Key takeaways:
Erleada (apalutamide) is an oral tablet that treats certain types of prostate cancer. Some calcium channel blockers, anti-infective medications, and grapefruit juice can raise Erleada levels in the body if they’re taken together.
Erleada can lower the levels of some blood thinners, statins, and proton pump inhibitors if they’re combined. It also affects several mental health medications, calcium channel blockers, and digoxin (Lanoxin).
Be sure to review your medication list with your cancer care team before starting Erleada. And don’t start any new medications during Erleada treatment without making sure there isn’t an interaction concern.
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Erleada (apalutamide) is an oral tablet that treats certain types of prostate cancer. Your prescriber will likely review your medication list for any drug interactions before you start taking Erleada. But knowing about possible interactions can help you take an active role in protecting your safety during treatment.
Erleada interactions at a glance
Below are lists of some Erleada interactions to be aware of. Keep in mind that some medications can interact with Erleada in more than one way. These aren’t comprehensive lists of every possible interaction. So be sure to review your medication list with your prescriber before starting Erleada to avoid any issues.
Medications and substances that can raise Erleada levels in the body include:
Some oral antifungal medications, such as ketoconazole
Some antibiotics, such as erythromycin (Ery-Tab, E.E.S.)
Some antiviral medications, such as ritonavir (Norvir)
Grapefruit and grapefruit juice
Some calcium channel blockers, such as diltiazem (Cardizem)
Gemfibrozil (Lopid)
Clopidogrel (Plavix)
Erleada may lower the levels of other medications if they’re taken together. Examples include:
Proton pump inhibitors (PPIs), such as omeprazole (Prilosec)
Digoxin (Lanoxin)
Some benzodiazepines, such as alprazolam (Xanax)
Calcium channel blockers, such as amlodipine (Norvasc) and diltiazem
Some antidepressants, such as sertraline (Zoloft) and amitriptyline
Statins, such as atorvastatin (Lipitor)
Blood thinners, such as warfarin and apixaban (Eliquis)
Let’s take a look at eight Erleada interactions in greater detail.
1. Warfarin and other blood thinners
Erleada can lower the levels of many blood thinners if they’re taken together. These include warfarin and direct-acting oral anticoagulants (DOACs), such as apixaban. This interaction may make blood thinners less effective at preventing blood clots.
Your prescriber may adjust your blood thinner dosage to account for this interaction. Or they may have you keep a closer eye out for any signs or symptoms of a blood clot. Seek emergency care right away if you develop any of the following:
Swelling, pain, or redness in just one leg
Chest pain
Coughing up blood
Trouble breathing
Clopidogrel, an antiplatelet medication, can also increase Erleada levels in the body. Your prescriber may switch you to a different blood thinner or lower your Erleada dosage to manage this interaction.
2. Cholesterol medications
Statins are common medications prescribed to lower high cholesterol levels. Examples include:
Simvastatin (Zocor)
Lovastatin (Altoprev)
Erleada may lower statin levels in the body if they’re taken together. This can make your cholesterol medication less effective.
Your prescriber will likely keep an eye on your cholesterol levels while you’re taking Erleada. They can adjust your statin dosage or recommend other options to lower your cholesterol levels if needed.
Gemfibrozil is a different type of cholesterol-lowering medication that interacts with Erleada in a different way. It can increase Erleada levels in the body if they’re taken together. Your prescriber may lower your Erleada dosage or switch you to a different cholesterol medication to manage this interaction.
3. Calcium channel blockers
Calcium channel blockers are medications that can manage heart rate and blood pressure, among other heart-related conditions. Examples include:
Erleada may lower the levels of many calcium channel blockers if they’re taken together. Your prescriber may need to adjust your dose or change your medication to ensure your heart condition is properly treated while you’re taking Erleada.
Some calcium channel blockers, such as verapamil and diltiazem, may also increase Erleada levels if you take it with them. Your prescriber may lower your Erleada dosage or change your heart medication if needed to manage this interaction.
