St. John's wort (Hypericum perforatum)

5-aminolevulinic acid [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant use of medicinal products with known phototoxic or photoallergic potential may enhance the phototoxic reaction to photodynamic therapy.

Abemaciclib [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant use of strong CYP3A4 inducers should be avoided due to the risk of decreased efficacy of abemaciclib.

Ability to drive [1], St. John's wort ---> SmPC of [1] of eMC

In rare cases St John's Wort may make you feel dizzy or sleepy. If affected do not drive or use machines.

Abiraterone [1], St. John's wort ---> SmPC of [1] of EMA

Strong inducers of CYP3A4 (decreased mean plasma AUCinf of abiraterone) during treatment are to be avoided, unless there is no therapeutic alternative.

Acalabrutinib [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant treatment with St. John's wort, which may unpredictably decrease acalabrutinib plasma concentrations, should be avoided.

Acenocoumarol, St. John's wort

St. John's wort may decrease the anticoagulant effect of acenocoumarol

Afatinib [1], St. John's wort ---> SmPC of [1] of EMA

Strong P-gp inducers may decrease exposure to afatinib

Alectinib [1], St. John's wort ---> SmPC of [1] of EMA

Appropriate monitoring is recommended for patients taking concomitant strong CYP3A inducers (including, but not limited to, carbamazepine, phenobarbital, phenytoin, rifabutin, rifampicin and St. John's Wort (Hypericum perforatum)).

Aliskiren [1], St. John's wort ---> SmPC of [1] of EMA

Inducers of P-gp might decrease the bioavailability of aliskiren. Caution required with concomitant use

Aliskiren/amlodipine [1], St. John's wort ---> SmPC of [1] of EMA

The concomitant use of CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.

Aliskiren/amlodipine/hydrochlorothiazide, St. John's wort ---> SmPC of [aliskiren] of EMA

Inducers of P-gp might decrease the bioavailability of aliskiren. Caution required with concomitant use

Aliskiren/hydrochlorothiazide [1], St. John's wort ---> SmPC of [1] of EMA

Inducers of P-gp might decrease the bioavailability of aliskiren. Caution required with concomitant use

Alitretinoin [1], St. John's wort ---> SmPC of [1] of eMC

Patients should be prospectively cautioned not to self-medicate with the herbal supplement St. John's Wort because a possible interaction has been suggested with hormonal contraceptives based on reports of breakthrough bleeding on oral contraceptives

Almotriptan [1], St. John's wort ---> SmPC of [1] of eMC

Undesirable effects may be more common during concomitant use of triptans and herbal preparations containing St John's Wort (Hypericum perforatum ).

Alprazolam, St. John's wort

The co-administration may decrease the effect of alprazolam

Aminophylline [1], St. John's wort ---> SmPC of [1] of eMC

St John's Wort (Hypericum perforatum) may decrease aminophylline clearance resulting in increased plasma theophylline concentrations and the potential for increased toxicity

Amiodarone, St. John's wort

The strong CYP3A4 induction may decrease the plasma concentrations of amiodarone. St. John's Wort should be avoided

Amitriptyline, St. John's wort [2] ---> SmPC of [2] of eMC

The co-administration may increase the serotoninergic effects and the adverse reactions. St. John's Wort should be avoided

Amlodipine, St. John's wort ---> SmPC of [amlodipine/valsartan] of EMA

The concomitant use of CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.

Amlodipine/valsartan [1], St. John's wort ---> SmPC of [1] of EMA

The concomitant use of CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.

Amlodipine/valsartan/hydrochlorothiazide [1], St. John's wort ---> SmPC of [1] of EMA

The concomitant use of CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.

Amprenavir [1], St. John's wort ---> SmPC of [1] of EMA

Herbal preparations containing St John's wort (Hypericum perforatum) must not be used while taking amprenavir due to the risk of decreased plasma concentrations and reduced clinical effects of amprenavir

Amprenavir/ritonavir, St. John's wort ---> SmPC of [amprenavir] of EMA

Herbal preparations containing St John's wort (Hypericum perforatum) must not be used while taking amprenavir due to the risk of decreased plasma concentrations and reduced clinical effects of amprenavir

Antidepressants with serotonergic effect, St. John's wort ---> SmPC of [vortioxetine] of EMA

Concomitant use of antidepressants with serotonergic effect and St. John's wort may result in a higher incidence of adverse reactions including serotonin syndrome

Antidepressants, St. John's wort

The co-administration may increase the serotoninergic effects and the adverse reactions. St. John's Wort should be avoided

Antiepileptics, St. John's wort

St. John's wort, enzymatic inductor, may decrease the plasma concentrations of antiepileptic agent (with risk of seizures). St. John's Wort should be avoided

Apixaban [1], St. John's wort ---> SmPC of [1] of EMA

The concomitant use of apixaban with strong CYP3A4 and P-gp inducers may lead to reduced apixaban plasma concentrations. No dose adjustment for apixaban (almost always) is required during concomitant therapy with such agents

Apremilast [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of strong CYP3A4 enzyme inducer rifampicin resulted in a reduction of systemic exposure of apremilast. Therefore, the use of strong CYP3A4 enzyme inducers with apremilast is not recommended.

Aprepitant [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant administration of aprepitant with active substances that strongly induce CYP3A4 activity should be avoided as the combination results in reductions of the plasma concentrations of aprepitant that may result in decreased efficacy of aprepitant

Aripiprazole [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant administration of aripiprazole and inducers of CYP3A4 may be expected to reduce the geometric means of Cmax and AUC for aripiprazole. The concomitant use of CYP3A4 inducers with aripiprazole should be avoided

Atazanavir [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant use of St. John's wort (CYP3A4 induction) with atazanavir may be expected to result in significant reduction in atazanavir plasma levels. Co-administration is contraindicated.

Atazanavir/cobicistat [1], St. John's wort ---> SmPC of [1] of EMA

Coadministration (contraindicated) of EVOTAZ with strong inducers of CYP3A may result in decreased plasma concentrations of atazanavir and/or cobicistat, leading to loss of therapeutic effect and possible development of resistance to atazanavir.

