Xtandi Interactions: Alcohol, Medications, and Others

An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.

Before you start taking Xtandi, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Xtandi interacts with herbs or vitamins and supplements, see the “Are there other interactions with Xtandi?” section below.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The table below lists drugs that may interact with Xtandi. Keep in mind that this table does not include all drugs that may interact with Xtandi. For more information about some of these interactions, see the “Drug interactions explained” section below.

* To learn more about Xtandi’s side effects, see this article.

Xtandi is not known to interact with alcohol. But Xtandi and alcohol can cause some similar side effects, such as headache and fatigue. So, these side effects may worsen if you drink alcohol during your Xtandi treatment.

If you have questions about consuming alcohol while taking Xtandi, talk with your doctor or pharmacist.

Learn more about certain drug interactions that can occur with Xtandi.

Interaction with certain opioids

Xtandi can interact with certain opioids, which are used to treat pain.

Examples of opioid medications that may interact with Xtandi include:

• fentanyl (Actiq, Fentora, others)
• hydrocodone (Hysingla ER)
• oxycodone (Oxycontin, Roxybond, others)

What could happen

Taking Xtandi with certain opioids could make the opioid less effective. This is because Xtandi speeds up the activity of an enzyme (protein) that breaks down certain opioids in your body. As a result, the level of the opioid in your system may be low, which could make the drug less effective.

Starting Xtandi treatment when you’re already taking an opioid could increase your risk of opioid withdrawal.* This is because Xtandi could cause the level of the opioid in your system to be lower than usual. In some cases, this could lead to opioid withdrawal.

* Withdrawal symptoms are side effects that happen when you stop taking a drug your body has become dependent on. With dependence, your body relies on a drug to function as usual.

What you can do

Doctors may prescribe opioids for cancer pain, including that of prostate cancer. (Xtandi is used to treat prostate cancer in certain adults.) If needed, your doctor can recommend an opioid that’s safe to take with Xtandi.

If you take Xtandi with an opioid, your doctor will check your pain levels closely. They’ll prescribe a dosage of the opioid that provides pain relief without causing bothersome side effects. You should not take a higher dose of either medication than your doctor prescribes.

If you start Xtandi treatment after you’re already taking an opioid, tell your doctor right away if you have symptoms of opioid withdrawal. These may include abdominal pain, runny nose, and body aches. They’ll recommend what to do if you have these symptoms.

If you’re taking Xtandi with an opioid that can interact with it, it’s important that you do not stop taking Xtandi without speaking with your doctor first. If you stop taking Xtandi, the level of opioid in your system may quickly rise. This could result in an opioid overdose. If you need to stop taking Xtandi, your doctor may want to lower your opioid dose as well.

If you have questions about taking Xtandi with opioids, talk with your doctor or pharmacist.

Interaction with certain proton pump inhibitors

Xtandi can interact with certain PPIs. These medications are used to treat conditions related to high levels of stomach acid, such as heartburn.

Examples of PPIs that could interact with Xtandi include:

• esomeprazole (Nexium)
• lansoprazole (Prevacid)
• omeprazole (Prilosec)

What could happen

Taking Xtandi with certain PPIs could make the PPI less effective. Xtandi speeds up the activity of certain enzymes that break down certain PPIs in your system. Taking Xtandi could result in a low level of the PPI in your body, making the PPI less effective.

What you can do

Before taking Xtandi, tell your doctor if you’re taking a PPI. They can check whether Xtandi interacts with it and determine whether it’s safe to take them together. If necessary, your doctor can recommend a different PPI that isn’t known to interact with Xtandi.

If you have questions about taking Xtandi with PPIs, talk with your doctor or pharmacist.

Interaction with gemfibrozil

Xtandi can interact with gemfibrozil (Lopid), which helps lower triglyceride levels.

What could happen

Taking Xtandi with gemfibrozil could increase your risk of side effects from Xtandi.

A specific enzyme breaks down Xtandi in your body. Gemfibrozil slows the activity of this enzyme, which could lead to a higher level of Xtandi in your body. This could increase your risk of side effects from Xtandi.

What you can do

If you take Xtandi with gemfibrozil, your doctor may prescribe a lower Xtandi dosage than usual. You should not take a higher dose of either medication than your doctor prescribes.

If you have questions about taking Xtandi with gemfibrozil, talk with your doctor or pharmacist.

Xtandi may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Xtandi.

Does Xtandi interact with supplements?

