Clopidogrel and Apalutamide: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Clopidogrel
Apalutamide
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
Increased clopidogrel active metabolite exposure, an increased platelet inhibition and reduced clopidogrel exposure
Interaction Deep Dive
Avoid coadministration of clopidogrel and apalutamide (strong CYP2C19 inducer), as it may result in increased clopidogrel active metabolite exposure and increased platelet inhibition which could potentiate the risk of bleeding1. Concomitant use of apalutamide with clopidogrel (CYP2C19 substrate) may also result in reduced clopidogrel exposure. Substitution of the medication primarily metabolized by CYP2C19 is recommended during apalutamide therapy. If coadministration is required, evaluate patient for loss of substrate activity 2.
Why it happens (mechanism)
Induction of CYP2C19-mediated metabolism of clopidogrel
Literature reports
2 reports — tap to read
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.
b) Coadministration of a single dose of apalutamide with omeprazole, CYP2C19 substrate, resulted in a 85% decrease in the omeprazole AUC 3.
Common questions
Can I take Clopidogrel and Apalutamide together?
Increased clopidogrel active metabolite exposure, an increased platelet inhibition and reduced clopidogrel exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clopidogrel 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 "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
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 Clopidogrel 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 (3)
- Product Information: PLAVIX(R) oral tablets, clopidogrel bisulfate oral tablets. sanofi-aventis US LLC (per FDA), Bridgewater, NJ, 2022. DailyMed
- Product Information: ERLEADA(R) oral tablets, apalutamide oral tablets. Janssen Products LP (per FDA), Horsham, PA, 2024. DailyMed
- Product Information: Erleada(TM) oral tablets, apalutamide oral tablets. Janssen Products, LP (per FDA), Horsham, PA, 2018. DailyMed
Keep reading about Clopidogrel
Keep reading about Apalutamide
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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