Atorvastatin [1], St. John's wort ---> SmPC of [1] of eMC

Concomitant administration of atorvastatin with inducers of cytochrome P450 3A can lead to variable reductions in plasma concentrations of atorvastatin.

Avapritinib [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration with strong or moderate CYP3A inducers should be avoided because it may decrease the plasma concentrations of avapritinib

Axitinib [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of axitinib with strong CYP3A4/5 inducers may decrease axitinib plasma concentrations. Selection of concomitant medicinal products with no or minimal CYP3A4/5 induction potential is recommended.

Bedaquiline [1], St. John's wort ---> SmPC of [1] of EMA

Bedaquiline exposure may be reduced during co-administration with inducers of CYP3A4. Co-administration of bedaquiline and moderate or strong CYP3A4 inducers used systemically should be avoided.

Bictegravir/emtricitabine/tenofovir alafenamide [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration may decrease bictegravir and tenofovir alafenamide plasma concentrations. Co-administration with St John's wort is contraindicated, due to the effect of St John's wort on the bictegravir component of Biktarvy.

Binimetinib [1], St. John's wort ---> SmPC of [1] of EMA

Inducers of Pgp transport (such as Saint John's wort or phenytoin) may decrease binimetinib exposure, which could result in a decrease of efficacy.

Bortezomib [1], St. John's wort ---> SmPC of [1] of EMA

The concomitant use of bortezomib with strong CYP3A4 inducers is not recommended, as efficacy may be reduced.

Bosentan [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant administration of bosentan and CYP3A4 inductors is expected to lead to reduced systemic exposure to bosentan. A clinically significant reduction of efficacy cannot be excluded.

Bosutinib [1], St. John's wort ---> SmPC of [1] of EMA

The concomitant use of bosutinib with strong CYP3A inductors should be avoided, as a decrease in bosutinib plasma levels will occur.

Breast-feeding, St. John's wort

It should not be used during breast-feeding

Brigatinib [1], St. John's wort ---> SmPC of [1] of EMA

The concomitant use of strong CYP3A inducers with Alunbrig should be avoided

Brivaracetam [1], St. John's wort ---> SmPC of [1] of EMA

Other strong enzyme inducers (such as St John´s wort (Hypericum perforatum)) may also decrease the systemic exposure of brivaracetam. Therefore, starting or ending treatment with St John's wort should be done with caution.

Brotizolam, St. John's wort

The strong CYP3A4 induction may decrease the plasma concentrations of brotizolam

Buspirone [1], St. John's wort ---> SmPC of [1] of eMC

When used buspirone in combination with a potent inducer of CYP3A4, an adjustment of the dosage of buspirone may be necessary to maintain buspirone's anxiolytic effect.

Cabazitaxel [1], St. John's wort ---> SmPC of [1] of EMA

Repeated administration of rifampin, a strong CYP3A inducer, resulted in an increase in cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur

Cabozantinib [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of cabozantinib with strong CYP3A4 inductors (decreased plasma cabozantinib exposure (AUC) should be approached with caution.

Canagliflozin [1], St. John's wort ---> SmPC of [1] of EMA

Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.

Canagliflozin/metformin [1], St. John's wort ---> SmPC of [1] of EMA

Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.

Cannabidiol [1], St. John's wort ---> SmPC of [1] of EMA

Strong inducers of CYP3A4 administered concomitantly with cannabidiol may decrease the plasma concentrations of cannabidiol and decrease the effectiveness of cannabidiol. Dose adjustment may be necessary.

Carbamazepine, St. John's wort [2] ---> SmPC of [2] of eMC

St. John's wort, enzymatic inductor, may decrease the plasma concentrations of carbamazepine (with risk of seizures). St. John's Wort should be avoided

Cariprazine [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of cariprazine with strong and moderate inducers of CYP3A4 may result in a significant decrease in total cariprazine exposure, therefore the co-administration of cariprazine and strong or moderate CYP3A4 inducers is contraindicated

Ceritinib [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of ceritinib with strong CYP3A inducers decreases ceritinib plasma concentrations. Concomitant use of strong CYP3A inducers should be avoided.

Cerivastatin, St. John's wort

St. John's wort, strong CYP3A4 inductor, may decrease the plasma concentrations of statine. St. John's Wort should be avoided

Cilostazol [1], St. John's wort ---> SmPC of [1] of EMA

The effect of CYP3A4 and CYP2C19 inducers on cilostazol pharmacokinetics has not been evaluated. The antiplatelet effect may theoretically be altered

Citalopram, St. John's wort [2] ---> SmPC of [2] of eMC

Dynamic interactions between citalopram and the herbal remedy St John's wort (Hypericum perforatum) can occur, resulting in an increase in undesirable effects

Clarithromycin [1], St. John's wort ---> SmPC of [1] of eMC

Drugs that are inducers of CYP3A may induce the metabolism of clarithromycin. This may result in sub-therapeutic levels of clarithromycin leading to reduced efficacy.

Clomipramine, St. John's wort

Concomitant administration of clomipramine with St. John's wort during the treatment may decrease the plasma concentrations of clomipramine.

Cobicistat [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of cobicistat with medicinal products that are strong inducers of CYP3A may result in decreased plasma concentrations of cobicistat. Coadministration is contraindicated

Cobimetinib [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant use of moderate and strong CYP3A inducers should be avoided. Given that cobimetinib concentrations are likely to be significantly reduced when co-administered with moderate to strong CYP3A inducers, patient's efficacy may be compromised.

Conjugated oestrogens/bazedoxifene [1], St. John's wort ---> SmPC of [1] of EMA

Herbal preparations containing St John's wort (Hypericum perforatum) may induce the metabolism of oestrogens. Clinically, an increased metabolism of oestrogens may lead to decreased effect and changes in the uterine bleeding profile.

