Drug interactions
Enzalutamide + Siponimod
Severity: Major
Enzalutamide and Siponimod: major interaction.
Last updated Sources: EMA SmPC
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
Enzalutamide is a strong CYP3A4 inducer and a moderate CYP2C9 inducer, which can significantly lower siponimod exposure. Loss of efficacy is more likely in patients with CYP2C9*1/*3 or *2/*3 genotype.
What this interaction means in plain words
Enzalutamide and Siponimod 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.
Enzalutamide belongs to Endocrine; Siponimod belongs to Central Nervous System.
Why it happens
Enzalutamide induces CYP3A4 and CYP2C9, increasing siponimod clearance.
What to do
Avoid the combination because siponimod labeling advises against it. If it cannot be avoided, monitor closely for reduced efficacy and lymphocyte counts.
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 Siponimod
- Cladribine + Siponimod Contraindicated
- Fingolimod + Siponimod Contraindicated
- Fluconazole + Siponimod Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Siponimod Contraindicated
- Ponesimod + Siponimod Contraindicated
- Siponimod + Thioridazine Contraindicated
Other interactions of Enzalutamide
- Doravirine + Enzalutamide Contraindicated
- Elbasvir / grazoprevir + Enzalutamide Contraindicated
- Ensitrelvir + Enzalutamide Contraindicated
- Enzalutamide + Fostemsavir Contraindicated
- Enzalutamide + Isavuconazonium Contraindicated
- Enzalutamide + Lenacapavir Contraindicated
Frequently asked questions
Can I take Enzalutamide with Siponimod?
MediHelp rates the interaction as major. Enzalutamide and Siponimod 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. Enzalutamide is a strong CYP3A4 inducer and a moderate CYP2C9 inducer, which can significantly lower siponimod exposure. Loss of efficacy is more likely in patients with CYP2C9*1/*3 or *2/*3 genotype.
How serious is the interaction between Enzalutamide and Siponimod?
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 because siponimod labeling advises against it. If it cannot be avoided, monitor closely for reduced efficacy and lymphocyte counts.
What other medicines interact with Siponimod?
MediHelp also lists interactions of Siponimod with, for example, Cladribine, Fingolimod, Fluconazole. The full list is on the Siponimod page.
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