Drug interactions
Apalutamide + Larotrectinib
Severity: Major
Apalutamide and Larotrectinib: 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, a strong CYP3A4 inducer, can lower larotrectinib plasma concentrations because larotrectinib is mainly cleared by CYP3A4. This may reduce its antitumor activity.
What this interaction means in plain words
Apalutamide and Larotrectinib 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; Larotrectinib belongs to Oncology.
Why it happens
Apalutamide induces CYP3A4, increasing the metabolic clearance of larotrectinib.
What to do
Avoid the combination if possible. If it is unavoidable, double the larotrectinib dose and return to the previous dose after the inducer has been stopped for about 3 to 5 half-lives.
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 Apalutamide
- Apalutamide + Cabotegravir Contraindicated
- Apalutamide + Cobicistat Contraindicated
- Apalutamide + Doravirine Contraindicated
- Apalutamide + Elbasvir / grazoprevir Contraindicated
- Apalutamide + Ensitrelvir Contraindicated
- Apalutamide + Fostemsavir Contraindicated
Other interactions of Larotrectinib
Frequently asked questions
Can I take Apalutamide with Larotrectinib?
MediHelp rates the interaction as major. Apalutamide and Larotrectinib 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, a strong CYP3A4 inducer, can lower larotrectinib plasma concentrations because larotrectinib is mainly cleared by CYP3A4. This may reduce its antitumor activity.
How serious is the interaction between Apalutamide and Larotrectinib?
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 if possible. If it is unavoidable, double the larotrectinib dose and return to the previous dose after the inducer has been stopped for about 3 to 5 half-lives.
What other medicines interact with Apalutamide?
MediHelp also lists interactions of Apalutamide with, for example, Cabotegravir, Cobicistat, Doravirine. The full list is on the Apalutamide page.
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