Coumarin anticoagulants, St. John's wort

The co-administration decreases the anticoagulant effect (risk of thromboembolias). St. John's Wort should be avoided

Crizotinib [1], St. John's wort ---> SmPC of [1] of EMA

Coadministration of crizotinib with strong CYP3A inducers may decrease crizotinib plasma concentrations. The concurrent use of strong CYP3A inducers should be avoided

Cyclophosphamide, St. John's wort

The CYP3A4 induction may increase the toxicity of cyclophosphamide (prodrug)

Cyclosporine [1], St. John's wort ---> SmPC of [1] of eMC

Decreased cyclosporine plasma levels. The co-administration is contraindicated

Cyproterone [1], St. John's wort ---> SmPC of [1] of eMC

Inducers of CYP3A4 may reduce the levels of cyproterone acetate.

Cyproterone/ethinylestradiol [1], St. John's wort ---> SmPC of [1] of eMC

The enzymatic induction by St. John's wort may decrease the plasma levels of ethinylestradiol. St. John's Wort should be avoided

Dabigatran etexilate [1], St. John's wort ---> SmPC of [1] of EMA

Dabigatran etexilate is a substrate for the efflux transporter P-gp. Concomitant administration of a P-gp inducer is expected to result in decreased dabigatran concentrations and should be avoided

Dabigatran [1], St. John's wort ---> SmPC of [1] of EMA

Dabigatran etexilate is a substrate for the efflux transporter P-gp. Concomitant administration of a P-gp inducer is expected to result in decreased dabigatran concentrations and should be avoided

Dabrafenib [1], St. John's wort ---> SmPC of [1] of EMA

Dabrafenib is a substrate for the metabolising enzymes CYP3A4. Medicines that are strong inductors of CYP3A4 are therefore likely to decrease dabrafenib concentrations. Avoid coadministration of dabrafenib with potent inducers of CYP3A4.

Daclatasvir [1], St. John's wort ---> SmPC of [1] of EMA

Daclatasvir is contraindicated in combination with medicinal products that strongly induce CYP3A4 and P-gp, and thus may lead to lower exposure and loss of efficacy of daclatasvir.

Dapoxetine [1], St. John's wort ---> SmPC of [1] of eMC

Combination dapoxetine and serotonergic drugs (SD) may lead to incidence of serotonin associated effects. Dapoxetine should not be used with SD or in 14 d. of discontinuing SD. SD should not be given in 7 d. after discontinuing dapoxetine

Darifenacin [1], St. John's wort ---> SmPC of [1] of EMA

Substances that are inducers of CYP3A4 are likely to decrease the plasma concentrations of darifenacin.

Darolutamide [1], St. John's wort ---> SmPC of [1] of EMA

Use of strong and moderate CYP3A4 inducers and P-gp inducers (e.g. carbamazepine, phenobarbital, St. John's Wort, phenytoin, and rifampicin) during treatment with darolutamide is not recommended, unless there is no therapeutic alternative.

Darunavir/cobicistat, St. John's wort ---> SmPC of [darunavir] of EMA

Darunavir and cobicistat are metabolised by CYP3A, and co-administration with CYP3A inducers may result in subtherapeutic plasma exposure to darunavir. Co-administration of darunavir/cobicistat with strong inducers of CYP3A is contraindicated

Darunavir/cobicistat/emtricitabine/tenofovir alafenamide [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration is contraindicated due to the potential for loss of therapeutic effect

Darunavir/ritonavir, St. John's wort ---> SmPC of [darunavir] of EMA

Concomitant use of darunavir/ritonavir with strong CYP3A4 inductors may decrease plasma concentrations of darunavir and ritonavir. Concomitant use of darunavir/ritonavir with strong CYP3A4 inductors is contraindicated

Dasabuvir with ombitasvir/paritaprevir/ritonavir, St. John's wort ---> SmPC of [dasabuvir] of EMA

CYP3A4 induction by St. John's Wort may decrease the plasma concentrations of dasabuvir, ombitasvir and paritaprevir. Concomitant use is contraindicated

Dasabuvir [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration (contraindicated) of dasabuvir with medicinal products that are strong or moderate enzyme inducers is expected to decrease dasabuvir plasma concentrations and reduce its therapeutic effect

Dasatinib [1], St. John's wort ---> SmPC of [1] of EMA

The administration of dasatinib with a strong CYP3A4 inductor may increase metabolism and decrease dasatinib plasma concentrations. Therefore, concomitant use of potent CYP3A4 inducers with dasatinib is not recommended.

Delavirdine, St. John's wort

St. John's wort, strong CYP3A4 inductor, may decrease the plasma concentrations of non-nucleoside reverse transcriptase inhibitor. St. John's Wort should be avoided

Desogestrel [1], St. John's wort ---> SmPC of [1] of eMC

Interactions can occur with medicinal products that induce microsomal enzymes, which can result in increased clearance of sex hormones

Dextromethorphan/quinidine [1], St. John's wort ---> SmPC of [1] of EMA

Potent CYP3A4 inducers may accelerate the metabolism of quinidine, resulting in lower plasma concentrations and hence decreased inhibition of CYP2D6. This may lead to decreased efficacy of dextromethorphan/quinidine.

Dienogest, St. John's wort

The enzymatic induction may decrease the plasma levels of dienogest

Digoxin, St. John's wort

St. John's wort, inductor of transporters of P-glycoprotein, may decrease the exposure to digoxin. St. John's Wort should be avoided

Diltiazem [1], St. John's wort ---> SmPC of [1] of eMC

Co-administration of diltiazem with a CYP3A4 inducer may result in a decrease of diltiazem plasma concentrations.

Dolutegravir [1], St. John's wort ---> SmPC of [1] of EMA

The strong CYP3A4 and UGT1A1 induction may decrease the exposition of dolutegravir.

Dolutegravir/abacavir/lamivudine [1], St. John's wort ---> SmPC of [1] of EMA

The strong CYP3A4 and UGT1A1 induction may decrease plasma levels of dolutegravir. Co-administration with St. John's wort is discouraged.

