What the FDA labels say about taking them together
Dihydroergotamine and enzalutamide
Enzalutamide's FDA label (Xtandi) of May 25, 2021 names dihydroergotamine in its drug interactions section; the dihydroergotamine labels PlainMeds reads (4) do not name enzalutamide. The enzalutamide label: “Concomitant use of XTANDI with narrow therapeutic index drugs that are metabolized by CYP3A4, CYP2C9 and CYP2C19 should be avoided, as enzalutamide may decrease their exposure.”
Check it at the source: the dihydroergotamine FDA label on DailyMed (effective March 6, 2025, Oceanside Pharmaceuticals); the enzalutamide FDA label on DailyMed (effective July 28, 2026, Astellas Pharma US, Inc.).
What does the dihydroergotamine label say about enzalutamide?
Dihydroergotamine's label (effective March 6, 2025) and its 3 other brand-application labels do not name enzalutamide in these sections. A label lists what its studies and reports found; it is not a complete list.
Source: FDA drug label (Dihydroergotamine Mesylate), NDA020148 (Bausch), as published by Oceanside Pharmaceuticals, effective March 6, 2025 (SPL set 977de209-c53a-4cb4-9f3f-1e850600a9dc), via openFDA; the full label on DailyMed
What does the enzalutamide label say about dihydroergotamine?
Xtandi label (Astellas Pharma US, Inc., May 25, 2021), drug interactionsConcomitant use of XTANDI with narrow therapeutic index drugs that are metabolized by CYP3A4 (e.g., alfentanil, cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus and tacrolimus), CYP2C9 (e.g., phenytoin, warfarin) and CYP2C19 (e.g., S-mephenytoin, clopidogrel) should be avoided, as enzalutamide may decrease their exposure.
Source: FDA drug label (Xtandi, NDA213674), Astellas Pharma US, Inc., effective May 25, 2021 (SPL set 381cd215-78c9-4208-8595-7ae7a279b236), via openFDA
Source: FDA drug label (Xtandi), Astellas Pharma US, Inc., effective July 28, 2026 (SPL set b129fdc9-1d8e-425c-a5a9-8a2ed36dfbdf), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Dihydroergotamine | Enzalutamide | |
|---|---|---|
| Labeled for | Migraine | Prostate cancer |
| Boxed warning | Yes | No |
| Pharmacy cost (NADAC) | $29.44 per mL 4 mg/mL nasal spray | n/a |
| Shortage now | No current entry | No current entry |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once