Drug interactions
Apalutamide + Methadone
Severity: Major
Apalutamide and Methadone: 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 inducer of CYP3A4 and can lower methadone concentrations. This may cause reduced analgesia or opioid withdrawal in patients on methadone maintenance. When apalutamide is stopped, methadone levels may rise again.
What this interaction means in plain words
Apalutamide and Methadone 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; Methadone belongs to Musculoskeletal.
Why it happens
Induction of CYP3A4 (and possibly CYP2B6) by apalutamide increases methadone metabolism.
What to do
Monitor closely for withdrawal symptoms and loss of effect, and titrate methadone upward as needed. Reassess the dose and watch for sedation or respiratory depression when apalutamide is discontinued.
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 Methadone
- Alvimopan + Methadone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Methadone Contraindicated
- Droperidol + Methadone Contraindicated
- Ibutilide + Methadone Contraindicated
- Isocarboxazid + Methadone Contraindicated
- Lefamulin + Methadone 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 Methadone?
MediHelp rates the interaction as major. Apalutamide and Methadone 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 inducer of CYP3A4 and can lower methadone concentrations. This may cause reduced analgesia or opioid withdrawal in patients on methadone maintenance. When apalutamide is stopped, methadone levels may rise again.
How serious is the interaction between Apalutamide and Methadone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor closely for withdrawal symptoms and loss of effect, and titrate methadone upward as needed. Reassess the dose and watch for sedation or respiratory depression when apalutamide is discontinued.
What other medicines interact with Methadone?
MediHelp also lists interactions of Methadone with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Droperidol. The full list is on the Methadone page.
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