Drug interactions
Apalutamide + Ritonavir
Severity: Major
Apalutamide and Ritonavir: 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 can lower ritonavir concentrations, which may reduce its pharmacokinetic boosting effect on partner protease inhibitors. This risks virologic failure and resistance.
What this interaction means in plain words
Apalutamide and Ritonavir 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; Ritonavir belongs to Anti Virals.
Why it happens
Apalutamide induces CYP3A4 (and P-gp), increasing ritonavir clearance.
What to do
Avoid the combination if possible, or monitor HIV viral load closely and consider an alternative to apalutamide. Review the entire antiretroviral regimen, as other drugs are also affected.
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 Ritonavir
- Alfuzosin + Ritonavir Contraindicated
- Amiodarone + Ritonavir Contraindicated
- Avanafil + Ritonavir Contraindicated
- Colchicine + Ritonavir Contraindicated
- Dronedarone + Ritonavir Contraindicated
- Eletriptan + Ritonavir Contraindicated
Frequently asked questions
Can I take Apalutamide with Ritonavir?
MediHelp rates the interaction as major. Apalutamide and Ritonavir 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 can lower ritonavir concentrations, which may reduce its pharmacokinetic boosting effect on partner protease inhibitors. This risks virologic failure and resistance.
How serious is the interaction between Apalutamide and Ritonavir?
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, or monitor HIV viral load closely and consider an alternative to apalutamide. Review the entire antiretroviral regimen, as other drugs are also affected.
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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