Xtandi interactions: what to avoid and why (simple, honest guide)

If you're starting Xtandi (enzalutamide) or you're already on it, you're probably wondering: Can I still have a glass of wine? What about my sleep meds, vitamins, or that CBD tincture a friend swears by? Totally fair questions. Xtandi is a powerful treatment for prostate cancer, and like many powerful medicines, it has a lot of potential interactionssome big, some minor, and some that simply require a little planning.

Let's make this easy. In this guide, we'll walk through the most important Xtandi interactions in plain language, highlight what's safe, what to avoid, and where to pause and check. Think of this as a friendly, practical companion to your treatmentbecause the goal is simple: keep you safe, maximize benefit, and avoid surprises.

Quick take

Here's the 10-second version. Xtandi speeds up certain liver enzymes (CYP3A4, CYP2C9, CYP2C19). Translation: it can lower the levels of many other medications you take, sometimes enough that they stop working well. On the flip side, a few drugs can raise Xtandi levels and increase side effects like fatigue, dizziness, or high blood pressure. There's also a small but real seizure risk in people with certain histories.

How common are these interactions? A lot. Major drug databases list hundreds (with many flagged as "major")that's why bringing your full medication and supplement list to every visit matters. If something changesnew antibiotic, new sleep aid, new supplementflag it early. According to the Drugs.com interaction checker, Xtandi has 600+ potential interactions, including categories that need careful management. It also notes disease interactions such as seizure risk and considerations with renal impairment that your team may weigh.

Big picture

So, what does Xtandi's enzyme-inducing effect mean for real life? In short: some medicinesespecially those for anxiety, sleep, pain, and certain infectionsmay be less effective. You might find your sleep aid doesn't touch your insomnia like it used to, or your usual pain med doesn't quite cut it. That's not you "tolerating" it; it's the drug levels dropping. The fix is usually a plan: an alternative medication, a dose change, or timing tweaks guided by your clinician.

There are also a handful of medications that can raise Xtandi exposure and uptick side effects. You and your care team can navigate these safely with a good checklist and clear communication. We'll show you how.

Drug pairs

Let's go through the most common and clinically relevant Xtandi drug interactions you're likely to encounter. If you see your medication below, don't panicthis is your prompt to bring it up with your oncologist or pharmacist. Many combinations are workable with adjustments.

Meds Xtandi can make less effective (because it speeds up metabolism):

• Anxiety and sleep medicines
  • Benzodiazepines like clonazepam, diazepam, midazolam may have reduced effect. If you use them regularly, dropping levels could even trigger withdrawal symptoms. Consumer health resources such as Medical News Today and Healthline note this class as a frequent concern.
  • Sedative-hypnotics like zolpidem, eszopiclone, suvorexant can be less effective for sleep while on Xtandi.
• Antidepressants and related agents
  • Trazodone, vilazodone, nefazodone may be less effective. If you're taking these for sleep or mood, keep your prescriber in the loop so you don't slide backward on symptoms.
• Opioids and pain control
  • Oxycodone, hydrocodone, fentanyl, and codeine can deliver less pain relief. If you're dependent on a stable dose, watch for signs of undertreated pain or withdrawal. Healthline and Medical News Today both flag this as clinically relevant.
• Antifungals and antibiotics
  • Azole antifungals like itraconazole, ketoconazole, voriconazole and antibiotics like rifampin or clarithromycin can get complicatedsometimes levels go up, sometimes down. These often require avoiding the combination or adjusting doses. Don't be surprised if your oncology team reaches out to your other prescribers here.
• Cardiometabolic and common meds
  • Statins, anticoagulants (including apixaban), some antidiabetics, and proton pump inhibitors (PPIs) like omeprazole or pantoprazole may be affected. These are case-by-case calls; use a checker and clinician guidance.

Meds that may raise Xtandi levels or side effects:

• Strong CYP2C8 inhibitors such as gemfibrozil can increase Xtandi levels, potentially intensifying fatigue, dizziness, falls, hypertension, or seizure risk. If you're on gemfibrozil for lipids, your clinician might switch to a different agent.

