Drug interactions
Apalutamide + Cyclosporin
Severity: Major
Apalutamide and Cyclosporin: major interaction.
Last updated Sources: US FDA label
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 strongly induces CYP3A4 and P-glycoprotein and can sharply lower cyclosporine concentrations. This risks loss of immunosuppression, with graft rejection or flares of the underlying disease.
What this interaction means in plain words
Apalutamide and Cyclosporin 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; Cyclosporin belongs to Miscellaneous.
Why it happens
Induction of CYP3A4 and P-glycoprotein by apalutamide increases cyclosporine metabolism and efflux.
What to do
Avoid if possible. If coadministered, measure cyclosporine trough levels frequently and increase the dose as needed, with reassessment after apalutamide is stopped.
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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References
Other interactions of Cyclosporin
- Adenovirus types 4 and 7 live + Cyclosporin Contraindicated
- Aliskiren + Cyclosporin Contraindicated
- Bcg vaccine live + Cyclosporin Contraindicated
- Bosentan + Cyclosporin Contraindicated
- Cidofovir + Cyclosporin Contraindicated
- Cyclosporin + Dengue vaccine Contraindicated
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 Cyclosporin?
MediHelp rates the interaction as major. Apalutamide and Cyclosporin 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 strongly induces CYP3A4 and P-glycoprotein and can sharply lower cyclosporine concentrations. This risks loss of immunosuppression, with graft rejection or flares of the underlying disease.
How serious is the interaction between Apalutamide and Cyclosporin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid if possible. If coadministered, measure cyclosporine trough levels frequently and increase the dose as needed, with reassessment after apalutamide is stopped.
What other medicines interact with Cyclosporin?
MediHelp also lists interactions of Cyclosporin with, for example, Adenovirus types 4 and 7 live, Aliskiren, Bcg vaccine live. The full list is on the Cyclosporin page.
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