Drug interactions
Enzalutamide + Sirolimus
Severity: Major
Enzalutamide and Sirolimus: 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
Sirolimus is a CYP3A4 and P-gp substrate, and strong inducers markedly lower its blood concentrations. This may cause under-immunosuppression and graft rejection.
What this interaction means in plain words
Enzalutamide and Sirolimus 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; Sirolimus belongs to Miscellaneous.
Why it happens
Enzalutamide induces CYP3A4 and P-gp, increasing sirolimus clearance.
What to do
Avoid if possible. If it is unavoidable, monitor sirolimus trough levels frequently and adjust the dose, with re-adjustment after enzalutamide is stopped.
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 Enzalutamide
- Doravirine + Enzalutamide Contraindicated
- Elbasvir / grazoprevir + Enzalutamide Contraindicated
- Ensitrelvir + Enzalutamide Contraindicated
- Enzalutamide + Fostemsavir Contraindicated
- Enzalutamide + Isavuconazonium Contraindicated
- Enzalutamide + Lenacapavir Contraindicated
Other interactions of Sirolimus
- Adenovirus types 4 and 7 live + Sirolimus Contraindicated
- Bcg vaccine live + Sirolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Sirolimus Contraindicated
- Ketoconazole + Sirolimus Contraindicated
- Levoketoconazole + Sirolimus Contraindicated
- Measles mumps and rubella vaccine live + Sirolimus Contraindicated
Frequently asked questions
Can I take Enzalutamide with Sirolimus?
MediHelp rates the interaction as major. Enzalutamide and Sirolimus 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. Sirolimus is a CYP3A4 and P-gp substrate, and strong inducers markedly lower its blood concentrations. This may cause under-immunosuppression and graft rejection.
How serious is the interaction between Enzalutamide and Sirolimus?
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 if possible. If it is unavoidable, monitor sirolimus trough levels frequently and adjust the dose, with re-adjustment after enzalutamide is stopped.
What other medicines interact with Enzalutamide?
MediHelp also lists interactions of Enzalutamide with, for example, Doravirine, Elbasvir / grazoprevir, Ensitrelvir. The full list is on the Enzalutamide page.
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