Erleada (apalutamide) is a prescription oral tablet used to treat certain types of prostate cancer. Erleada can cause side effects that range from mild to serious. Examples include heart-related side effects, fatigue (low energy), and joint pain.

Erleada is used in adults to treat prostate cancer that meets either of the following criteria:

  • It is metastatic (cancer has spread beyond the prostate) and castration-sensitive (cancer responds to treatment with drugs that lower testosterone levels in the body).
  • It is nonmetastatic (cancer has not spread beyond the prostate) and castration-resistant (cancer did not respond to testosterone-lowering treatment).

Keep reading to learn about the common, mild, and serious side effects Erleada can cause. For a general overview of the drug, including details about its uses, see this article.

Some people may experience mild to serious side effects during Erleada treatment. Examples of the drug’s commonly reported side effects include:

This isn’t a complete list of side effects Erleada may cause. And, although these side effects are considered common, it doesn’t mean they’ll happen to everyone who takes this medication.

As with most drugs, mild side effects have been reported with Erleada. These include:

In most cases, these side effects should be temporary. And some may be easily managed. But if you have symptoms that are ongoing or bothersome, talk with your doctor or pharmacist. And do not stop taking Erleada unless your doctor recommends it.

Erleada may cause mild side effects other than those listed above. See the drug’s prescribing information for details.

* To learn more about this side effect, see the “Side effects explained” section below.

While rare, Erleada treatment can cause serious side effects. Having certain preexisting medical conditions or taking certain medications can increase your risk of serious side effects from this drug.

Serious side effects that have been reported with Erleada include:

If you develop serious side effects while taking Erleada, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

* To learn more about this side effect, see the “Side effects explained” section below.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Erleada, visit MedWatch.

Get answers to some frequently asked questions about Erleada’s side effects.

Can Erleada cause hair loss?

No, it’s not expected to. Hair loss wasn’t a side effect reported by people taking Erleada in studies.

Other drugs used to treat prostate cancer can cause hair loss as a side effect. Examples include docetaxel (Taxotere) and mitoxantrone. But this side effect isn’t likely with Erleada.

Talk with your doctor if you have concerns about hair loss and whether any of the medications you take could cause it.

How long do Erleada’s side effects typically last?

It depends. In most cases, side effects caused by Erleada are mild and go away on their own within a few hours to days. In rare cases, the drug can cause side effects that are long term or cause long-term complications. A few examples include:

Talk with your doctor if you experience side effects from Erleada that don’t go away. They can review your symptoms and recommend the best treatment. This may include stopping Erleada and exploring other prostate cancer treatments instead.

* To learn more about this side effect, see the “Side effects explained” section below.

Learn more about some of the side effects Erleada may cause.

Heart-related side effects

Heart-related side effects are rare but possible with Erleada treatment, according to studies. These side effects can be life threatening in rare cases. Heart-related side effects reported in studies of Erleada include high blood pressure and heart attack.

High blood pressure doesn’t cause symptoms, except in a hypertensive crisis. But having high blood pressure increases your risk of heart disease and other serious events, including heart attack.

Symptoms of a heart attack include:

Your risk of heart-related side effects may be higher if you’ve had any of the following conditions in the 6 months prior to starting Erleada:

People who’d had heart-related conditions in the previous 6 months were not included in Erleada’s studies.

What might help

Before you start treatment, your doctor will determine whether your heart is healthy enough for Erleada. If they prescribe the drug for you, they’ll likely monitor your heart health throughout your treatment. This may include teaching you to monitor your blood pressure at home.

Call your local emergency number or go to the nearest emergency room if you think you’re having symptoms of a heart attack. This is a life threatening emergency that requires immediate medical care.

Bone fracture

Bone fractures (broken bones) are a potential side effect of Erleada and were somewhat common in the drug’s studies.

In people taking Erleada to treat metastatic prostate cancer, this side effect was more likely to occur about 2 months after starting treatment. In studies of people taking Erleada to treat nonmetastatic prostate cancer, broken bones were more likely to happen after nearly a year of treatment.

Symptoms of a broken bone include any of the following at or around the affected bone(s):

  • pain
  • swelling
  • bruising
  • discolored skin
  • inability to move or put weight on the affected area

Treatment with Erleada also increases your risk of falls, which may lead to broken bones.

What might help

Your doctor will evaluate your risk of bone fractures to determine whether your bones are healthy enough for you to take this drug. If they prescribe Erleada for you, they’ll likely monitor your bone health throughout your treatment.

Immediately call your doctor or seek medical care, such as at an urgent care facility, if you suspect you’ve broken a bone while taking Erleada.

Stroke or ministroke

Although rare in studies, stroke and ministroke are possible side effects of Erleada. With a stroke, there’s a lack of blood supply and oxygen reaching your brain tissue, which can quickly cause brain cells to die.

Symptoms of a stroke or ministroke include:

  • weakness or numbness in your arms, legs, or face, especially on one side of the body
  • inability to speak or understand others
  • sudden confusion
  • difficulty or inability to walk or balance

Having certain conditions, such as high blood pressure, diabetes, or high cholesterol, can increase your risk of stroke or ministroke. And taking Erleada may further increase this risk.

What might help

Before prescribing Erleada, your doctor will evaluate your risk of stroke. They may want to make sure that certain conditions, such as high blood pressure, are properly managed before you start taking this drug.

Call your local emergency number or go to the nearest emergency room if you think you’re having symptoms of a stroke or ministroke. These are life threatening conditions that require immediate medical care.

If you have a stroke or ministroke while taking Erleada, your doctor will determine whether it’s safe for you to continue taking the drug.