Dolutegravir/lamivudine [1], St. John's wort ---> SmPC of [1] of EMA

As Dovato is a fixed-dose tablet, an additional 50 mg tablet of dolutegravir should be administered, approximately 12 hours after Dovato for the duration of the St. John's wort co-administration. Induction of UGT1A1 and CYP3A enzymes

Dolutegravir/rilpivirine [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration may cause significant decreases in rilpivirine plasma concentrations. This may result in loss of therapeutic effect of Juluca. Co-administration of Juluca with St. John's wort is contraindicated

Doravirine [1], St. John's wort ---> SmPC of [1] of EMA

Doravirine should not be co-administered with medicinal products that are strong CYP3A enzyme inducers as significant decreases in doravirine plasma concentrations are expected to occur, which may decrease the effectiveness of doravirine

Doravirine/lamivudine/tenofovir disoproxil [1], St. John's wort ---> SmPC of [1] of EMA

Doravirine should not be co-administered with medicinal products that are strong CYP3A enzyme inducers as significant decreases in doravirine plasma concentrations are expected to occur, which may decrease the effectiveness of doravirine

Dronedarone [1], St. John's wort ---> SmPC of [1] of EMA

Rifampicin decreased dronedarone exposure. Therefore, co-administration of rifampicin and other potent CYP3A4 inducers is not recommended as they decrease dronedarone exposure.

Drugs primarily metabolised by CYP1A2, St. John's wort

St. John's wort, strong CYP3A4 inductor, may decrease the plasma concentrations of the medicinal products primarily metabolised by CYP1A2

Drugs primarily metabolised by CYP3A4, St. John's wort

St. John's wort, strong CYP3A4 inductor, may decrease the plasma concentrations of the medicinal products primarily metabolised by CYP3A4

Duloxetine [1], St. John's wort ---> SmPC of [1] of EMA

In rare cases, serotonin syndrome has been reported in patients using SSRIs/SNRIs concomitantly with serotonergic agents. Caution is advisable if duloxetine is used concomitantly with serotonergic agents

Dydrogesterone/estradiol [1], St. John's wort ---> SmPC of [1] of eMC

Herbal preparations containing St John's wort (Hypericum perforatum) may induce the metabolism of estrogens and progestagens.

Edoxaban [1], St. John's wort ---> SmPC of [1] of EMA

The concomitant use of edoxaban with P-gp inducers may lead to reduced edoxaban plasma concentrations. Edoxaban should be used with caution when co-administered with P-gp inducers.

Efavirenz [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of efavirenz and St. John's wort is contraindicated. Plasma levels of efavirenz can be reduced by concomitant use of St. John's wort due to induction of drug-metabolising enzymes and/or transport proteins by St. John's wort.

Elbasvir/grazoprevir [1], St. John's wort ---> SmPC of [1] of EMA

CYP3A or P-gp induction. Co-administration is contraindicated.

Eletriptan [1], St. John's wort ---> SmPC of [1] of eMC

Undesirable effects may be more common during concomitant use of triptans and herbal preparations containing St. John's wort (Hypericum perforatum)

Eliglustat [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant administration of a strong CYP3A4 inducer resulted in a decrease in eliglustat exposure. Use of a strong CYP3A inducer with eliglustat is not recommended in poor, intermediate and extensive metabolisers.

Elvitegravir [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of elvitegravir with medicines that are strong inducers of CYP3A is contraindicated as the expected decrease in elvitegravir plasma levels can lead to loss of therapeutic effect and possible development of resistance to elvitegravir

Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of Genvoya and some medicinal products that induce CYP3A may result in significantly decreased cobicistat and elvitegravir plasma concentrations, which may result in loss of therapeutic effect and development of resistance.

Elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil [1], St. John's wort ---> SmPC of [1] of EMA

The contraindicated coadministration of Stribild and St. John's wort (CYP3A inducer) may result in significantly decreased cobicistat and elvitegravir plasma concentrations, which may result in loss of therapeutic effect and development of resistance

Emtricitabine/rilpivirine/tenofovir alafenamide [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration may cause significant decreases in the plasma concentrations of rilpivirine (induction of CYP3A) and tenofovir alafenamide (induction of P-gp). Co-administration is contraindicated.

Emtricitabine/rilpivirine/tenofovir disoproxil [1], St. John's wort ---> SmPC of [1] of EMA

Emtricitabine/rilpivirine/tenofovir must not be used in combination with products containing St John's wort as co-administration may cause significant decreases in rilpivirine plasma concentrations.

Emtricitabine/tenofovir alafenamide [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of St. John's wort, a P-gp inducer, may decrease tenofovir alafenamide plasma concentrations, which may result in loss of therapeutic effect and development of resistance.

Encorafenib [1], St. John's wort ---> SmPC of [1] of EMA

A reduction in encorafenib exposure is likely and may result in compromised efficacy. Alternative agents with no or minimal CYP3A induction potential should be considered.

Entrectinib [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of entrectinib with CYP3A/P-gp inducers (including, but not limited to, carbamazepine, phenobarbital, phenytoin, rifabutin, rifampicin, St. John's Wort -Hypericum perforatum-, apalutamide, ritonavir) should be avoided.

Eplerenone [1], St. John's wort ---> SmPC of [1] of eMC

Due to the risk of decreased eplerenone efficacy, the concomitant use of strong CYP3A4 inducers with eplerenone is not recommended

Erlotinib [1], St. John's wort ---> SmPC of [1] of EMA

Erlotinib is metabolised in the liver by the hepatic cytochromes in humans, primarily CYP3A4 and to a lesser extent by CYP1A2. Potent inducers of CYP3A4 activity increase erlotinib metabolism and significantly decrease erlotinib plasma concentrations.

Erythromycin, St. John's wort

The CYP3A4 induction may increase the metabolism of erythromycin and decrease its plasma concentrations and effect

Escitalopram [1], St. John's wort ---> SmPC of [1] of eMC

Concomitant use of SSRIs and herbal remedies containing St. John's Wort (Hypericum perforatum) may result in an increased incidence of adverse reactions

Esomeprazole [1], St. John's wort ---> SmPC of [1] of EMA

Medicinal products known to induce CYP2C19 or CYP3A4 or both (such as rifampicin and St. John's wort (Hypericum perforatum)) may lead to decreased esomeprazole serum levels by increasing the esomeprazole metabolism.

