Enzalutamide (Xtandi) and Ketamine Therapy | Tovani Health
Xtandi (Enzalutamide) — Androgen receptor inhibitor (prostate cancer)
Verdict at Tovani Health
Strong CYP3A4 inducer — lowers ketamine levels, same directionality as phenytoin and rifampin.
Enzalutamide and ketamine are compatible with planning. The KAP-relevant interaction is straightforward but in the *opposite* direction from what most people expect: instead of an inhibitor raising ketamine levels, enzalutamide is a strong CYP3A4 inducer that accelerates ketamine metabolism and lowers plasma levels. Standard KAP dosing may be subtherapeutic. We adjust upward. The interaction develops over 1-2 weeks of enzalutamide therapy and persists 1-2 weeks after stopping. Other intrinsic concerns — fatigue, hot flashes, falls, seizure risk in select patients — belong to enzalutamide and oncology management.
If you take Xtandi regularly and are considering at-home ketamine therapy, the combination is safe with monitoring or modest dose adjustment. This page covers the brief pharmacologic context and what we do at intake.
How Xtandi interacts with ketamine
Enzalutamide blocks androgen receptor binding, nuclear translocation, and DNA binding. It's also a strong CYP3A4 inducer and moderate CYP2C9/2C19 inducer. CYP3A4 induction develops over 1-2 weeks and persists for 1-2 weeks after stopping.
What we do at intake
Disclose chronic enzalutamide use including start date. Coordinate with oncology — don't change enzalutamide around KAP. We adjust the KAP dose to account for accelerated metabolism.
Bottom line
Enzalutamide and ketamine are compatible with planning. The KAP-relevant interaction is straightforward but in the opposite direction from what most people expect: instead of an inhibitor raising ketamine levels, enzalutamide is a strong CYP3A4 inducer that accelerates ketamine metabolism and lowers plasma levels. Standard KAP dosing may be subtherapeutic. We adjust upward. The interaction develops over 1-2 weeks of enzalutamide therapy and persists 1-2 weeks after stopping. Other intrinsic concerns — fatigue, hot flashes, falls, seizure risk in select patients — belong to enzalutamide and oncology management.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Xtandi (Enzalutamide) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Ketamine: A Review of Clinical Pharmacokinetics and Pharmacodynamics in Anesthetic and Pain Therapy. Peltoniemi MA, Hagelberg NM, Olkkola KT, Saari TI. Clinical Pharmacokinetics. 2016. PMID: 27028535
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 22, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.