4. Some antidepressant and anxiety medications
Erleada can lower the levels of several antidepressant and anxiety medications, such as:
Nefazodone
Citalopram (Celexa)
Clomipramine (Anafranil)
Imipramine (Tofranil)
Triazolam (Halcion)
Diazepam (Valium)
This interaction can leave your mental health condition undertreated. Your prescriber may change your dosage or switch you to a different medication while you’re taking Erleada to avoid this issue. Or they may have you monitor your symptoms and let them know if your depression or anxiety issues are worsening.
5. Digoxin
Erleada can lower digoxin levels, which can make it less effective. Digoxin is a medication with a narrow therapeutic index. This means there’s a very small difference between an effective dose and an ineffective or toxic dose. So in most cases, your prescriber will monitor your digoxin levels closely to ensure they stay within the desired range.
Erleada can also interfere with certain lab tests used to monitor digoxin levels. So it’s important that your prescriber is aware you’re taking Erleada. This will let them know they need to order specific lab testing to ensure your digoxin level results are accurate.
6. Some oral antifungals, antibiotics, and antiviral medications
Several anti-infectives can increase Erleada levels in the body. These include oral antifungals, antibiotics, and antivirals such as:
Ciprofloxacin (Cipro)
Clarithromycin (Biaxin)
Fluconazole (Diflucan)
Itraconazole (Sporanox)
Indinavir (Crixivan)
Ritonavir or medications that contain it, such as Paxlovid (nirmatrelvir / ritonavir)
You may need a lower Erleada dosage if you’re taking it along with one of these medications long term. If you’re taking a short course of an anti-infective, your prescriber may just monitor you for any issues. Just be sure to let your healthcare team know you’re taking Erleada before starting an anti-infective medication.
7. Grapefruit juice
Grapefruit and grapefruit juice can interact with many medications, and Erleada is no exception. Grapefruit can raise Erleada levels in the body, so it’s best to avoid it during treatment.
8. Proton pump inhibitors
PPIs are common OTC and prescription medications that treat chronic acid reflux or gastroesophageal reflux disease. Examples include:
Pantoprazole (Protonix)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Erleada can lower PPI levels in the body if they’re taken together. This can make the PPI less effective at reducing stomach acid. Your prescriber may increase your PPI dosage or choose a different acid-reducing medication to manage this interaction. Or they may have you monitor your symptoms and let them know if acid reflux returns or worsens while you’re taking these medications.
Frequently asked questions
You can take Erleada at any time of day, with or without food. But it’s best to be consistent with when and how you take it. So the best time is one that works well for you on a daily basis.
In most cases, you’ll continue taking Erleada as long as it’s controlling your cancer and you aren’t experiencing bothersome or dangerous side effects. Your cancer care team will typically monitor you regularly throughout treatment to make sure Erleada is still working well for you.
You can take Erleada at any time of day, with or without food. But it’s best to be consistent with when and how you take it. So the best time is one that works well for you on a daily basis.
In most cases, you’ll continue taking Erleada as long as it’s controlling your cancer and you aren’t experiencing bothersome or dangerous side effects. Your cancer care team will typically monitor you regularly throughout treatment to make sure Erleada is still working well for you.
The bottom line
Erleada (apalutamide) is an oral tablet that treats certain types of prostate cancer. Some medications can raise Erleada levels in the body if they’re taken together. These include some calcium channel blockers, anti-infective medications, and grapefruit juice.
Erleada can lower the levels of other medications if they’re combined, which can make them less effective. These include some blood thinners, statins, and proton pump inhibitors. It also includes several mental health medications, calcium channel blockers, and digoxin (Lanoxin).
Be sure to review your medication list with your cancer care team before starting Erleada. And don’t start any new medications during Erleada treatment without making sure there isn’t an interaction concern.
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References
Deguigne, M., et al. (2018). Enzalutamide and analytical interferences in digoxin assays. Clinical Toxicology.
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Examine. (n.d.). CYP2C8 inhibitors.
Examine. (n.d.). CYP3A4/3A5 substrates.
Janssen Products. (2026). Erleada- apalutamide tablet, film coated .
Ruplin, A., et al. (2024). Review of drug-drug interactions in patients with prostate cancer. Journal of Oncology Pharmacy Practice.
U.S. Food and Drug Administration. (2021). Grapefruit juice and some drugs don’t mix.
