Drug interactions between apalutamide and Miradon
Interactions between your drugs
Applies to: Miradon (anisindione) and apalutamide
Consumer information for this interaction is not currently available.
GENERALLY AVOID: Apalutamide and Enzalutamide may reduce the effects of oral anticoagulants. The proposed mechanism is induction of the enzyme CYP450 2C9. Induction of this enzyme by enzalutamide in prostate cancer patients has been shown to reduce the systemic exposure (AUC) of S-warfarin by 56%. Similarly, apalutamide has been reported to decrease S-warfarin AUC by 46%. The reduction in plasma concentration may lead to a loss of clinical effect.
MANAGEMENT: Concomitant use of apalutamide or enzalutamide with warfarin and coumarin-like anticoagulants should be avoided. If concomitant therapy is required, additional INR monitoring should be conducted and anticoagulant dosage adjusted accordingly, particularly following initiation, discontinuation, or change of dosage of enzalutamide in patients who are stabilized on their anticoagulant regimen. Patients should be monitored for altered anticoagulation and advised to promptly report any signs of blood clots (e.g., chest pain, shortness of breath, and sudden loss of vision, or pain, redness or swelling in an extremity) to their physician.
- Cerner Multum, Inc. "Australian Product Information." O 0
- "Product Information. Erleada (apalutamide)." Janssen Biotech, Inc., Horsham, PA, PA.
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- "Product Information. Xtandi (enzalutamide)." Astellas Pharma US, Inc, Deerfield, IL.
Drug and food interactions
Applies to: Miradon (anisindione)
Nutrition and diet can affect your treatment with anisindione. Therefore, it is important to keep your vitamin supplement and food intake steady throughout treatment. For example, increasing vitamin K levels in the body can promote clotting and reduce the effectiveness of anisindione. While there is no need to avoid products that contain vitamin K, you should maintain a consistent level of consumption of these products. Foods rich in vitamin K include beef liver, broccoli, Brussels sprouts, cabbage, collard greens, endive, kale, lettuce, mustard greens, parsley, soy beans, spinach, Swiss chard, turnip greens, watercress, and other green leafy vegetables. Moderate to high levels of vitamin K are also found in other foods such as asparagus, avocados, dill pickles, green peas, green tea, canola oil, margarine, mayonnaise, olive oil, and soybean oil. However, even foods that do not contain much vitamin K may occasionally affect the action of anisindione. There have been reports of patients who experienced bleeding complications and increased INR or bleeding times after consuming large quantities of cranberry juice, mangos, grapefruit, grapefruit juice, grapefruit seed extract, or pomegranate juice. Again, you do not need to avoid these foods completely, but it may be preferable to limit their consumption, or at least maintain the same level of use while you are receiving anisindione. Talk to a healthcare provider if you are uncertain about what foods or medications you take that may interact with anisindione. It is important to tell your doctor about all medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
When anisindione is given with enteral (tube) feedings, you may interrupt the feeding for one hour before and one hour after the anisindione dose to minimize potential for interaction. Feeding formulas containing soy protein should be avoided.
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
Drug Interaction Classification
|Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.|
|No interaction information available.|
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.