Drug interactions
Apalutamide + Nelfinavir
Severity: Major
Apalutamide and Nelfinavir: 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 is a strong inducer of CYP3A4 and CYP2C19 and can substantially lower nelfinavir exposure. Reduced nelfinavir levels may lead to loss of virologic control and development of HIV resistance.
What this interaction means in plain words
Apalutamide and Nelfinavir 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; Nelfinavir belongs to Anti Virals.
Why it happens
Apalutamide induces CYP3A4 and CYP2C19, which metabolize nelfinavir, increasing its clearance.
What to do
Avoid the combination where possible and choose an antiretroviral regimen without dependence on these enzymes. If coadministration is unavoidable, monitor HIV viral load and consider therapeutic drug monitoring.
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 Apalutamide
- Apalutamide + Cabotegravir Contraindicated
- Apalutamide + Cobicistat Contraindicated
- Apalutamide + Doravirine Contraindicated
- Apalutamide + Elbasvir / grazoprevir Contraindicated
- Apalutamide + Ensitrelvir Contraindicated
- Apalutamide + Fostemsavir Contraindicated
Other interactions of Nelfinavir
- Alfuzosin + Nelfinavir Contraindicated
- Avanafil + Nelfinavir Contraindicated
- Dronedarone + Nelfinavir Contraindicated
- Eletriptan + Nelfinavir Contraindicated
- Ergotamine + Nelfinavir Contraindicated
- Flibanserin + Nelfinavir Contraindicated
Frequently asked questions
Can I take Apalutamide with Nelfinavir?
MediHelp rates the interaction as major. Apalutamide and Nelfinavir 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 CYP2C19 and can substantially lower nelfinavir exposure. Reduced nelfinavir levels may lead to loss of virologic control and development of HIV resistance.
How serious is the interaction between Apalutamide and Nelfinavir?
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 antiretroviral regimen without dependence on these enzymes. If coadministration is unavoidable, monitor HIV viral load and consider therapeutic drug monitoring.
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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