Enzalutamide and Apixaban: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Aug 8, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Enzalutamide
Apixaban
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.
Let's talk about taking Eliquis (apixaban), your blood thinner, together with Xtandi (enzalutamide), a prostate cancer medicine. These two can pull your apixaban level in opposite directions. Enzalutamide can speed up how your body breaks down apixaban, which could make it too weak and raise the risk of a clot. At the same time, enzalutamide can block a transporter that removes apixaban, which could push its level up and raise the risk of bleeding.
Because it can swing either way, this pairing is one doctors usually try to avoid. The good news: please don't change anything on your own. Your care team can review your medicines and choose a safe plan for you.
Effect: Altered apixaban exposure (net direction unpredictable). Apixaban is a substrate of both CYP3A4 and P-gp. Enzalutamide is a strong CYP3A4 inducer (would decrease apixaban AUC, raising thrombotic risk) and also a P-gp inhibitor (would increase apixaban exposure, raising bleeding risk).
- Direction: Opposing mechanisms; net effect uncertain.
- Evidence: Theoretical.
- Severity: Major.
- Onset: Unspecified; induction typically develops over days to weeks.
- Management: Avoid coadministration. If unavoidable, involve the prescriber to individualize therapy and monitor closely for both thrombotic and bleeding signs.
What happens
Altered apixaban exposure
Interaction Deep Dive
When apixaban (which serves as a substrate for both CYP3A4 and P-gp) is given together with a potent CYP3A4 inducer like enzalutamide, apixaban exposure may fall, raising the likelihood of thrombotic events2; because enzalutamide additionally inhibits P-gp, the combination could instead raise apixaban exposure and heighten the risk of bleeding events 1. The concurrent use of apixaban and enzalutamide should be avoided 21.
Why it happens (mechanism)
Induction of CYP3A4-mediated apixaban metabolism; inhibition of P-gp-mediated efflux transport of apixaban
How to manage this interaction
The main guidance here is to avoid using these two together. Because apixaban is a narrow-margin blood thinner, both a drop in its level (clot risk) and a rise (bleeding risk) matter.
- Keep taking both exactly as prescribed until your care team advises otherwise. Do not stop or adjust either one on your own.
- Ask your pharmacist or prescriber to review this combination. They may choose an alternative medicine or, if both are truly needed, individualize your therapy and monitor you more closely.
- Watch for and report unusual bleeding or bruising, or any signs of a clot such as swelling, leg pain, chest pain, or shortness of breath.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Enzalutamide and Apixaban together?
Enzalutamide can shift your apixaban level either up (bleeding risk) or down (clot risk), so this combo is generally avoided. Do not change anything yourself, ask your pharmacist or doctor to review it. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Enzalutamide and Apixaban 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 Enzalutamide and Apixaban interaction managed?
The main guidance here is to avoid using these two together. Because apixaban is a narrow-margin blood thinner, both a drop in its level (clot risk) and a rise (bleeding risk) matter. Keep taking both exactly as prescribed until your care team advises otherwise. Do not stop or adjust either one on your own. Ask your pharmacist or prescriber to review this combination. They may choose an alternativ… 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 Enzalutamide or Apixaban 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 (2)
- Steffel J, Collins R, Antz M, et al: 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021; 23(10):1612-1676.
- Mar PL, Gopinathannair R, Gengler BE, et al: Drug interactions affecting oral anticoagulant use. Circ Arrhythm Electrophysiol 2022; 15(6):e007956. PubMed
Keep reading about Enzalutamide
Keep reading about Apixaban
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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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