Clopidogrel with Apalutamide Interaction Details
Brand Names Associated with Clopidogrel
- Clopidogrel
- Plavix®
Brand Names Associated with Apalutamide
- Apalutamide
- Erleada®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Mar 04, 2024
Interaction Effect
Increased clopidogrel active metabolite exposure and increased platelet inhibition
Interaction Summary
Coadministration of clopidogrel and strong CYP2C19 inducers results in increased clopidogrel active metabolite exposure. In a study of healthy adults, coadministration of rifampin, a strong CYP2C19 inducer, with a 600-mg loading dose of clopidogrel increased the AUC and Cmax of clopidogrel metabolites by 3.8-fold. Additionally, the mean inhibition of platelet aggregation at 4 hours post-dose was 34% higher in the presence of rifampin compared to administration of clopidogrel alone. Increased inhibition of platelet aggregation could potentiate the risk of bleeding. Avoid concomitant use of clopidogrel with strong CYP2C19 inducers[1].
Severity
Major
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Coadministration of clopidogrel and strong CYP2C19 inducers results in increased clopidogrel active metabolite exposure and increased platelet inhibition which could potentiate the risk of bleeding. Avoid concomitant use of clopidogrel with strong CYP2C19 inducers[1].
Mechanism Of Interaction
Induction of CYP2C19-mediated metabolism of clopidogrel to active metabolite
Literature Reports
A) Coadministration of rifampin 300 mg twice daily for 7 days with a single 600-mg loading dose of clopidogrel in healthy adults increased the mean AUC and Cmax of clopidogrel metabolites by 3.8-fold due to CYP2C19 induction by rifampin. Compared to administration of clopidogrel alone, the mean inhibition of platelet aggregation at 4 hours post-dose was 34% higher in the presence of rifampin [1].
References
1 ) Product Information: PLAVIX(R) oral tablets, clopidogrel bisulfate oral tablets. Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership (per FDA), Bridgewater, NJ, 2021.
Clopidogrel Overview
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Clopidogrel is used alone or with aspirin to prevent serious or life-threatening problems with the heart and blood vessels in people who have had a stroke, heart attack, or severe chest pain. This includes people who have percutaneous coronary intervention (PCI; angioplasty; a type of heart surgery) that may involve inserting coronary stents (metal tubes surgically placed in clogged blood vessels to improve blood flow) or who have coronary artery bypass grafting (CABG; a type of heart surgery). Clopidogrel is also used to prevent serious or life-threatening problems with the heart and blood vessels in people who have peripheral arterial disease (poor circulation in the blood vessels that supply blood to the legs). Clopidogrel is in a class of medications called antiplatelet medications. It works by preventing platelets (a type of blood cell) from collecting and forming clots that may cause a heart attack or stroke.
Apalutamide Overview
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Apalutamide is used to treat certain types of prostate cancer (cancer in men that begins in the prostate [a male reproductive gland]) and has spread to other parts of the body or that has not spread to other parts of the body but has not been helped by other medical treatments. Apalutamide is in a class of medications called androgen receptor inhibitors. It works by blocking the effects of androgen (a male reproductive hormone) to stop the growth and spread of cancer cells.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.