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Other drugs, alcohol, and more


Erleada (apalutamide) is a brand-name oral tablet that’s prescribed for certain types of prostate cancer. Erleada has interactions with some other drugs. Examples include clarithromycin and warfarin (Jantoven).

An interaction occurs when one substance causes another substance to have a different effect than expected.

To learn more about Erleada’s interactions, keep reading. For additional information about Erleada, including details about its uses, see this article.

Before you start treatment with Erleada, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Erleada interacts with supplements, herbs, or vitamins, see the “Erleada and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Erleada. Keep in mind that this table doesn’t include all drugs that may interact with Erleada. These interactions are described in detail just below in “Drug interactions in depth.”

There aren’t any known interactions between Erleada and alcohol. However, your doctor may advise you to avoid or limit alcohol consumption during Erleada treatment.

This is because drinking alcohol while taking the drug may worsen some Erleada side effects*. For example, you may experience:

  • nausea
  • diarrhea
  • fatigue (low energy)

If you consume alcohol during Erleada treatment, these side effects may be more likely to occur. If you have questions about drinking alcohol while taking Erleada, talk with your doctor.

*To learn more about Erleada’s side effects, see this article.

Here’s a closer look at certain drug interactions of Erleada.

Drugs that reduce the action of certain enzymes in your body

Erleada is broken down by certain enzymes in your body, called cytochrome p450 3A4 (CYP3A4) and cytochrome p450 2C8 (CYP2C8). Enzymes are proteins that help chemical reactions happen in the body.

Certain drugs can reduce the action of CYP3A4 and CYP2C8 enzymes. These drugs are called CYP3A4 or CYP2C8 inhibitors.

Interaction result:Taking Erleada with drugs that are strong CYP3A4 or CYP2C8 inhibitors can increase the risk of side effects from Erleada.

Interaction explained:Drugs that are strong CYP3A4 or CYP2C8 inhibitors stop these enzymes from breaking down Erleada as well as usual. This can cause Erleada to build up in your body, which can raise your risk of its side effects*.

Examples of drugs that are strong CYP3A4 or CYP2C8 inhibitors: Here are some strong CYP3A4 or CYP2C8 inhibitors that may interact with Erleada:

  • clarithromycin
  • cobicistat (Tybost)
  • gemfibrozil (Lopid)
  • itraconazole (Sporanox, Tolsura)
  • ketoconazole
  • nefazodone
  • nelfinavir (Viracept)
  • posaconazole (Noxafil)
  • ritonavir (Norvir)

Steps you or your doctor may take:Before starting Erleada, talk with your doctor or pharmacist about other drugs that you take. They can tell you if these drugs are strong CYP3A4 or CYP2C8 inhibitors.

If you take Erleada with a drug that’s a strong CYP3A4 or CYP2C8 inhibitor, tell your doctor if you have bothersome Erleada side effects*. If needed, your doctor may reduce your Erleada dosage.

*To learn more about Erleada’s side effects, see this article.

Drugs that are broken down by certain enzymes in your body

Some drugs are broken down by certain enzymes in your body, called cytochrome p450 3A4 (CYP3A4), cytochrome p450 2C9 (CYP2C9), and cytochrome p450 2C19 (CYP2C19). Enzymes are proteins that help chemical reactions happen.

Erleada increases the action of CYP3A4, CYP2C9, and CYP2C19 enzymes.

Interaction result:Erleada can reduce the effectiveness of drugs that CYP3A4, CYP2C9, and CYP2C19 enzymes break down.

Interaction explained:Taking Erleada with drugs that these enzymes break down can speed up the breakdown of these drugs. This can lower the level of these drugs in your body, which can make them less effective.

Examples of drugs that are broken down by CYP3A4, CYP2C9, and CYP2C19: Here are some drugs that are broken down by these enzymes that may interact with Erleada:

  • atazanavir (Reyataz)
  • diazepam (Valium)
  • felodipine
  • lovastatin (Altoprev)
  • midazolam
  • omeprazole (Prilosec)
  • phenytoin (Dilantin)
  • ranolazine
  • rilpivirine (Edurant)
  • sildenafil (Viagra)
  • simvastatin (Zocor)
  • warfarin (Jantoven)

Steps you or your doctor may take:Before starting Erleada, talk with your doctor or pharmacist about other drugs that you take. They can tell you if CYP3A4, CYP2C9, and CYP2C19 break down these drugs.

If you take Erleada with one of these drugs, your doctor may increase your dosage of the interacting drug. Or they may recommend switching to a different drug that doesn’t interact with Erleada.

Drugs that are transported by certain proteins in your body

Some drugs are transported by certain proteins in your body, called P-glycoprotein (P-gp), breast cancer resistance
protein (BCRP), and organic anion transporting polypeptide 1B1 (OATP1B1).

