Drug Interaction Report

Mitapivat and Mifepristone: Interaction Details

A pharmacist-reviewed analysis of the Mitapivat and Mifepristone interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Mifepristone

Korlym Mifeprex
+

Mitapivat

Aqvesme Pyrukynd Pyrukynd®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
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.

Of 295 documented Mitapivat interactions, 262 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
unspecified
Evidence
theoretical
Severity
Major

What happens

Increased CYP3A4 substrates exposure, reduced miFEPRIStone exposure and reduced efficacy of miFEPRIStone

Interaction Deep Dive

Avoid coadministration of miFEPRIStone and strong and moderate CYP3A4 inducer1. Assess for miFEPRIStone efficacy following coadministration as apalutamide may induce miFEPRIStone metabolism 2, potentially resulting in reduced miFEPRIStone efficacy 1. Use extreme caution when miFEPRIStone (strong CYP3A4 inhibitor) is coadministered with drugs that have high first pass metabolism via CYP3A4, as it may increase CYP3A4 substrates exposure. Use the lowest dose and/or decreased frequency with therapeutic monitoring. Prefer alternative drugs without these metabolic characteristics when possible. Wait at least 2 weeks after stopping miFEPRIStone before initiating strong and moderate CYP3A4 inducer that also are CYP3A4 substrates 1.

Why it happens (mechanism)

Inhibition of CYP3A4-mediated metabolism by miFEPRIStone; induction of CYP3A4-mediated metabolism of miFEPRIStone

Common questions

Can I take Mitapivat and Mifepristone together?

Increased CYP3A4 substrates exposure, reduced miFEPRIStone exposure and reduced efficacy of miFEPRIStone Always confirm with your pharmacist or prescriber before making any change.

How serious is the Mitapivat and Mifepristone 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 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 Mitapivat or Mifepristone 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)

  1. Product Information: KORLYM(R) oral tablets, mifepristone oral tablets. Corcept Therapeutics Incorporated (per Dailmed), Redwood City, CA, 2024. DailyMed
  2. Product Information: MIFEPREX(R) oral tablets, mifepristone oral tablets. Danco Laboratories, LLC (per FDA), New York, NY, 2023. DailyMed
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Mifepristone

Keep reading about Mifepristone

All Mifepristone interactions (225)
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Mitapivat

Keep reading about Mitapivat

All Mitapivat interactions (295) Mitapivat drug information
Also serious with: Mavacamten Ranolazine Ensitrelvir Zoliflodacin
Beyond drug–drug

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:

Mifepristone + Activated Charcoal American Hellebore Arsenic Cesium Ephedra Grapefruit Sida Cordifolia St. John's Wort + 143 more
Mitapivat + Activated Charcoal Grapefruit St. John's Wort Acacia Rigidula Adrafinil African Wild Potato Alkanna Alpine Ragwort + 146 more

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.