Drug interactions
Apalutamide + Netupitant-palonosetron
Severity: Major
Apalutamide and Netupitant-palonosetron: 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 can substantially reduce netupitant exposure, which relies on CYP3A4 for clearance. This may reduce antiemetic efficacy and risk breakthrough nausea and vomiting.
What this interaction means in plain words
Apalutamide and Netupitant-palonosetron 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; Netupitant-palonosetron belongs to Gastrointestinal Tract.
Why it happens
CYP3A4 induction by apalutamide increases netupitant metabolism and lowers its concentrations.
What to do
Avoid the combination where possible and use an alternative antiemetic regimen. If co-used, monitor for loss of antiemetic control.
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 Netupitant-palonosetron
- Apomorphine + Netupitant-palonosetron Contraindicated
- Flibanserin + Netupitant-palonosetron Contraindicated
- Avapritinib + Netupitant-palonosetron Major
- Carbamazepine + Netupitant-palonosetron Major
- Cobimetinib + Netupitant-palonosetron Major
- Encorafenib + Netupitant-palonosetron Major
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 Netupitant-palonosetron?
MediHelp rates the interaction as major. Apalutamide and Netupitant-palonosetron 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 can substantially reduce netupitant exposure, which relies on CYP3A4 for clearance. This may reduce antiemetic efficacy and risk breakthrough nausea and vomiting.
How serious is the interaction between Apalutamide and Netupitant-palonosetron?
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 use an alternative antiemetic regimen. If co-used, monitor for loss of antiemetic control.
What other medicines interact with Netupitant-palonosetron?
MediHelp also lists interactions of Netupitant-palonosetron with, for example, Apomorphine, Flibanserin, Avapritinib. The full list is on the Netupitant-palonosetron page.
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