Drug interactions
Enzalutamide + Tacrolimus
Severity: Major
Enzalutamide and Tacrolimus: 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 can substantially lower tacrolimus blood concentrations. Subtherapeutic tacrolimus increases the risk of graft rejection or loss of immunosuppressive control.
What this interaction means in plain words
Enzalutamide and Tacrolimus 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; Tacrolimus belongs to Miscellaneous.
Why it happens
Induction of intestinal and hepatic CYP3A4 (and P-glycoprotein) increases tacrolimus clearance.
What to do
Avoid the combination if possible; if unavoidable, monitor tacrolimus trough levels frequently and increase the dose as needed. Re-adjust the dose downward when enzalutamide is stopped, as induction wanes over weeks.
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 Tacrolimus
- Adenovirus types 4 and 7 live + Tacrolimus Contraindicated
- Bcg vaccine live + Tacrolimus Contraindicated
- Cidofovir + Tacrolimus Contraindicated
- Cyclosporin + Tacrolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Tacrolimus Contraindicated
- Measles mumps and rubella vaccine live + Tacrolimus Contraindicated
Frequently asked questions
Can I take Enzalutamide with Tacrolimus?
MediHelp rates the interaction as major. Enzalutamide and Tacrolimus 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 can substantially lower tacrolimus blood concentrations. Subtherapeutic tacrolimus increases the risk of graft rejection or loss of immunosuppressive control.
How serious is the interaction between Enzalutamide and Tacrolimus?
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; if unavoidable, monitor tacrolimus trough levels frequently and increase the dose as needed. Re-adjust the dose downward when enzalutamide is stopped, as induction wanes over weeks.
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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