Drug interactions
Apalutamide + Levoketoconazole
Severity: Moderate
Apalutamide and Levoketoconazole: moderate 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
Levoketoconazole is cleared mainly by CYP3A4 and other pathways, and apalutamide induces CYP3A4. Reduced levoketoconazole exposure may weaken cortisol control in Cushing syndrome. Levoketoconazole is also a CYP3A4 inhibitor, which could modestly increase apalutamide exposure.
What this interaction means in plain words
Apalutamide and Levoketoconazole can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Apalutamide belongs to Endocrine; Levoketoconazole belongs to Endocrine.
Why it happens
Apalutamide induces CYP3A4 and other metabolic enzymes, increasing the clearance of levoketoconazole.
What to do
Monitor urinary free cortisol and clinical response, and adjust the levoketoconazole dose if needed. Watch for apalutamide adverse effects.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Levoketoconazole
- Alfuzosin + Levoketoconazole Contraindicated
- Alprazolam + Levoketoconazole Contraindicated
- Amiodarone + Levoketoconazole Contraindicated
- Avanafil + Levoketoconazole Contraindicated
- Cisapride + Levoketoconazole Contraindicated
- Clarithromycin + Levoketoconazole Contraindicated
Frequently asked questions
Can I take Apalutamide with Levoketoconazole?
MediHelp rates the interaction as moderate. Apalutamide and Levoketoconazole can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Levoketoconazole is cleared mainly by CYP3A4 and other pathways, and apalutamide induces CYP3A4. Reduced levoketoconazole exposure may weaken cortisol control in Cushing syndrome. Levoketoconazole is also a CYP3A4 inhibitor, which could modestly increase apalutamide exposure.
How serious is the interaction between Apalutamide and Levoketoconazole?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor urinary free cortisol and clinical response, and adjust the levoketoconazole dose if needed. Watch for apalutamide adverse effects.
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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