Estradiol valerate/norgestrel [1], St. John's wort ---> SmPC of [1] of eMC

St John's Wort (Hypericum Perforatum) may induce the metabolism of oestrogens and progestagens. Clinically, an increased metabolism of oestrogens and progestagens may lead to decreased efficacy and changes in uterine bleeding profile

Estradiol [1], St. John's wort ---> SmPC of [1] of eMC

Herbal preparations containing Hypericum perforatum may induce the metabolism of estrogens and progestagens. Clinically, an increased metabolism of estrogens and progestagens may lead to decreased effects and changes in the uterine bleeding profile.

Estradiol/norethisterone [1], St. John's wort ---> SmPC of [1] of eMC

Herbal preparations containing St John's wort (Hypericum perforatum) may induce the metabolism of oestrogens and progestogens.

Estriol [1], St. John's wort ---> SmPC of [1] of eMC

The metabolism of estrogens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes

Estrogens, St. John's wort ---> SmPC of [estradiol] of eMC

Herbal preparations containing Hypericum perforatum may induce the metabolism of estrogens and progestagens. Clinically, an increased metabolism of estrogens and progestagens may lead to decreased effects and changes in the uterine bleeding profile.

Ethinyl estradiol [1], St. John's wort ---> SmPC of [1] of eMC

The enzymatic induction by St. John's wort may decrease the plasma levels of ethinylestradiol. St. John's Wort should be avoided

Ethinylestradiol/chlormadinone, St. John's wort

Interactions can occur with drugs that induce hepatic enzymes which can result in increased clearance of sex hormones

Ethinylestradiol/desogestrel [1], St. John's wort ---> SmPC of [1] of eMC

Interactions can occur with drugs that induce microsomal enzymes, which can result in increased clearance of sex hormones

Ethinylestradiol/drospirenone [1], St. John's wort ---> SmPC of [1] of eMC

Interactions can occur with drugs that induce hepatic enzymes which can result in increased clearance of sex hormones

Ethinylestradiol/etonogestrel [1], St. John's wort ---> SmPC of [1] of eMC

Interactions can occur with drugs that induce hepatic enzymes which can result in increased clearance of sex hormones

Ethinylestradiol/gestodene [1], St. John's wort ---> SmPC of [1] of eMC

Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.

Ethinylestradiol/norgestimate [1], St. John's wort ---> SmPC of [1] of eMC

Drugs or herbal products that induce enzymes, especially CYP3A4, may decrease the plasma concentrations of contraceptive hormones, and may decrease their effectiveness and/or increase breakthrough bleeding.

Etonogestrel [1], St. John's wort ---> SmPC of [1] of eMC

Interactions can occur with medicinal products that induce microsomal enzymes, specifically cytochrome P450 enzymes, which can result in increased clearance of sex hormones

Etoposide, St. John's wort

St. John's wort, strong CYP3A4 inductor, may decrease the plasma concentrations of etoposide. St. John's Wort should be avoided

Etravirine [1], St. John's wort ---> SmPC of [1] of EMA

St John's wort is expected to decrease the plasma concentrations of etravirine. Combination not recommended.

Everolimus [1], St. John's wort ---> SmPC of [1] of EMA

Large decrease in exposure of everolimus expected. Preparations containing St John's Wort should not be used during treatment with everolimus

Exemestane [1], St. John's wort ---> SmPC of [1] of eMC

The co-administration of drugs known to induce CYP3A4 may reduce the efficacy of exemestane.

Ezetimibe/atorvastatin [1], St. John's wort ---> SmPC of [1] of eMC

Concomitant administration of atorvastatin with inducers of cytochrome P450 3A4 (e.g., efavirenz, rifampicin, St. John's Wort) can lead to variable reductions in plasma concentrations of atorvastatin.

Felodipine [1], St. John's wort ---> SmPC of [1] of eMC

St. John's wort, enzymatic inductor, may decrease the plasma concentrations of calcium antagonist. St. John's Wort should be avoided

Felodipine/metoprolol, St. John's wort

It has been shown that inductors of cytochrome P450-3A4 system decrease the plasma concentrations of felodipine. The concomitant use with strong CYP3A4 inductors should be avoided

Felodipine/ramipril [1], St. John's wort ---> SmPC of [1] of eMC

The CYP3A4 induction may decrease the plasma levels of felodipine. The co-administration of felodipine with CYP3A4 inductors should be avoided

Fentanyl [1], St. John's wort ---> SmPC of [1] of EMA

The potent CYP3A4 induction may decrease plasma concentrations of fentanyl. St. John's Wort should be avoided

Fesoterodine [1], St. John's wort ---> SmPC of [1] of EMA

Induction of CYP3A4 may lead to subtherapeutic plasma levels. Concomitant use (of fesoterodine) with CYP3A4 inducers is not recommended

Fingolimod [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of fingolimod with strong CYP3A4 enzyme inducers may reduce the AUC of fingolimod and its metabolite. Concomitant administration with St. John's Wort is not recommended

Fluoxetine [1], St. John's wort ---> SmPC of [1] of eMC

An increase in serotonergic effects, such as serotonin syndrome, may occur when selective serotonin reuptake inhibitors and herbal preparations containing St John's Wort (Hypericum perforatum) are used together.

Fluvoxamine [1], St. John's wort ---> SmPC of [1] of eMC

The serotonergic effects of fluvoxamine may be enhanced when used in combination with other serotonergic agents

Fosamprenavir/ritonavir, St. John's wort ---> SmPC of [fosamprenavir] of EMA

CYP3A4 induction by St. John's wort may decrease exposition of amprenavir. Herbal preparations containing St John's wort must not be combined with fosamprenavir

Fosaprepitant [1], St. John's wort ---> SmPC of [1] of EMA

The strong CYP3A4 induction may decrease the plasma concentrations of fosaprepitant. Concomitant administration of fosaprepitant with herbal preparations containing St. John's Wort is not recommended.