Everyday drugs and OTCs worth double-checking: amlodipine, metoprolol, lisinopril or losartan, metformin, PPIs (omeprazole/pantoprazole), tamsulosin, and even routine vitamins like D and B12. Many of these can be used safely; the point is to verify. The Drugs.com Xtandi interactions list is a helpful starting point you and your pharmacist can review together.

Alcohol sense

Can you drink on Xtandi? Short answer: likely yes, in moderation. There isn't a clear, direct "chemical clash" reported between alcohol and Xtandi. But alcohol can worsen the very side effects that make some days harderdizziness, fatigue, headacheand it can raise fall risk. Patient-friendly sources like Medical News Today note this practical reality: the interaction is less about liver enzymes and more about how you feel and function.

What does that look like in real life? If you enjoy the occasional drink, think in terms of light intake on low-symptom days. Skip alcohol on days you feel more woozy or off-balance. Don't combine alcohol with sedatives or opioidslayering depressants can be a recipe for falls or confusion. And if you have a history that raises seizure risk, stricter limits (or abstaining) might be safest. A quick chat with your oncology team can help set realistic, personalized limits that fit your life and treatment goals.

Supplements

Supplements can be a bit of a wild westlabels don't always tell the full story, and products vary widely in quality. With Xtandi, a few standouts deserve special attention.

St. John's wortavoid
This herb can ramp up the same enzymes Xtandi affects and may lower Xtandi levels, potentially reducing cancer control. Many consumer health resources flag this as a clear no-go while on enzalutamide. If you're considering it for mood support, ask your clinician about alternatives that won't clash with your therapy.

Cannabis and CBD
This one's nuanced. Cannabis and CBD may be less effective while on Xtandi due to metabolic changes, and sedation/coordination effects can overlap with Xtandi's side effect profile. If you use cannabis or CBDfor sleep, appetite, or paintalk openly with your team about dose, frequency, and goals. Patient-focused sources, including Medical News Today, note the uncertainties and suggest monitoring how you feel and function.

Vitamins and minerals
Standard-dose vitamins generally don't have confirmed interactions with Xtandi. Still, flag any high-dose regimens. If your team recommends calcium and vitamin D for bone health (common in prostate cancer care), keep taking those as directed. You can also double-check any nutrient on reputable interaction lists such as Drugs.com if you're curious.

Protein powders and "testosterone boosters"
A quick word of caution here. Products that claim to "boost testosterone," "enhance male performance," or "supercharge vitality" can be misleading or even risky. Some contain undeclared stimulants or androgen-like components that go directly against what your cancer therapy is trying to do. If a label looks bold and vague, bring it to your pharmacist for a reality check before you take it.

Food, shots, labs

Food
Good news: no specific foods are known to interact significantly with Xtandi. You can take it with or without foodconsistency is key. If taking it with a small snack helps you remember, do that. If morning coffee and pills is your routine, that works too.

Vaccines
There aren't known direct interactions between Xtandi and vaccines. Staying up to date is important, especially during cancer treatment. Just let your oncology team coordinate timing around your cycles and how you're feeling.

Lab tests and monitoring
Xtandi doesn't notoriously interfere with lab assays, but your team may watch your blood pressure, fall risk, fractures, and metabolic markers like lipids or glucose. If you have a home BP cuff, bring a log to visitsreal-world readings often tell a clearer story than a single clinic number.

Extra care

Xtandi is overall well tolerated by many people, but certain histories call for extra caution.

Seizure risk and neurologic conditions
If you've had seizures, a stroke, brain metastases, or significant head trauma, tell your team. The risk is still relatively small, but knowing your history allows everyone to plan smartly. New neurologic symptomslike sudden confusion, severe headaches, or unusual movementsdeserve urgent attention. If anything feels off, don't drive; call your clinician.

Falls, fractures, and bone health
Falls are a serious concern, especially if fatigue, dizziness, or blood pressure changes creep in. A few simple steps can help: a home safety walk-through (clear clutter, check rugs and lighting), balance and strength exercises (a physical therapist can tailor a plan), and appropriate bone health strategies (think DEXA scans if indicated, vitamin D and calcium per your clinician's advice).

Heart and blood pressure
Xtandi can nudge up blood pressure for some people. If you're on antihypertensives, levels could shift, either from Xtandi itself or from changes in how those meds are metabolized. A home monitor and a shared planwhat readings are "okay," what's "call-us"make life easier.

