apalutamide at a glance
Medicine class
Selective androgen-receptor inhibitor
Usual role
Treatment of specific hormone-sensitive or castration-resistant prostate cancers
Food
May be taken with or without food
Important safety issues
Rash, hypertension, falls, fractures, seizures and medicine interactions
What is apalutamide used for?
The selected UK product is licensed in adult men for:
Non-metastatic castration-resistant prostate cancer with a high risk of developing metastatic disease.
Metastatic hormone-sensitive prostate cancer, in combination with androgen-deprivation therapy.
How does apalutamide work?
Apalutamide attaches to androgen receptors and blocks signals from testosterone and related hormones. It prevents the receptor entering the cell nucleus and activating genes that promote prostate-cancer cell growth.
apalutamide preparations and strengths
Tablet
Route: Oral
Strengths: 60 mg, 240 mg
How to take apalutamide
Follow the oncology team's instructions. The selected tablet may be taken with or without food.
Swallow the tablet whole; do not crush or split it.
If swallowing is difficult, the whole tablet may be dispersed first in non-fizzy water and then mixed with water, orange juice, green tea, apple sauce or drinkable yoghurt. Use the mixture immediately and rinse the container with water to take any residue.
The tablet can be given through a suitable nasogastric tube by a healthcare professional using the product instructions.
apalutamide side effects
Common or expected effects
- Tiredness
- Skin rash or itching
- High blood pressure
- Hot flushes
- Joint pain or muscle spasms
- Diarrhoea
- Reduced appetite or weight loss
- Falls or fractures
- Underactive thyroid
- Hair loss or altered taste
Get urgent medical advice
- Seizure
- Severe blistering, peeling or widespread skin reaction
- Chest pain or other symptoms of ischaemic heart disease
- Sudden weakness or speech difficulty suggesting a stroke
- New or worsening cough and breathlessness suggesting interstitial lung disease
- Serious disturbance of heart rhythm
apalutamide in pregnancy
Apalutamide is contraindicated in women who are or may become pregnant because it may harm a developing baby. Male patients should use a condom, together with another highly effective contraceptive method when relevant, during treatment and for three months after the final dose; discuss contraception and fertility with the specialist team.
apalutamide while breastfeeding
Apalutamide should not be used while breastfeeding. It is unknown whether it passes into human milk, and risk to a breastfed child cannot be excluded.
apalutamide interactions
Apalutamide strongly induces several drug-metabolising enzymes and transporters, so a complete medicine review is essential before starting or stopping it.
Warfarin and related anticoagulants
Apalutamide can reduce anticoagulant exposure; avoid the combination where possible or arrange additional INR monitoring.
CYP3A4, CYP2C19 or CYP2C9 substrates
Medicines including simvastatin, midazolam, omeprazole, diazepam and phenytoin may become less effective.
Levothyroxine and valproate
Exposure may fall through enzyme induction, requiring monitoring for reduced clinical effect.
Common questions about apalutamide
Answers are fully visible for fast scanning and source review.
What prostate cancers is apalutamide licensed to treat?
It is licensed for high-risk non-metastatic castration-resistant prostate cancer and for metastatic hormone-sensitive prostate cancer in combination with androgen-deprivation therapy.
Is apalutamide chemotherapy?
No. It is an endocrine treatment that directly blocks androgen receptors used by prostate-cancer cells.
Does apalutamide lower testosterone?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.