Fosphenytoin [1], St. John's wort ---> SmPC of [1] of eMC

Serum levels of phenytoin can be reduced by concomitant use of the herbal preparations containing St John's wort

Fostemsavir [1], St. John's wort ---> SmPC of [1] of EMA

Significant decreases in temsavir plasma concentrations may also occur when fostemsavir is co-administered with other strong CYP3A inducers, and may result in loss of virologic response

Frovatriptan [1], St. John's wort ---> SmPC of [1] of eMC

As with other triptans the risk of the occurrence of serotonin syndrome may be increased.

Gefitinib [1], St. John's wort ---> SmPC of [1] of EMA

Substances that are inducers of CYP3A4 activity may increase metabolism and decrease gefitinib plasma concentrations and thereby reduce the efficacy of gefitinib. Concomitant medicinal products that induce CYP3A4 should be avoided.

Gestagens, St. John's wort ---> SmPC of [estradiol] of eMC

Herbal preparations containing Hypericum perforatum may induce the metabolism of estrogens and progestagens. Clinically, an increased metabolism of estrogens and progestagens may lead to decreased effects and changes in the uterine bleeding profile.

Gilteritinib [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant use of Xospata with strong CYP3A/P-gp inducers (e.g., phenytoin, rifampin and St. John's Wort) should be avoided because they can decrease gilteritinib plasma concentrations.

Glasdegib [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant use with strong CYP3A4 inducers (e.g., rifampicin, carbamazepine, enzalutamide, mitotane, phenytoin and St. John's Wort) should be avoided, as this is likely to decrease glasdegib plasma concentrations.

Glecaprevir/pibrentasvir [1], St. John's wort ---> SmPC of [1] of EMA

Medicinal products that are strong P-gp and CYP3A inducers could significantly decrease glecaprevir or pibrentasvir plasma levels and may lead to reduced therapeutic effect of Maviret or loss of virologic response. Co-administration is contraindicated

Guanfacin [1], St. John's wort ---> SmPC of [1] of EMA

There was a significant decrease in the rate and extent of guanfacine exposure when co-administered with rifampin, a CYP3A4 inducer. Other CYP3A4 inducers may have a comparable effect

Halogenated anaesthetics, St. John's wort ---> SmPC of [sevoflurane] of eMC

Severe hypotension and delayed emergence from anaesthesia with halogenated inhalational anaesthetics have been reported in patients treated long-term with St John's Wort.

Hemp extract, St. John's wort

The co-administration may decrease the Cmax and THC and CBD.

Hydrocortisone [1], St. John's wort ---> SmPC of [1] of EMA

Potent CYP 3A4 inducers can enhance the metabolic clearance of cortisol, decrease terminal half-life and thus reduce circulating levels and increase fluctuations of cortisol (due to shorter terminal half-life).

Ibrutinib [1], St. John's wort ---> SmPC of [1] of EMA

Preparations containing St. John's Wort are contraindicated during treatment with ibrutinib, as efficacy may be reduced.

Idelalisib [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of idelalisib with moderate or strong CYP3A inducers should be avoided as this may result in decreased efficacy

IMAOs, St. John's wort

The co-administration may increase the serotoninergic effects and the adverse reactions. St. John's Wort should be avoided

Imatinib [1], St. John's wort ---> SmPC of [1] of EMA

Substances that are inducers of CYP3A4 activity may significantly reduce exposure to imatinib, potentially increasing the risk of therapeutic failure. Concomitant use of strong CYP3A4 inducers and imatinib should be avoided.

Indinavir [1], St. John's wort ---> SmPC of [1] of EMA

Concurrent use of indinavir with herbal preparations containing St John 's wort (Hypericum perforatum) is contraindicated

Irinotecan [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of ONIVYDE with inducers of CYP3A4 may reduce systemic exposure of ONIVYDE.

Isavuconazole [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of CRESEMBA with potent/moderate CYP3A4/5 inducers is contraindicated, since these medicinal products can significantly decrease plasma concentrations of isavuconazole

Itraconazol [1], St. John's wort ---> SmPC of [1] of eMC

Coadministration of itraconazole with potent enzyme inducers of CYP3A4 may decrease the bioavailability of itraconazole and hydroxy-itraconazole to such an extent that efficacy may be largely reduced.

Ivabradine [1], St. John's wort ---> SmPC of [1] of EMA

The combination of ivabradine 10 mg twice daily with St John's Wort was shown to reduce ivabradine AUC by half. The intake of St John's Wort should be restricted during the treatment with ivabradine.

Ivacaftor [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of ivacaftor with rifampicin, a strong CYP3A inducer, decreased ivacaftor exposure (AUC) and M1 exposure. Co-administration with strong CYP3A inducers is not recommended

Ivacaftor/tezacaftor/elexacaftor [1], St. John's wort ---> SmPC of [1] of EMA

Elexacaftor and tezacaftor exposures are also expected to decrease during co-administration with strong CYP3A inducers; therefore, co-administration with strong CYP3A inducers is not recommended.

Ixabepilone, St. John's wort

The strong CYP3A4 induction may reduce plasma concentrations of ixabepilone

Ixazomib [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of ixazomib with rifampicin decreased ixazomib Cmax by 54% and AUC by 74%. Therefore, co-administration of strong CYP3A inducers with ixazomib is not recommended

Ketoconazole, St. John's wort

The strong CYP3A4 induction significantly decreases the bioavailability of ketoconazole. St. John's Wort should be avoided

Lacosamide [1], St. John's wort ---> SmPC of [1] of EMA

The enzymatic induction may decrease plasma concentrations of lacosamide. Starting or ending treatment with enzyme inducers should be done with caution

Lansoprazole [1], St. John's wort ---> SmPC of [1] of eMC

Enzyme inducers affecting CYP2C19 and CYP3A4 can markedly reduce the plasma concentrations of lansoprazole.