Before you start taking Xtandi, talk with your doctor and pharmacist about any herbs or vitamins and supplements you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Xtandi interactions with herbs

Xtandi can interact with St. John’s wort, which may be used to ease symptoms of depression and other conditions.

St. John’s wort may speed up the activity of an enzyme that helps break down Xtandi in your body. This can reduce the amount of Xtandi in your system and make the drug less effective.

Your doctor can recommend whether it’s safe to take St. John’s wort with Xtandi. If you take them together, your doctor may prescribe a higher Xtandi dosage than usual to help the drug be effective. Your doctor can also recommend an alternative to St. John’s wort for your condition.

Xtandi and vitamins

There are currently no reports of Xtandi interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Xtandi.

Does Xtandi interact with food?

There are currently no reports of Xtandi interacting with food. If you have questions about foods to avoid when taking Xtandi, talk with your doctor.

Does Xtandi interact with vaccines?

There are currently no reports of Xtandi interacting with vaccines. If you have questions about getting certain vaccines during your Xtandi treatment, talk with your doctor.

Does Xtandi interact with lab tests?

There are currently no reports of Xtandi interacting with lab tests. If you have questions about having certain lab tests during your treatment with Xtandi, talk with the healthcare professional ordering the test.

Does Xtandi interact with cannabis or CBD?

Cannabis(commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Xtandi. Taking Xtandi with a cannabis product could make the product less effective.

Before you start treatment with Xtandi, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions or other health factors may raise the risk of interactions with Xtandi. Before taking Xtandi, talk with your doctor about your health history. They’ll determine whether Xtandi is right for you.

Health conditions or other factors that might interact with Xtandi include:

Heart disease or related factors, such as high blood pressure: Taking Xtandi may increase the risk of developing heart disease. This risk may be greater for people with certain factors, such as high blood pressure, type 1 or type 2 diabetes. Or if you have existing heart disease, Xtandi could worsen your condition.

If you have heart disease or a related factor, your doctor can determine whether Xtandi is a safe treatment option for you.

Seizures or related factors: Seizures are a rare side effect of Xtandi. The risk of seizures may be greater for people who’ve had seizures before or who have certain other factors, such as brain damage or a brain infection.

If you’ve ever had seizures or a related factor, your doctor can recommend whether Xtandi is safe for you.

History of stroke or brain tumor: Your risk of having a seizure during your Xtandi treatment may be higher if you’ve had a stroke before. You may also have a higher risk if you have a brain tumor or have had one in the past. Your doctor can discuss whether Xtandi is safe for you to take.

Falls, bone fractures, or related factors: Taking Xtandi may lead to falls that result in bone fractures. This risk may be greater for people with certain factors. Examples include having osteoporosis or difficulty with balance.

If you have factors that raise your risk of falls or bone fractures, talk with your doctor about whether Xtandi is right for you.

Pregnancy: Xtandi is not prescribed for females* and is not safe to take during pregnancy. The drug may cause pregnancy loss or harm to a fetus.

If you’re prescribed Xtandi and you have a sexual partner who may become pregnant, it’s important to use birth control (such as condoms) during your Xtandi treatment. You’ll continue using birth control for at least 3 months after your last dose.

If you have questions about Xtandi and pregnancy, talk with your doctor.

Breastfeeding: Xtandi is not prescribed for females, and it’s not known whether it’s safe to take Xtandi while breastfeeding. If you have questions, talk with your doctor.

Allergic reaction: If you’ve had an allergic reaction to Xtandi or any of its ingredients, your doctor will likely not prescribe Xtandi. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

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

Taking certain steps can help you avoid interactions with Xtandi. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you start taking a new drug during your Xtandi treatment.

It’s also important to understand Xtandi’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. The paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Xtandi, ask your pharmacist to print a copy for you.)

If you have difficulty reading or understanding this information, your doctor or pharmacist can help.

Taking Xtandi exactly as prescribed can also help prevent interactions.

If you still have questions about Xtandi and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• Do other drugs that treat prostate cancer have similar interactions to Xtandi?
• If I take Xtandi and have certain health conditions, will I be monitored more closely during treatment?
• Should I let you know if I’m prescribed a new drug while taking Xtandi?

To learn more about Xtandi, see these articles:

• Xtandi (enzalutamide)
• Side Effects of Xtandi: What You Need to Know
• Dosage Details for Xtandi
• Xtandi and Cost: What You Need to Know

To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

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.