Erleada (apalutamide) is a drug that’s prescribed to treat certain kinds of prostate cancer. Erleada comes as a tablet that you swallow.

Erleada is prescribed for adults with certain kinds of prostate cancer. To learn more, see “What is Erleada used for?

Erleada basics

Erleada contains the active ingredient apalutamide. (The active ingredient is what makes a medication work.) Erleada is a kind of drug called an anti-androgen.

Erleada is a brand-name medication that’s not currently available as a generic.

Like most drugs, Erleada may cause mild or serious side effects. The lists that follow describe some of the more common side effects that Erleada may cause. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

  • your age
  • other health conditions you have
  • other medications you take

Your doctor or pharmacist can tell you more about the potential side effects of Erleada. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a short list of some of the mild side effects that Erleada can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Erleada’s prescribing information.

Mild side effects of Erleada that have been reported include:

  • changes in the way things taste
  • decreased appetite
  • diarrhea
  • fatigue (low energy) or weakness
  • flushing (temporary warmth, redness, or deepening of skin color)
  • joint pain
  • muscle spasms
  • nausea
  • rash*
  • swelling in your hands, feet, lymph nodes, or genitals
  • weight loss

Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

* To learn more about this side effect, see “Side effect focus.”

Serious side effects

Serious side effects from Erleada can occur, but they aren’t common. If you have serious side effects from Erleada, call your doctor right away. But if you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects of Erleada that have been reported include:

* This side effect was not reported in studies of Erleada, but it was reported after the drug became available to prescribe.
? To learn more about this side effect, see “Side effect focus.”

Side effect focus

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

Rash

Taking Erleada may cause a skin rash, as well as other skin-related side effects. A rash was one of the more common side effects reported in studies of the drug.

In a few cases, people have stopped taking Erleada due to having a rash.

In studies, the most common kind of rash Erleada caused was maculopapular rash. This rash often appears as bumps on your skin, along with discoloration. As well as a rash, people taking Erleada in studies also reported these skin-related side effects:

Serious skin reactions are also possible, which can be life threatening. These conditions include:

In addition to a rash, symptoms of these conditions may include:

  • fever
  • flu-like symptoms
  • mouth sores
  • swelling

What might help

Call your doctor right away if you develop a rash or any of the previously listed symptoms while taking Erleada. Keep in mind that a rash may be a symptom of an allergic reaction, a serious side effect that Erleada may cause. To learn about other symptoms of an allergic reaction, see “Allergic reaction.”

If you experience a rash during Erleada treatment, your doctor will likely recommend treatment for this side effect. Examples of rash treatments used by people who had this side effect in studies include:

Your doctor may lower your Erleada dose if you develop a rash. Or they may have you temporarily or permanently stop taking the drug, especially if your rash is serious. Temporarily stopping Erleada treatment may cause the rash to go away, but it may come back if you start taking the drug again.

Heart disease

Erleada can cause a kind of heart disease in some people. Heart disease wasn’t a common side effect seen in studies. But in rare cases, heart disease caused by Erleada has led to death. If you have concerns about your risk of heart disease with Erleada, talk with your doctor.

Symptoms of heart disease can include:

Having certain other medical conditions can raise your risk of heart disease if you take Erleada. These include:

What might help

Before prescribing Erleada, your doctor will review your medical history to determine your risk of heart disease. If you have another condition that raises your risk of this side effect, your doctor will likely make sure the other condition is well managed before prescribing Erleada. Your doctor will also monitor you for symptoms of heart disease while you’re taking Erleada.

Allergic reaction

Some people may have an allergic reaction to Erleada. But these reactions weren’t common in Erleada’s studies.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, usually in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to Erleada. But if you think you’re having a medical emergency, call 911 or your local emergency number.

Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. For detailed information, refer to our Erleada cost article. You can also check out our article on how to save money on prescriptions.

If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also explore support options offered by the manufacturer:

Your doctor will recommend the dosage of Erleada that’s right for you. Here are commonly prescribed dosages, but always take the dosage your doctor prescribes.

Form and strength

Erleada comes as tablets (pills) that you swallow. It’s available in two strengths: 60 milligrams (mg) and 240 mg.

Recommended dosage

The recommended dosage of Erleada is 240 mg taken once per day. Depending on the strength of Erleada your doctor prescribes, you’ll take either one 240-mg tablet or four 60-mg tablets. For information about taking Erleada, see “How is Erleada taken?

If you have certain health conditions, your doctor may lower your dosage to 180 mg or 120 mg per day.

Questions about Erleada’s dosage

Here are some common questions and answers about Erleada’s dosage.

  • What if I miss a dose of Erleada? If you miss a dose of Erleada, try to take the missed dose as soon as you remember. But if it’s the next day when you remember, skip the missed dose and take your next dose at the regular time. You should not take more than one dose of Erleada at a time or in one day.
  • Will I need to take Erleada long term? Yes. If you and your doctor agree that Erleada is working well for you, you’ll likely take the drug long term.
  • How long does Erleada take to work? Erleada begins working as soon as you take a dose. But it’s not known how long it takes to begin affecting cancer cells. The drug may begin to block hormones such as testosterone after a few days to a few weeks.