Lapatinib [1], St. John's wort ---> SmPC of [1] of EMA

The CYP3A4 and P-glycoprotein induction may decrease the exposure of lapatinib. St. John's Wort should be avoided

Larotrectinib [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of VITRAKVI with strong or moderate CYP3A and P-gp inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, or St. John's Wort) may decrease larotrectinib plasma concentrations and should be avoided

Lasofoxifene, St. John's wort

Lasofoxifene clearance may be increased in patients chronically treated with inducers of CYP3A4 and may result in reduced efficacy

Ledipasvir/sofosbuvir [1], St. John's wort ---> SmPC of [1] of EMA

Medicinal products that are potent P-gp inducers may significantly decrease ledipasvir and sofosbuvir plasma concentrations leading to reduced therapeutic effect of ledipasvir/sofosbuvir and thus are contraindicated with Harvoni

Lefamulin [1], St. John's wort ---> SmPC of [1] of EMA

Strong induction of CYP3A4. Co-administration of strong CYP3A inducers may result in reduced therapeutic effect of lefamulin and is contraindicated

Letermovir [1], St. John's wort ---> SmPC of [1] of EMA

Co-treatment with moderate and strong inducers may give rise to subtherapeutic letermovir exposure

Levonorgestrel [1], St. John's wort ---> SmPC of [1] of eMC

The metabolism of levonorgestrel is enhanced by concomitant use of liver enzyme inducers.

Levonorgestrel/ethinylestradiol [1], St. John's wort ---> SmPC of [1] of eMC

Interactions of enzyme inducers with oral contraceptives may lead to breakthrough bleeding and/or contraceptive failure: Women should temporarily use a barrier method in addition to the COC or choose another method of contraception.

Lomitapide [1], St. John's wort ---> SmPC of [1] of EMA

Medicines that induce CYP3A4 would be expected to increase the rate and extent of metabolism of lomitapide. Consequently, this would reduce the effect of lomitapide. Any impact on efficacy is likely to be variable.

Lopinavir/ritonavir [1], St. John's wort ---> SmPC of [1] of EMA

Concentrations of lopinavir may be reduced due to induction of CYP3A by the herbal preparation St John's wort. Herbal preparations containing St John's wort must not be combined with lopinavir and ritonavir.

Lorlatinib [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant administration of lorlatinib with strong CYP3A4/5 inducers may decrease lorlatinib plasma concentrations. The use of a strong CYP3A4/5 inducer with lorlatinib is contraindicated

Lovastatine, St. John's wort

St. John's wort, strong CYP3A4 inductor, may decrease the plasma concentrations of statine. St. John's Wort should be avoided

Lumacaftor/ivacaftor [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant use of lumacaftor/ivacaftor with St. John's wort is not recommended. The exposure of ivacaftor will be decreased, which may reduce the efficacy of lumacaftor/ivacaftor.

Lurasidone [1], St. John's wort ---> SmPC of [1] of EMA

Lurasidone and its active metabolite ID-14283 are primarily metabolised by CYP3A4. Lurasidone is contraindicated with strong CYP3A4 inductors

Macimorelin, St. John's wort [2] ---> SmPC of [2] of EMA

Administration of a CYP3A4 inducer may reduce the plasma macimorelin concentrations and may affect the diagnostic performance of the test and therefore should be avoided.

Macitentan [1], St. John's wort ---> SmPC of [1] of EMA

In the presence of strong CYP3A4 inducers reduced efficacy of macitentan could occur. The combination of macitentan with strong CYP3A4 inducers should be avoided

Maraviroc [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of maraviroc with St. John's Wort is expected to substantially decrease maraviroc concentrations and may result in suboptimal levels and lead to loss of virologic response and possible resistance to maraviroc.

Medroxyprogesterone, St. John's wort ---> SmPC of [estradiol] of eMC

Herbal preparations containing Hypericum perforatum may induce the metabolism of estrogens and progestagens. Clinically, an increased metabolism of estrogens and progestagens may lead to decreased effects and changes in the uterine bleeding profile.

Methadone, St. John's wort

The co-administration may decrease the plasma levels and the effect of methadone. St. John's Wort should be avoided

Metildigoxin, St. John's wort

The co-administration may decrease the plasma levels of metildigoxin

Midazolam [1], St. John's wort ---> SmPC of [1] of EMA

St John's Wort decreased plasma concentrations of midazolam by about 20-40% associated with a decrease in terminal half-life of about 15-17%.

Midostaurin [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant use of Rydapt with strong inducers of CYP3A4 (e.g. carbamazepine, rifampicin, enzalutamide, phenytoin, St. John's Wort [Hypericum perforatum]) is contraindicated

Mifepristone [1], St. John's wort ---> SmPC of [1] of eMC

CYP3A4 inductors may induce mifepristone metabolism (lowering serum levels of mifepristone).

Mirtazapine [1], St. John's wort ---> SmPC of [1] of eMC

Co-administration of mirtazapine with other serotonergic active substances may lead to an incidence of serotonin associated effects (serotonin syndrome). Caution should be advised

Mitotane [1], St. John's wort ---> SmPC of [1] of EMA

Mitotane has been shown to have an inductive effect on cytochrome P450 enzymes. Therefore, the plasma concentrations of the substances metabolised via cytochrome P450 may be modified.

Moclobemide, St. John's wort

The combination of moclobemide and St. John's wort increases the risk of serotoninergic syndrome

Naldemedine [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant use of strong CYP3A inducers such as St. John's wort (Hypericum perforatum), rifampicin, carbamazepine, phenobarbital and phenytoin is not recommended.

Naloxegol [1], St. John's wort ---> SmPC of [1] of EMA

Naloxegol is not recommended in patients who are taking strong CYP3A4 inducers (e.g. carbamazepine, rifampin, St. John's Wort)

Naproxen/esomeprazole [1], St. John's wort ---> SmPC of [1] of eMC

Drugs known to induce CYP2C19 and CYP3A4 may lead to decreased esomeprazole serum levels by increasing the esomeprazole metabolism.

