Drug interactions
Apalutamide + Zonisamide
Severity: Moderate
Apalutamide and Zonisamide: 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
Apalutamide is a strong CYP3A4 inducer and may reduce zonisamide concentrations, which could lead to loss of seizure control. Zonisamide is metabolized partly by CYP3A4.
What this interaction means in plain words
Apalutamide and Zonisamide 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; Zonisamide belongs to Central Nervous System.
Why it happens
CYP3A4 induction by apalutamide increases zonisamide metabolic clearance.
What to do
Monitor seizure control and zonisamide levels where available, and increase the zonisamide dose if needed. Reassess the dose if apalutamide is stopped.
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 Zonisamide
- Zonisamide + Zuranolone Major
- Acetazolamide + Zonisamide Moderate
- Amisulpride + Zonisamide Moderate
- Amobarbital + Zonisamide Moderate
- Asenapine transdermal + Zonisamide Moderate
- Asenapine + Zonisamide Moderate
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 Zonisamide?
MediHelp rates the interaction as moderate. Apalutamide and Zonisamide 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 is a strong CYP3A4 inducer and may reduce zonisamide concentrations, which could lead to loss of seizure control. Zonisamide is metabolized partly by CYP3A4.
How serious is the interaction between Apalutamide and Zonisamide?
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 seizure control and zonisamide levels where available, and increase the zonisamide dose if needed. Reassess the dose if apalutamide is stopped.
What other medicines interact with Zonisamide?
MediHelp also lists interactions of Zonisamide with, for example, Zuranolone, Acetazolamide, Amisulpride. The full list is on the Zonisamide page.
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