Drug interactions
Apalutamide + Brexpiprazole
Severity: Major
Apalutamide and Brexpiprazole: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Apalutamide is a strong CYP3A4 inducer and lowers brexpiprazole exposure, since brexpiprazole is cleared by CYP3A4 and CYP2D6. This can lead to loss of antipsychotic efficacy and relapse.
What this interaction means in plain words
Apalutamide and Brexpiprazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Apalutamide belongs to Endocrine; Brexpiprazole belongs to Central Nervous System.
Why it happens
Induction of CYP3A4 by apalutamide increases brexpiprazole metabolism and lowers plasma concentrations.
What to do
Brexpiprazole labeling advises doubling the dose when a strong CYP3A4 inducer is added, with reduction back to the usual dose if the inducer is stopped. Monitor clinical response, or consider an alternative to apalutamide where possible.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Brexpiprazole
Other interactions of Apalutamide
- Apalutamide + Cabotegravir Contraindicated
- Apalutamide + Cobicistat Contraindicated
- Apalutamide + Doravirine Contraindicated
- Apalutamide + Elbasvir / grazoprevir Contraindicated
- Apalutamide + Ensitrelvir Contraindicated
- Apalutamide + Fostemsavir Contraindicated
Frequently asked questions
Can I take Apalutamide with Brexpiprazole?
MediHelp rates the interaction as major. Apalutamide and Brexpiprazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Apalutamide is a strong CYP3A4 inducer and lowers brexpiprazole exposure, since brexpiprazole is cleared by CYP3A4 and CYP2D6. This can lead to loss of antipsychotic efficacy and relapse.
How serious is the interaction between Apalutamide and Brexpiprazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Brexpiprazole labeling advises doubling the dose when a strong CYP3A4 inducer is added, with reduction back to the usual dose if the inducer is stopped. Monitor clinical response, or consider an alternative to apalutamide where possible.
What other medicines interact with Brexpiprazole?
MediHelp also lists interactions of Brexpiprazole with, for example, Alfentanil, Amisulpride, Atazanavir. The full list is on the Brexpiprazole page.
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