Clindamycin and Enzalutamide: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 1, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Enzalutamide
Clindamycin
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. Enzalutamide (Xtandi) speeds up a liver enzyme called CYP3A4 that helps break down many other medicines. Clindamycin, an antibiotic, is partly cleared by that same enzyme. So when you take them together, your body may clear the clindamycin faster than usual, which could leave you with less antibiotic in your system than you need to fully treat an infection.
The good news is this is a theoretical concern, meaning it's based on how the drugs work rather than lots of real-world reports. Your care team can manage it, sometimes by adjusting the antibiotic dose or watching your infection more closely. Please don't change anything on your own, just check in with your pharmacist or doctor.
Mechanism: Enzalutamide is a strong CYP3A4 inducer; clindamycin is a CYP3A4 substrate. Induction increases clindamycin metabolism, lowering its exposure (AUC/Cmax) and risking subtherapeutic antibiotic concentrations and treatment failure.
- Direction: Reduced clindamycin effect (efficacy loss).
- Evidence: Theoretical; magnitude not quantified.
- Onset: Unspecified; enzymatic induction typically develops over days to weeks.
- Severity on file: Major.
Management: Avoid coadministration where feasible. If unavoidable, the clindamycin dose may need to be increased and individualized, with closer monitoring of clinical response to therapy. Note enzalutamide induction can persist after discontinuation.
What happens
Reduced CYP3A4 substrates with NTI exposure and reduced efficacy of CYP3A4 substrates with NTI
Interaction Deep Dive
Coadministration of enzalutamide (a potent CYP3A inducer) with CYP3A4 substrates should be avoided when even a small decrease in concentration could lower the exposure of those substrates, potentially leading to their therapeutic failure. Should such coadministration be unavoidable, titrate the dosage of these substrates upward as necessary1.
Why it happens (mechanism)
Induction of CYP3A4-mediated metabolism by enzalutamide
How to manage this interaction
What your care team may do:
- Consider whether these two can be avoided together, or choose an alternative antibiotic if appropriate.
- If both are needed, the clindamycin dose may need to be adjusted and individualized by your team.
- Monitor your infection more closely to be sure the antibiotic is working.
What you should do:
- Keep taking both exactly as prescribed unless your prescriber tells you otherwise.
- Tell your pharmacist or doctor you take Xtandi so they can plan the antibiotic accordingly.
- Report if your infection isn't improving or seems to be getting worse.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Clindamycin and Enzalutamide together?
Enzalutamide can speed up how your body clears clindamycin, which may weaken the antibiotic's effect, so let your care team know you take both so they can adjust the dose or monitor your response. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clindamycin and Enzalutamide 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 Clindamycin and Enzalutamide interaction managed?
What your care team may do: Consider whether these two can be avoided together, or choose an alternative antibiotic if appropriate. If both are needed, the clindamycin dose may need to be adjusted and individualized by your team. Monitor your infection more closely to be sure the antibiotic is working. What you should do: Keep taking both exactly as prescribed unless your prescriber tells you othe… 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Clindamycin or Enzalutamide 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: XTANDI® oral capsules, oral tablets, enzalutamide oral capsules, oral tablets. Astellas Pharma US Inc (per FDA), Northbrook, IL, 2025. DailyMed
Keep reading about Enzalutamide
Keep reading about Clindamycin
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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