+

palonosetron

2 interactions

Monitor/Modify Tx

apalutamide + palonosetron

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• pasireotide
Erleada (apalutamide)

+

pasireotide

1 interaction

Monitor/Modify Tx

apalutamide + pasireotide

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• perampanel
Erleada (apalutamide)

+

perampanel

2 interactions

Monitor/Modify Tx

apalutamide + perampanel

incr. perampanel start dose to 4 mg/day: combo may decr. perampanel levels, efficacy; may alter seizure control (hepatic metab. induced; antagonistic effects, apalutamide may decr. seizure threshold)

• phenytoin
Erleada (apalutamide)

+

phenytoin

1 interaction

Monitor/Modify Tx

apalutamide + phenytoin

monitor phenytoin levels: combo may decr. levels of both drugs, efficacy; may alter seizure control (hepatic metab. induced; antagonistic effects, apalutamide may decr. seizure threshold)

• prednisolone
Erleada (apalutamide)

+

prednisolone

1 interaction

Monitor/Modify Tx

apalutamide + prednisolone

consider prednisolone dose adjustment: combo may decr. prednisolone levels, efficacy (hepatic metab. induced)

• prednisone
Erleada (apalutamide)

+

prednisone

2 interactions

Monitor/Modify Tx

apalutamide + prednisone

consider prednisone dose adjustment: combo may decr. prednisone levels, efficacy (hepatic metab. induced)

• primaquine
Erleada (apalutamide)

+

primaquine

1 interaction

Monitor/Modify Tx

apalutamide + primaquine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• promethazine
Erleada (apalutamide)

+

promethazine

1 interaction

Monitor/Modify Tx

apalutamide + promethazine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, seizures (additive effects)

• propranolol
Erleada (apalutamide)

+

propranolol

1 interaction

Monitor/Modify Tx

apalutamide + propranolol

monitor BP, HR: combo may decr. propranolol levels, efficacy (hepatic metab. induced)

• repaglinide
Erleada (apalutamide)

+

repaglinide

2 interactions

Monitor/Modify Tx

apalutamide + repaglinide

monitor glucose: combo may decr. repaglinide levels, efficacy (hepatic metab. induced, hepatic transport induced)

• risperidone
Erleada (apalutamide)

+

risperidone

1 interaction

Monitor/Modify Tx

apalutamide + risperidone

ORAL RISPERIDONE: consider incr. risperidone dose up to double; IM RISPERIDONE: consider incr. risperidone dose or additional oral risperidone; SC RISPERIDONE: consider incr. risperidone to next highest dose; consider additional oral risperidone if on highest SC dose: combo may decr. risperidone levels, efficacy (hepatic metab. induced)

• sacituzumab govitecan
Erleada (apalutamide)

+

sacituzumab govitecan

1 interaction

Monitor/Modify Tx

apalutamide + sacituzumab govitecan

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• sildenafil
Erleada (apalutamide)

+

sildenafil

1 interaction

Monitor/Modify Tx

apalutamide + sildenafil

PULMONARY HTN: consider sildenafil dose adjustment; ED: caution advised: combo may decr. sildenafil levels, efficacy (hepatic metab. induced)

• tacrolimus
Erleada (apalutamide)

+

tacrolimus

1 interaction

Monitor/Modify Tx

apalutamide + tacrolimus

monitor tacrolimus levels, ECG, electrolytes: combo may decr. tacrolimus levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metab. induced, P-gp-mediated transport induced; additive effects)

• telavancin
Erleada (apalutamide)

+

telavancin

2 interactions

Monitor/Modify Tx

apalutamide + telavancin

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• terbutaline
Erleada (apalutamide)

+

terbutaline

1 interaction

Monitor/Modify Tx

apalutamide + terbutaline

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• thyroid
Erleada (apalutamide)

+

thyroid

2 interactions

Monitor/Modify Tx

apalutamide + thyroid

monitor thyroid fxn: combo may decr. thyroid hormone levels, efficacy (UGT possibly induced)

• tolterodine
Erleada (apalutamide)

+

tolterodine

1 interaction

Monitor/Modify Tx

apalutamide + tolterodine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• triamcinolone
Erleada (apalutamide)

+

triamcinolone

1 interaction

Monitor/Modify Tx

apalutamide + triamcinolone

consider triamcinolone dose adjustment: combo may decr. triamcinolone levels, efficacy (hepatic metab. induced)

• triclabendazole
Erleada (apalutamide)

+

triclabendazole

1 interaction

Monitor/Modify Tx

apalutamide + triclabendazole

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• trifluridine
Erleada (apalutamide)

+

trifluridine

2 interactions

Monitor/Modify Tx

apalutamide + trifluridine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• triptorelin
Erleada (apalutamide)

+

triptorelin

1 interaction

Monitor/Modify Tx

apalutamide + triptorelin

monitor ECG, electrolytes: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects, androgen deprivation may prolong QT)

• vardenafil
Erleada (apalutamide)

+

vardenafil

1 interaction

Monitor/Modify Tx

apalutamide + vardenafil

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• venlafaxine
Erleada (apalutamide)

+

venlafaxine

1 interaction

Monitor/Modify Tx

apalutamide + venlafaxine

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• vilanterol inhaled
Erleada (apalutamide)

+

vilanterol inhaled

1 interaction

Monitor/Modify Tx

apalutamide + vilanterol inhaled

monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias (additive effects)

• vilazodone
Erleada (apalutamide)

+

vilazodone

1 interaction

Monitor/Modify Tx

apalutamide + vilazodone

consider incr. vilazodone dose up to 2-fold, max 80 mg/day, if concurrent use >14 days: combo may decr. vilazodone levels, efficacy (hepatic metab. induced)

• vortioxetine
Erleada (apalutamide)

+

vortioxetine

1 interaction

Monitor/Modify Tx

apalutamide + vortioxetine

consider incr. vortioxetine dose up to 3x maintenance dose if apalutamide coadmin. for >14 days: combo may decr. vortioxetine levels, efficacy (hepatic metab. induced)

• zonisamide
Erleada (apalutamide)

+

zonisamide

1 interaction

Monitor/Modify Tx

apalutamide + zonisamide

consider zonisamide dose adjustment: combo may decr. zonisamide levels, efficacy; may alter seizure control (hepatic metab. induced; antagonistic effects, apalutamide may decr. seizure threshold)