Find answers to some commonly asked questions about Erleada.

How does Erleada work?

How a drug works is referred to as its mechanism of action. Erleada works to treat prostate cancer by blocking certain hormones called androgens, such as testosterone. Androgens are hormones that encourage prostate cells to grow, including cancerous prostate cells. Blocking androgens causes prostate cancer cells to die and stops them from spreading in your body.

If you’d like to learn more about how Erleada works, talk with your doctor or pharmacist.

Will Erleada cure my cancer?

No, Erleada doesn’t cure cancer. There currently isn’t a cure for prostate cancer.

But drugs such as Erleada can help people live longer without their cancer worsening or spreading. It can also delay the need for chemotherapy (traditional drugs prescribed to treat cancer).

If you have other questions about what to expect from Erleada treatment, talk with your doctor.

Is Erleada a chemotherapy drug?

No, Erleada isn’t a chemotherapy drug. It’s a kind of hormone therapy that works by reducing the levels of androgen hormones, including testosterone, in your body.

In comparison, chemotherapy drugs work by attacking cells in your body that grow rapidly. This not only cancer cells but also fast-growing healthy cells. Because of this, chemotherapy often causes many side effects, such as hair loss or mouth sores.

According to American Cancer Society guidelines, drugs such as Erleada may be prescribed with chemotherapy in certain people with prostate cancer. To learn more about the treatment option that’s right for you, talk with your doctor.

Erleada is prescribed for adults with the following conditions:

  • Metastatic, castration-sensitive prostate cancer: “Metastatic” means the cancer has spread beyond your prostate to other parts of the body. “Castration-sensitive” means the cancer may be treated with drugs that lower the testosterone level in your body.
  • Nonmetastatic, castration-resistant prostate cancer: “Nonmetastatic” means the cancer hasn’t spread beyond your prostate. “Castration-resistant” means treatments that lower the testosterone level in your body don’t work to treat the cancer.

Prostate cancer affects the prostate, which is a small gland located under the bladder in males.

Erleada treats prostate cancer by blocking certain hormones called androgens, such as testosterone. Androgens are hormones that encourage prostate cells to grow, including cancerous prostate cells. Blocking androgens causes prostate cancer cells to die, and it stops them from spreading in your body.

If you’ve had surgery to remove your testicles, you’ll likely take Erleada by itself. If you haven’t had this surgery, you’ll take Erleada with other drugs to treat your prostate cancer. To learn more, see “How is Erleada taken?

Note: In this article, we use the term “males” to refer to someone’s sex assigned at birth. For more information, see our article on the difference between sex and gender.

Both Erleada and Zytiga are prescribed to treat prostate cancer in adults, but they may be used to treat different types. They also both come as tablets that you swallow.

To find out more about these drugs, check out this comparison of Erleada and Zytiga. You can also talk with your doctor about the treatment that’s right for your condition.

Erleada and Xtandi are both drugs that treat prostate cancer in adults. They work the same way to treat cancer, which is by blocking the hormone testosterone. They both come as pills that you swallow. But these drugs do differ in some ways.

See this comparison of Erleada and Xtandi to learn more about how these drugs compare. Also, ask your doctor whether one of these drugs may be right for you.

Your doctor will explain how you should take Erleada. They will also explain how much to take and how often. Be sure to follow your doctor’s instructions.

Taking Erleada

Erleada comes as tablets that you swallow whole.

If you have difficulty swallowing tablets, you can try these tips. Also, let your doctor know about your difficulty taking tablets. They may prescribe the Erleada 60-mg tablets, which are slightly smaller than the 240-mg tablets. This means you’d take four 60-mg tablets if your dosage is 240 mg once per day.

Another option for taking Erleada is to make a liquid mixture from the tablets that you can drink. But you must do this correctly. For specific instructions, see our Erleada dosage article or ask your doctor.

If needed, Erleada may also be dispersed (broken up into pieces) in water and administered through a feeding tube.

Accessible medication containers and labels

Certain pharmacies may provide medication labels that:

  • have large print
  • use braille
  • contain a code you can scan with a smartphone to change the text into audio

Your doctor or pharmacist may be able to recommend a pharmacy that offers these options if your current pharmacy doesn’t.

Also, your pharmacist may be able to put Erleada in an easy-open container. They may also recommend tools to help make it simpler to open the drug’s container.

Taking Erleada with other drugs

Erleada may be taken with other drugs to treat prostate cancer. If you haven’t had surgery to remove your testicles to treat prostate cancer, you’ll take Erleada with a kind of drug called a gonadotropin-releasing hormone (GnRH) analog.

Examples of GnRH analogs include:

  • LHRH agonists such as leuprolide (Lupron Depot, Eligard) or histrelin (Supprelin LA)
  • LHRH antagonists such as degarelix (Firmagon)

Your doctor can tell you more about other medications you may take with Erleada.

Questions about taking Erleada

Here are answers to common questions about taking Erleada.

