Abiraterone and Apalutamide: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Apalutamide
Abiraterone
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Reduced abiraterone exposure and reduced efficacy of abiraterone
Interaction Deep Dive
Concomitant use of abiraterone acetate (a CYP3A4 substrate) and a strong CYP3A4 inducer may result in decreased abiraterone exposure and should be avoided3. Coadministration with carBAMazepine decreased exposure of abiraterone by 67% respectively. Monitor abiraterone acetate plasma concentrations to ensure therapeutic exposure during necessary coadministration with a strong CYP3A4 inducer 4. Coadministration with rifAMPin decreased exposure of abiraterone by 55%. If a strong CYP3A4 inducer must be coadministered, increase the abiraterone acetate dosage frequency to twice a day during coadministration. If the strong CYP3A4 inducer is discontinued, resume the previous abiraterone acetate dose and frequency 21.
Why it happens (mechanism)
Induction of CYP3A4-mediated metabolism of abiraterone
Literature reports
2 reports — tap to read
a) A 65-year-old man with metastatic castration-resistant prostate cancer, treated with abiraterone acetate 1000 mg/day and prednisoLONE 10 mg, initiated on carBAMazepine 200 mg twice daily for treatment of facial neuropathy experienced a 67% decrease in abiraterone AUC and a 61% decrease in abiraterone trough concentration. The patient's other medications included paracetamol, leuprorelin, pantoprazole, calcium plus cholecalciferol, denosumab, clemastine, and fentaNYL. The patient had no PSA response, with a maximum PSA decline of 5% at 2 months following carBAMazepine initiation. Following discontinuation of carBAMazepine, the abiraterone exposure normalized. Using the Drug Interaction Probability Score (5 out of 9), this interaction is probable 4.
b) In a pharmacokinetic drug interaction study in healthy subjects receiving rifAMPin 600 mg daily for 6 days, a single dose of abiraterone acetate 1000 mg resulted in a decrease of 55% in the mean plasma AUC(infinity) of abiraterone 213.
Common questions
Can I take Abiraterone and Apalutamide together?
Reduced abiraterone exposure and reduced efficacy of abiraterone Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abiraterone and Apalutamide interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Abiraterone or Apalutamide need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (4)
- Product Information: ZYTIGA(R) oral tablets, abiraterone acetate oral tablets. Janssen Biotech Inc (per FDA), Horsham, PA, 2018. DailyMed
- Product Information: YONSA(R) oral tablets, abiraterone acetate oral tablets. Sun Pharmaceutical Industries Inc (per FDA), Cranbury, NJ, 2018. DailyMed
- Product Information: AKEEGA(TM) oral tablets, niraparib, abiraterone acetate oral tablets. Janssen Biotech, Inc. (per FDA), Horsham, PA, 2023. DailyMed
- Benoist GE, van der Doelen MJ, Ter Heine R, et al: A clinically relevant decrease in abiraterone exposure associated with carbamazepine use in a patient with castration-resistant metastatic prostate cancer. Br J Clin Pharmacol 2018; 84(5):1064-1067. PubMed
Keep reading about Apalutamide
Keep reading about Abiraterone
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