Erleada increases the action of P-gp, BCRP, and OATP1B1 proteins.

Interaction result:Erleada can reduce the effectiveness of drugs transported by P-gp, BCRP, and OATP1B1 proteins.

Interaction explained:Taking Erleada with drugs that these proteins transport can lower the level of these drugs in your body. This can make them less effective.

Examples of drugs that are transported by P-gp, BCRP, and OATP1B1: Here are some drugs transported by these proteins that may interact with Erleada:

  • cabotegravir (Vocabria, Apretude)
  • dabigatran (Pradaxa)
  • digoxin (Lanoxin)
  • fexofenadine (Allegra Allergy)
  • rosuvastatin (Crestor)

Steps you or your doctor may take:Before starting Erleada, talk with your doctor or pharmacist about other drugs that you take. They can tell you if these drugs are transported by P-gp, BCRP, and OATP1B1 proteins.

If you take Erleada with one of these drugs, your doctor will monitor your treatment to make sure the drug is still working for you. If the drug seems less effective than usual, your doctor may recommend switching to a different drug that doesn’t interact with Erleada.

Erleada may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Erleada.

Erleada and supplements

It’s possible for drugs to interact with supplements such as vitamins and herbs.

Erleada and herbs

There are no specific reports of herbs interacting with Erleada. However, that doesn’t mean herbal interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Erleada treatment.

Erleada and vitamins

There are no specific reports of vitamins interacting with Erleada. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Erleada.

Erleada interactions with food

Grapefruit and grapefruit juice may interact with Erleada. Specifically, regularly consuming grapefruit products can stop your body from breaking down Erleada. This raises the level of Erleada in your body, which increases your risk of side effects from Erleada.* Due to this risk, your doctor may recommend not consuming grapefruit and grapefruit juice while taking the drug.

* For details about Erleada’s side effects, see this article.

Erleada and vaccines

There aren’t any known interactions between Erleada and vaccines. Talk to your doctor or pharmacist to see whether you’re due for any vaccines.

Erleada interactions with lab tests

Erleada isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk to your doctor.

ERLEADA INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been reported to interact with Erleada. Specifically, Erleada may increase the breakdown of cannabis and cannabis products in your body. So cannabis may have reduced or changed effects if you take it with Erleada.

Before you start treatment with Erleada, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many U.S. states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Erleada. Before you take this drug, be sure to talk with your doctor about your health history. Erleada may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Erleada include:

  • Heart disease or stroke: If you have a history of heart disease or stroke, Erleada may not be safe for you. Taking the drug could raise your risk of heart attack and stroke. Talk with your doctor about whether Erleada is right for you.
  • Heart disease risk factors. If you have heart disease risk factors, such as high blood pressure, high cholesterol, diabetes, obesity, or smoking, Erleada may not be safe for you. Taking the drug could raise your risk of heart attack and stroke. Talk with your doctor about whether Erleada is right for you.
  • History of seizures, brain injury, or brain tumor. If you have a history of seizures, brain injury, or brain tumor, Erleada may not be safe for you. Taking the drug could raise your risk of having seizures. Talk with your doctor about whether Erleada is right for you.
  • Allergic reaction: If you’ve had an allergic reaction to Erleada or any of its ingredients, your doctor will likely not prescribe Erleada. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
  • Risk of falls and fractures. Erleada can increase your risk of falls and fractures. If you have a history of falls, bone fractures, or weak bones, talk with your doctor about whether Erleada is right for you.
  • Breastfeeding: Erleada is not intended for use in females*. It’s not known whether it’s safe to use Erleada while breastfeeding. It shouldn’t be taken by someone who is breastfeeding.
  • Pregnancy: Erleada is not intended for use in females*. The drug could cause fetal harm and miscarriage if used during pregnancy. It shouldn’t be taken by someone who is pregnant. If you have a sexual partner who could become pregnant, you should use condoms while taking Erleada and for 3 months after your last dose.

*Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

You can take certain steps to help prevent interactions with Erleada. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

  • Let them know if you drink alcohol or use cannabis.
  • Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
  • Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Erleada label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Erleada doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Erleada by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Erleada. These resources might help:

  • Overview of Erleada:For a general overview of Erleada, you can see this article.
  • Side effects:If you’re interested in the side effects of Erleada, see this article. Another option is to refer to the Erleada prescribing information.
  • Dosage specifics: To learn about the dosage of Erleada, see this article.
  • Cost: If you’d like to learn about (Erleada or brand-name drug) and cost, see this article.
  • Facts about your diagnosis: To learn more about prostate cancer, see our cancer hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.



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