  • Should I take Erleada with food? You may take Erleada doses with or without food.
  • Can Erleada be chewed, crushed, or split? No, you should not chew, crush, or split Erleada tablets. You should swallow them whole or make a liquid mixture that you take by mouth, as described previously.
Questions for your doctor

You may have questions about Erleada and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

  • Before your appointment, write down questions such as:
    • How will Erleada affect my body, mood, or lifestyle?
  • Bring someone with you to your appointment if doing so will help you feel more comfortable.
  • If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So don’t be afraid to ask questions or offer feedback on your treatment.

There are important considerations to discuss with your doctor before you begin treatment with Erleada. It’s important that you tell your doctor about your overall health and any medical conditions you may have.

You should also tell your doctor about all medications you take, including any over-the-counter (OTC) medications. They’ll want to check for any interactions with Erleada.

Interactions

Taking a medication with certain vaccines, foods, and other things can affect how the medication works. These effects are called interactions.

Before taking Erleada, be sure to tell your doctor about all medications you take, including prescription and OTC kinds. Also, describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Erleada.

Interactions with drugs or supplements

Erleada can interact with several kinds of drugs. These drugs include:

This list does not contain all kinds of drugs that may interact with Erleada. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with Erleada.

Warnings

Erleada may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Erleada. Factors to consider include those in the following list.

  • Heart disease: Erleada can cause heart disease and, in some cases, may lead to a heart attack. If you already have heart disease, taking Erleada could make your condition worse. Your doctor can determine whether Erleada is safe for you to take.
  • Diabetes: If you have diabetes, you have a higher risk of developing heart disease from Erleada. Your doctor can help determine whether Erleada is safe for you to take.
  • High cholesterol: People with high cholesterol have a higher risk of developing heart disease during Erleada treatment. If you have high cholesterol, talk with your doctor about whether Erleada is right for you.
  • Past stroke, brain injury, or brain tumor: In rare cases, Erleada can cause a stroke or ministroke. You may have a higher risk of this side effect if you’ve had a stroke, brain tumor, or brain injury in the past. Talk with your doctor about whether Erleada is a safe treatment option for you.
  • Seizures: In rare cases, Erleada can cause seizures. You may have a higher risk of this side effect if you already have seizures or epilepsy. Your doctor can help determine whether Erleada is safe for you to take.
  • Lung conditions: If you have any lung conditions, let your doctor know before you take Erleada. It’s possible that this drug may cause interstitial lung disease and pneumonitis. Taking Erleada may make lung problems worse. Your doctor can recommend a different drug for your prostate cancer.
  • Allergic reaction: If you’ve had an allergic reaction to Erleada or any of its ingredients, your doctor will likely not prescribe Erleada. Ask your doctor what other medications are better options for you.

Erleada and alcohol

It should be safe to drink alcohol during Erleada treatment. But drinking large amounts of alcohol can cause many of the same side effects as Erleada.

Drinking alcohol while taking Erleada can raise your risk of:

  • diarrhea
  • falls
  • fatigue (low energy)
  • nausea

If you drink alcohol, talk with your doctor about how much may be safe to drink during Erleada treatment.

Pregnancy and breastfeeding

Erleada is not intended for use in females, since it’s prescribed to treat prostate cancer.

If you’re a male taking Erleada who has a sexual partner who may become pregnant, you should use birth control, such as condoms, during treatment. You’ll need to continue using birth control for at least 3 months after your last dose of Erleada. If you have other questions about Erleada and pregnancy, talk with your doctor.

Note: In this article, we use the terms “females” and “males” to refer to someone’s sex assigned at birth. For more information, see our article on the difference between sex and gender.

Do not take more Erleada than your doctor prescribes. Taking more than this can lead to serious side effects.

What to do in case you take too much Erleada

Call your doctor if you think you’ve taken too much Erleada. You can also call 800-222-1222 to reach America’s Poison Centers, or use its online resource. But if you have severe symptoms, immediately call 911 or your local emergency number. Or go to the nearest emergency room.

If you’re considering treatment with Erleada, talk with your doctor or pharmacist. Ask questions to help feel comfortable about the risks and benefits of taking this drug. Some examples of questions you may want to ask include:

  • What should I know about alternative drugs for Erleada?
  • Does Erleada cause sexual side effects?
  • How will I know whether Erleada is working for me?
  • Will I need to have lab tests done while taking Erleada? If so, how often will I have them done?

You can also learn more about treatments for prostate cancer.

Q:

If I have side effects from Erleada, is there a lower dosage I can try?

Anonymous

A:

Yes, in most cases. Depending on the side effect and how severe it is, you may be able to try a lower dosage of Erleada.

The usual Erleada dosage is 240 milligrams (mg) taken once per day. If you experience side effects that bother you or are serious, your doctor will most likely have you temporarily stop taking Erleada. Once side effects go away or become less bothersome, you’ll start taking Erleada again. But your doctor may lower your dosage to 180 mg or 120 mg, taken once per day.

If you experience a serious side effect, such as a life threatening allergic reaction, your doctor will most likely have you permanently stop taking Erleada. If this happens, your doctor can talk with you about other treatment options for your condition.

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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.