Apalutamide

(a' puh loo" tuh mide)

Brand Name(s): , Erleada^®

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WHY is this medicine prescribed?

Apalutamide is used to treat certain types of prostate cancer (cancer in men that begins in the prostate [a male reproductive gland]) and has spread to other parts of the body or that has not spread to other parts of the body but has not been helped by other medical treatments. Apalutamide is in a class of medications called androgen receptor inhibitors. It works by blocking the effects of androgen (a male reproductive hormone) to stop the growth and spread of cancer cells.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Apalutamide comes as a tablet to take by mouth. It is usually taken with or without food once a day. Take apalutamide at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take apalutamide exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the tablets whole; do not split, chew, or crush them. If you cannot swallow the tablets whole, place the tablets whole in 120 mL (4 ounces) of applesauce by stirring; however, do not crush the tablets. Wait 15 minutes and then stir the mixture and tablets until well mixed without any chunks remaining. Using a spoon, swallow the mixture right away. Rinse the container with 60 mL (2 ounces) of water and immediately take the mixture. Rinse the container again with 60 mL (2 ounces) of water to ensure the whole dose is taken. Swallow the entire mixture immediately or within 1 hour of preparation. Do not store the mixture for future use.

Your doctor may tell you to stop taking apalutamide for a short time or decrease your dose if you experience serious side effects during your treatment. Be sure to talk to your doctor about how you are feeling during your treatment with apalutamide.

If your doctor has prescribed another medication such as goserelin (Zoladex), histrelin (Supprelin LA, Vantas), leuprolide (Eligard, Lupron, in Lupaneta Pack), or triptorelin (Trelstar, Triptodur) to treat your prostate cancer, you will need to continue receiving this medication during your treatment with apalutamide.

Continue to take apalutamide even if you feel well. Do not stop taking apalutamide without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

What SPECIAL PRECAUTIONS should I follow?

Before taking apalutamide,

• tell your doctor and pharmacist if you are allergic to apalutamide, any other medications, or any of the ingredients in apalutamide tablets. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin), fexofenadine (Allegra), gemfibrozil (Lopid), itraconazole (Onmel, Sporanox, Tolsura), ketoconazole (Nizoral), omeprazole (Prilosec, in Yosprala, Zegerid), midazolam (Nayzilam, Seizalam), rifampin (Rifadin, Rimactane, in Rifamate, in Rifater), rosuvastatin (Crestor, Ezallor). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with apalutamide, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
• tell your doctor if you have or have ever had heart problems such as a heart attack, angina (chest pain), heart failure, or hypertension or a stroke or ministroke. Also, tell your doctor if you have ever had seizures, a brain injury, a brain tumor, high cholesterol, diabetes, or osteoporosis.
• you should know that apalutamide is only for use in men. Women should not take this medication, especially if they are or may become pregnant or are breastfeeding. If taken by pregnant women, apalutamide may harm the fetus. If a pregnant woman takes apalutamide, she should call her doctor immediately.
• if your partner is pregnant, you must use a condom whenever you have sex during your treatment with apalutamide and for three months after your final dose. If your partner is not pregnant but could become pregnant, you must use a condom and another form of birth control whenever you have sex during your treatment and for 3 months after your final dose. Do not donate semen or sperm while you are taking apalutamide and for 3 months after your final dose.
• you should know that apalutamide may cause seizures. Do not drive a car or operate machinery until you know how this medication affects you.
• you should know that apalutamide may cause your muscles and bones to get weak, which may increase your risk of falling and breaking a bone.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it. However, if you do not remember until the next day, skip the missed dose and continue your regular dosing schedule. Do not take more than one dose in one day and do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Apalutamide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• weakness
• tiredness
• joint pain
• muscle weakness or stiffness
• diarrhea
• nausea
• loss of appetite
• weight loss
• hot flashes

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment:

• seizures
• loss of consciousness
• swelling of the arms, legs, hands, or feet
• falling
• chest pain
• shortness of breath
• numbness or weakness of face, arm, or leg, especially on one side of the body; difficulty talking or understanding; difficulty seeing in one or both eyes; dizziness; loss of balance or coordination; or difficulty walking
• rash
• skin blistering, peeling, or redness with or without a fever

Apalutamide may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ([WEB]) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. [WEB]

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website ([WEB]) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at [WEB]. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to apalutamide.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2023. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: February 15, 2021.