Abrocitinib and Apalutamide: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Apalutamide
Abrocitinib
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.
Here's what's going on. Apalutamide (Erleada) speeds up some of the liver enzymes that break down abrocitinib (Cibinqo), the medicine used for eczema. When those enzymes work faster, your body clears abrocitinib more quickly, so there is less of it in your blood.
The likely result is that abrocitinib may not work as well, and your eczema symptoms like itching and skin flares could come back or not improve as expected. This is based mostly on how these drugs behave in theory, not on a large study. The good news is your care team can plan around it, so don't stop either medicine on your own. Just let your doctor or pharmacist know you take both.
Effect: Apalutamide, a strong enzyme inducer, is expected to reduce exposure of abrocitinib and its active metabolites.
Mechanism: Induction of CYP2C19 and CYP2C9-mediated abrocitinib metabolism, increasing clearance and lowering plasma concentrations (reduced PD response). Neither agent is enhanced here; this is loss of efficacy, not toxicity.
- Magnitude: Extrapolated from rifampin data (Cmax down ~31%, AUC down ~56%).
- Onset: Unspecified; enzyme induction typically develops over days to weeks.
- Evidence: Theoretical.
- Management: Avoid concomitant use with strong CYP2C19/CYP2C9 inducers; if unavoidable, monitor for reduced clinical response.
What happens
Decreased abrocitinib and active metabolite exposure
Interaction Deep Dive
When abrocitinib is given together with potent inducers of CYP2C19 or CYP2C9, the exposure to abrocitinib along with its active metabolites can be reduced, potentially causing a diminished or lost clinical response. In one instance, combining rifampin (a strong inducer of CYP2C19) with abrocitinib produced a 31% reduction in Cmax and a 56% reduction in AUC for abrocitinib and its active metabolites. Concurrent administration of abrocitinib with strong CYP2C19 or CYP2C9 inducers should be avoided1.
Why it happens (mechanism)
Induction of CYP2C19 and CYP2C9-mediated abrocitinib metabolism
How to manage this interaction
What your care team may do:
- Because apalutamide can lower abrocitinib levels, prescribers generally try to avoid using these two together when possible.
- If both are needed, your team may watch your eczema response more closely and individualize your plan.
What you should do:
- Keep taking both exactly as prescribed unless your doctor tells you otherwise.
- Tell your pharmacist or prescriber that you take both, and mention if your skin symptoms return or stop improving.
- Do not adjust or stop either medicine on your own.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) Giving rifampin 600 mg once daily for 8 days (a strong CYP2C19 inducer) together with abrocitinib 200 mg produced a 31% reduction in Cmax and a 56% reduction in AUC(infinity) of abrocitinib and its active metabolites 1.
Common questions
Can I take Abrocitinib and Apalutamide together?
Apalutamide can make abrocitinib less effective by speeding up its breakdown, so your eczema may not stay controlled. Prescribers usually avoid this combination, so check with your doctor or pharmacist before using both. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abrocitinib 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 is the Abrocitinib and Apalutamide interaction managed?
What your care team may do: Because apalutamide can lower abrocitinib levels, prescribers generally try to avoid using these two together when possible. If both are needed, your team may watch your eczema response more closely and individualize your plan. What you should do: Keep taking both exactly as prescribed unless your doctor tells you otherwise. Tell your pharmacist or prescriber that you t… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Abrocitinib 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 (1)
- Product Information: CIBINQO(TM) oral tablets, abrocitinib oral tablets. Pfizer Labs (per FDA), New York, NY, 2022. DailyMed
Keep reading about Apalutamide
Keep reading about Abrocitinib
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