Sudden kidney injury

While very rare, sudden kidney injury (also called acute kidney failure) was a side effect reported in Erleada’s studies.

With acute kidney failure, your kidneys suddenly stop working. Usually, your kidneys are responsible for getting rid of excess fluid, salt, and waste products from your blood. Acute kidney failure means the amount of fluid, salt, and waste products in your blood increases. This can be life threatening in extreme cases.

Symptoms of sudden kidney injury include:

  • movements that are slow and sluggish
  • changes in your mood or mental status (thinking and decision making)
  • swelling or fluid retention
  • fatigue (low energy)
  • pain between your hips and ribs

What might help

Immediately call your doctor or go to the nearest emergency room if you think you’re having symptoms of sudden kidney injury while taking Erleada. If you experience sudden kidney injury during treatment, your doctor will determine whether it’s safe for you to continue taking Erleada.

Allergic reaction

Like most drugs, Erleada can cause an allergic reaction in some people. Symptoms can be mild to serious and can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)
  • swelling under your skin (usually in your eyelids, lips, hands, or feet)
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

There are also rare reports of serious, life threatening allergic reactions to Erleada. These reactions are described below.

Stevens-Johnson syndrome (SJS). The main symptom of SJS is a blistering rash, which can affect your face, chest, lips, mouth, genitals, eyes, and eyelids, among other places. Other symptoms include head and muscle aches, sore throat, and cough.

Toxic epidermal necrolysis (TEN). The main symptom caused by TEN is severe skin rash that blisters and peels. The rash can affect large areas of skin and can spread to areas such as your eyes, mouth, throat, or genitals.

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. DRESS syndrome is a reaction to a medication that causes an erupting skin rash. Other symptoms include fever, swollen lymph nodes, and inflammation affecting your internal organs.

Call your local emergency number or go to the nearest emergency room if you think you’re having symptoms of any of these conditions. SJS, TEN, and DRESS syndrome are life threatening emergencies that require immediate medical treatment.

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms. Examples include:

  • an antihistamine you swallow, such as Benadryl (diphenhydramine)
  • a product you apply to your skin, such as hydrocortisone cream

If your doctor confirms you’ve had a mild allergic reaction to Erleada, they’ll decide whether you should continue taking it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to Erleada, they may have you switch to a different treatment.

Keeping track of side effects

During your Erleada treatment, consider taking notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful when you first start taking a new drug or using a combination of treatments.

Your side effect notes can include things such as:

  • what dose of the drug you were taking when you had the side effect
  • how soon you had the side effect after starting that dose
  • what your symptoms were
  • how your symptoms affected your daily activities
  • what other medications you were taking
  • any other information you feel is important

Taking notes and sharing them with your doctor will help them learn more about how Erleada affects you. They can then use this information to adjust your treatment plan if needed.

Erleada may not be right for you if you have certain medical conditions. This is known as a drug-condition interaction. Other factors may also affect whether this drug is a good treatment option for you. Talk with your doctor about your health history before starting Erleada. Factors to consider include those described below.

Heart disease, including high blood pressure. Treatment with Erleada can cause heart-related side effects, which can be serious or even life threatening. If you have existing heart disease, including high blood pressure, your risk of these side effects from Erleada is higher. Your doctor can determine whether your heart is healthy enough for treatment with this medication.

Diabetes or high cholesterol. People with diabetes (type I or type II) or high cholesterol have an increased risk of developing heart-related side effects from Erleada. Your doctor can provide more information on whether this drug is safe for you to take. They may want to ensure your diabetes or high cholesterol is well managed before prescribing Erleada for you.

Brain injury, brain tumor, or stroke in the past. Erleada can cause stroke as a side effect in rare cases. If you’ve had a stroke, brain injury, or brain tumor in the past, you may have a higher risk of stroke from this drug. Your doctor can determine whether Erleada or a different prostate cancer treatment would be best for you.

Seizures. Though rare,seizures have been reported by people taking Erleada in studies. If you already have epilepsy or seizures, your risk of this side effect may be higher if you take this medication. Talk with your doctor to determine whether Erleada is safe for you.

Allergic reaction. If you’ve had an allergic reaction to Erleada or any of its ingredients, your doctor will likely not prescribe it for you. Ask them about other medications that might be better options.

Alcohol and Erleada

Alcohol and Erleada don’t directly interact with one another. But both can cause some similar side effects, such as diarrhea, nausea, and fatigue (low energy). So combining the two substances can increase your risk of these side effects, including the risk that they could be severe.

If you drink alcohol, talk with your doctor to learn more about how much alcohol may be safe to consume while you’re taking Erleada.

Pregnancy and breastfeeding with Erleada

It’s not known whether it’s safe to take Erleada while pregnant or breastfeeding. The drug has not been studied in females* and is approved for use only in males*.

Males taking Erleada who have a sexual partner that may become pregnant should use birth control, such as condoms, during treatment. You’ll need to continue using birth control for at least 3 months following your last Erleada dose.

* In this article, we use the terms “male” and “female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

Taking Erleada may cause side effects. In most cases, these are rare and go away on their own with time. But the drug can cause a few serious side effects in rare cases. These include serious allergic reactions affecting your skin and other parts of your body.

If you have questions about side effects Erleada can cause, talk with your doctor. Examples to help get you started include:

  • Can Erleada cause waking up at night to urinate as a side effect?
  • Do I have an increased risk of side effects from this drug based on my health history?
  • Do any of the other medications I take interact with Erleada and increase my risk of side effects?
  • Is my risk of allergic reactions higher when I first start treatment?

To learn more about Erleada, see these articles:

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.