Before start

The best time to set yourself up for success is right nowbefore starting, or at your very next visit. Here's a simple, copy-and-use checklist you can bring along.

Build a complete medication and supplement list

• Prescription meds, including doses and times you take them.
• Over-the-counter items: pain relievers, sleep aids, cold meds, antacids, allergy pills.
• Supplements and herbs: name, brand, dose, frequency.
• As-needed meds (PRNs): how often you actually use them.
• Alcohol and cannabis/CBD: typical weekly use, patterns, and goals (sleep, pain, appetite).

Bring this to every visit and update it whenever something changes. For each new item, ask your pharmacist or use an interaction tool like the Drugs.com checker and then share the results with your care team for context.

Set up a monitoring plan

• Which side effects to watch for: fatigue, dizziness, headaches, mood changes, sleep changes.
• Vitals to track: blood pressure at home (note time, sitting vs. standing), weight if monitoring appetite or edema.
• Pain control if you use opioids or benzodiazepines: is relief adequate, any withdrawal signs, any sedation?
• Fall-risk indicators: near falls, new balance issues, changes in gait.
• Seizure warning signs if relevant to your history.

When to call urgently

• New seizures or fainting spells.
• Severe dizziness, fall with injury, or head strike.
• Chest pain, sudden shortness of breath, or severe hypertension readings your team flagged.
• Sudden or extreme mood or behavior changes.

Real talk

Let me share a quick story I've seen play out more than once. A patientwe'll call him Danstarted Xtandi and kept his routine zolpidem for sleep. Within a couple of weeks, he noticed the zolpidem wasn't "doing much." He also used hydrocodone for shoulder pain after physical therapy, and that seemed weaker too. Instead of gritting his teeth, he brought it up right away. His oncologist and pharmacist switched his sleep strategy (a different agent plus a bedtime routine tweak) and adjusted his pain plansuddenly, nights were better, and PT was do-able again.

The moral isn't "meds fail on Xtandi." It's that Xtandi changes the playing field. When you tell your team what's really happeningsleep, pain, mood, energythey can help you pivot quickly. Honest updates are your superpower here.

Smart swaps

Worried your current meds might be on the "less effective" list? There are often safe alternatives. For sleep, behavioral approaches paired with non-interacting options may help. For pain, your clinician might choose agents less affected by enzyme induction or adjust your doses with a careful eye on safety. For anxiety or mood, the same principle appliesthere's rarely just one way to manage symptoms.

If you're using supplements for energy or stress, you might explore options with fewer interaction concerns, or shift focus to proven lifestyle changes: gentle exercise, regular meals, hydration, and structured rest. These aren't consolation prizes; they're often the foundations that make medications work better.

Stay empowered

Here's the heart of it: Xtandi interactions aren't here to scare you. They're here to guide you. You have a treatment doing real work against cancer. With a few smart habitscomplete med list, quick checks before adding anything new, honest symptom updatesyou can keep that treatment humming while protecting your quality of life.

And if you're feeling unsure about a specific drug or supplement, ask. Bring the bottle to clinic. Email your list ahead of time. Call the pharmacy. You're not being a hassleyou're being wise. What questions are on your list right now? What's one change you could make this week to simplify your routine or reduce fall risks at home?

If you've navigated Xtandi and found a sleep strategy that works, or a way to keep pain steady, share your experience with your care teamthey can pass along what helped to the next person who needs it.

Sources, trust

Everything here is grounded in the known pharmacology of enzalutamide and cross-checked against credible, patient-friendly resources. For scope and specifics of known Xtandi drug interactionsincluding how many are "major" and disease cautions like seizure risksee the Drugs.com interaction database. For practical, everyday guidance on Xtandi and alcohol, benzodiazepines, opioids, sedative-hypnotics, St. John's wort, cannabis/CBD, and safety factors, readable summaries from consumer health outlets such as Medical News Today and Healthline align with what clinicians see in practice. When articles or monographs differ, your oncology team's judgment winsthey know your health history, other meds, and goals best.

Bottom line: you deserve clear, kind information you can act on. Keep this guide handy, lean on your care team, and don't hesitate to raise your hand when something changes. You've got thisand you're not doing it alone.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.