Drug interactions
Apalutamide + Eplerenone
Severity: Major
Apalutamide and Eplerenone: 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 substantially lowers exposure to eplerenone, which is a CYP3A4 substrate. This can lead to loss of blood pressure control or of the heart failure benefit of eplerenone.
What this interaction means in plain words
Apalutamide and Eplerenone 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; Eplerenone belongs to Cardiovascular.
Why it happens
Apalutamide induces CYP3A4, increasing the metabolism of eplerenone and reducing its plasma concentrations.
What to do
Avoid the combination where possible and choose an alternative agent that is not CYP3A4-dependent. If it must be used, monitor blood pressure, potassium and clinical response, and adjust the eplerenone dose.
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 Eplerenone
- Amiloride + Eplerenone Contraindicated
- Atazanavir + Eplerenone Contraindicated
- Clarithromycin + Eplerenone Contraindicated
- Cobicistat + Eplerenone Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Eplerenone Contraindicated
- Ensitrelvir + Eplerenone 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 Eplerenone?
MediHelp rates the interaction as major. Apalutamide and Eplerenone 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 substantially lowers exposure to eplerenone, which is a CYP3A4 substrate. This can lead to loss of blood pressure control or of the heart failure benefit of eplerenone.
How serious is the interaction between Apalutamide and Eplerenone?
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 the combination where possible and choose an alternative agent that is not CYP3A4-dependent. If it must be used, monitor blood pressure, potassium and clinical response, and adjust the eplerenone dose.
What other medicines interact with Eplerenone?
MediHelp also lists interactions of Eplerenone with, for example, Amiloride, Atazanavir, Clarithromycin. The full list is on the Eplerenone page.
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