When You Can't Get Zytiga, What Are Your Options?

Being told your pharmacy doesn't have Zytiga in stock — or that your insurance won't cover it — is stressful enough without having to figure out the next step on your own. If you're dealing with advanced prostate cancer and your Zytiga (Abiraterone Acetate) prescription can't be filled, you need to know what alternatives exist.

The good news is that there are several other FDA-approved medications that treat the same types of prostate cancer as Zytiga. While none of them are identical to Zytiga, they target the same disease through related mechanisms and may be a solid option depending on your situation.

Let's walk through what Zytiga does, how it works, and which alternatives your oncologist might consider.

What Is Zytiga and How Does It Work?

Zytiga is the brand name for Abiraterone Acetate, an androgen biosynthesis inhibitor. It's prescribed for men with metastatic castration-resistant prostate cancer (mCRPC) or metastatic high-risk castration-sensitive prostate cancer (mCSPC).

Prostate cancer cells need testosterone to grow. Even after surgical castration or treatment with a GnRH analog (which dramatically lowers testosterone), the body can still produce small amounts of androgens in the adrenal glands and within the tumor itself. Zytiga blocks the enzyme CYP17A1, which is essential for producing these remaining androgens. By cutting off this fuel supply, Zytiga helps slow or stop cancer growth.

Zytiga is taken as a 1,000 mg oral dose once daily on an empty stomach, always in combination with prednisone (5 mg twice daily).

Alternatives to Zytiga

If Zytiga isn't available or isn't the right fit for you, here are the most common alternatives your oncologist may consider. Each works differently but targets the same underlying disease.

1. Enzalutamide (Xtandi)

Enzalutamide is one of the most commonly prescribed alternatives to Zytiga. While Zytiga blocks androgen production, Enzalutamide works by blocking the androgen receptor itself — the protein on cancer cells that testosterone binds to. This means even if small amounts of testosterone are present, Enzalutamide prevents the cancer cells from using it.

Key facts about Enzalutamide:

• FDA-approved for mCRPC and mCSPC
• Taken as 160 mg (four 40 mg capsules) once daily
• Can be taken with or without food
• Does not require concurrent prednisone
• Common side effects include fatigue, hot flashes, high blood pressure, and falls
• Brand-name cash price is approximately $13,000 to $16,000 per month

Enzalutamide may be preferred for patients who want to avoid the empty-stomach requirement or who cannot take corticosteroids long-term.

2. Apalutamide (Erleada)

Apalutamide is another androgen receptor inhibitor, similar to Enzalutamide. It was specifically approved for metastatic castration-sensitive prostate cancer (mCSPC) and non-metastatic castration-resistant prostate cancer (nmCRPC).

Key facts about Apalutamide:

• Taken as 240 mg (four 60 mg tablets) once daily
• Can be taken with or without food
• Common side effects include fatigue, rash, high blood pressure, and joint pain
• Does not require concurrent prednisone
• May be an option if your cancer hasn't yet spread to distant sites

Apalutamide may be particularly relevant if you have castration-sensitive prostate cancer and are looking for an alternative that doesn't require the strict food timing that Zytiga does.

3. Darolutamide (Nubeqa)

Darolutamide is a newer androgen receptor inhibitor approved for non-metastatic castration-resistant prostate cancer (nmCRPC) and, more recently, for metastatic castration-sensitive prostate cancer in combination with Docetaxel.

Key facts about Darolutamide:

• Taken as 600 mg (two 300 mg tablets) twice daily with food
• Lower rates of fatigue, falls, and fractures compared to some other androgen receptor inhibitors
• Does not cross the blood-brain barrier as readily, which may mean fewer central nervous system side effects
• Common side effects include fatigue, pain in extremities, and rash

Darolutamide is often considered for patients who are concerned about fatigue and cognitive side effects that can occur with other drugs in this class.

4. Docetaxel (Chemotherapy)

For patients with metastatic castration-resistant prostate cancer who need a different approach, Docetaxel-based chemotherapy remains a standard treatment option. Unlike the oral medications above, Docetaxel is given as an intravenous infusion, typically every three weeks.

Key facts about Docetaxel:

• Given as IV infusion every 3 weeks for up to 10 cycles
• Often combined with prednisone
• Common side effects include hair loss, nausea, fatigue, low white blood cell counts, and neuropathy
• Requires visits to an infusion center

Docetaxel is generally reserved for cases where hormonal therapies are no longer effective or when a more aggressive approach is needed.

What About Generic Abiraterone Acetate or Yonsa?

Before switching to a completely different medication, it's worth asking your doctor about these closely related options:

• Generic Abiraterone Acetate: Contains the same active ingredient as Zytiga and may be more readily available and less expensive. Cash prices for the generic range from approximately $500 to $3,000 per month.
• Yonsa: Another brand of Abiraterone Acetate that uses a micronized formulation. A key advantage is that Yonsa can be taken with or without food, unlike Zytiga which must be taken on an empty stomach. The dose is also different — 500 mg once daily for Yonsa versus 1,000 mg for Zytiga.

These aren't technically "alternatives" since they contain the same drug, but if your issue is availability or cost rather than the medication itself, they may solve the problem without changing your treatment plan.

How to Decide With Your Doctor

Switching cancer medications is never a decision to make on your own. Your oncologist will consider several factors when recommending an alternative, including:

• Your specific type and stage of prostate cancer
• Previous treatments you've received
• Your overall health and other medical conditions
• Side effect profiles and your personal risk factors
• Insurance coverage and out-of-pocket cost
• Drug interactions with other medications you take

If you're having trouble finding Zytiga, be upfront with your oncologist about it. They deal with these access issues regularly and can often find a solution quickly — whether that's a different pharmacy, a different formulation, or a different drug altogether.

Final Thoughts

Not being able to fill your Zytiga prescription is frustrating, but it doesn't mean you're out of options. Enzalutamide, Apalutamide, Darolutamide, and Docetaxel are all proven treatments for advanced prostate cancer, and generic Abiraterone Acetate or Yonsa may solve the problem without changing your drug at all.

Use Medfinder to check if Zytiga or its generic is available near you before considering a switch. And if you're curious about the latest availability updates, check out our Zytiga shortage update for 2026.