Naratriptan [1], St. John's wort ---> SmPC of [1] of eMC

Undesirable effects may be more common during concomitant use of triptans and herbal preparations containing St John's Wort (Hypericum perforatum)

Nateglinide [1], St. John's wort ---> SmPC of [1] of EMA

St John's wort may reduce the hypoglycaemic effect of nateglinide

Nefazodone, St. John's wort

Dynamic interactions between SSRI and the herbal remedy St John's wort (Hypericum perforatum) can occur, resulting in an increase in undesirable effects

Nelfinavir [1], St. John's wort ---> SmPC of [1] of EMA

Herbal preparations containing St. John's wort (Hypericum perforatum) must not be used while taking nelfinavir due to the risk of decreased plasma concentrations and reduced clinical effects of nelfinavir

Neratinib [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration with this medical product that is strong inducer of the CYP3A4/Pgp isoform of cytochrome P450 is contraindicated

Nevirapine [1], St. John's wort ---> SmPC of [1] of EMA

Coadministration of nevirapine with herbal preparations containing St. John's wort (Hypericum perforatum) is contraindicated due to the risk of decreased plasma concentrations and reduced clinical effects of nevirapine

Nilotinib [1], St. John's wort ---> SmPC of [1] of EMA

The concomitant administration of other medicinal products that induce CYP3A4 is likely to reduce exposure to nilotinib to a clinically relevant extent.

Nintedanib [1], St. John's wort ---> SmPC of [1] of EMA

Potent P-gp inducers may decrease exposure to nintedanib. Co-administration with nintedanib should be carefully considered.

Nomegestrol/estradiol [1], St. John's wort ---> SmPC of [1] of EMA

Interactions between oral contraceptives and enzyme-inducing medicinal products may lead to breakthrough bleeding and even contraceptive failure.

Non-nucleoside reverse transcriptase inhibitors, St. John's wort

St. John's wort, strong CYP3A4 inductor, may decrease the plasma concentrations of non-nucleoside reverse transcriptase inhibitor. St. John's Wort should be avoided

Norelgestromin/ethinylestradiol [1], St. John's wort ---> SmPC of [1] of EMA

Interactions can occur with medicinal products that induce hepatic enzymes which can result in increased clearance of sex hormones

Norethisterone acetate, St. John's wort

Reduced contraceptive efficacy with hepatic enzyme-inducing drugs

Norethisterone enantate, St. John's wort [2] ---> SmPC of [2] of eMC

Reduced contraceptive efficacy with hepatic enzyme-inducing drugs

Norethisterone, St. John's wort

The enzymatic induction may decrease the plasma levels and the effect of progestagen

Norgestimate, St. John's wort

The CYP3A4 induction may accelerate the norgestimate metabolism and decrease its plasma levels and effect. The induction lasts at least 4 weeks after dose interruption

Norgestrel, St. John's wort

The enzymatic induction may accelerate the metabolism of steroid hormones and decrease their plasma levels and effect.

Nortriptyline, St. John's wort

Saint John's wort may decrease the plasma levels of nortriptyline

Olaparib [1], St. John's wort ---> SmPC of [1] of EMA

Known strong inducers of CYP3A4/5 are not recommended with olaparib, as it is possible that the efficacy of olaparib could be substantially reduced

Olmesartan medoxomil/amlodipine [1], St. John's wort ---> SmPC of [1] of eMC

The concomitant use of amlodipine and CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.

Ombitasvir/paritaprevir/ritonavir [1], St. John's wort ---> SmPC of [1] of EMA

Coadministration of Viekirax with/without dasabuvir with drugs that are strong or moderate enzyme inducers is expected to decrease ombitasvir, paritaprevir, and ritonavir plasma levels and reduce their therapeutic effect. Concomitant use contraindicated

Omeprazole, St. John's wort

Principle actives known to induce CYP2C19 and CYP3A4 may increase the omeprazole metabolism and decrease its plasma levels

Oral contraceptives, St. John's wort [2] ---> SmPC of [2] of eMC

Pregnancies have been reported by users of combined hormonal contraceptives who also used some form of St. John's Wort.

Osimertinib [1], St. John's wort ---> SmPC of [1] of EMA

Concomitant use of St. John's Wort is contraindicated.

Ospemifene [1], St. John's wort ---> SmPC of [1] of EMA

Rifampicin, strong CYP3A/CYP2C9 enzyme inducer, decreased the ospemifene AUC by 58%. Therefore, co-administration of ospemifene with strong enzyme inducers would be expected to decrease the exposure of ospemifene, which may decrease the clinical effect.

P-glycoprotein substrates, St. John's wort

St. John's wort, inductor of transporters of P-glycoprotein, may decrease the exposure to medicinal products that are transported by P-glycoprotein

Palbociclib [1], St. John's wort ---> SmPC of [1] of EMA

Coadministration of CYP3A inducers may lead to decreased palbociclib exposure and consequently a risk for lack of efficacy. Therefore, concomitant use of palbociclib with strong CYP3A4 inducers should be avoided.

Paliperidone [1], St. John's wort ---> SmPC of [1] of EMA

St. John 's wort, inducer of P-gp, may increase in renal clearance of paliperidone

Panobinostat [1], St. John's wort ---> SmPC of [1] of EMA

Strong inducers may reduce the efficacy of panobinostat, therefore the concomitant use of strong CYP3A4 inducers should be avoided.

Paracetamol, St. John's wort

The enzymatic inductor may decrease the plasma levels of paracetamol and increase its hepatotoxicity. St. John's Wort should be avoided

Paroxetine, St. John's wort [2] ---> SmPC of [2] of eMC

As with other SSRIs, co-administration with serotonergic drugs may lead to an incidence of 5-HT associated effects (serotonin syndrome)

Perampanel [1], St. John's wort ---> SmPC of [1] of EMA

St. John's wort, enzymatic inductor, may decrease the plasma concentrations of antiepileptic agent (with risk of seizures). St. John's Wort should be avoided

Phenobarbital, St. John's wort

St. John's wort, enzymatic inductor, may decrease the plasma concentrations of phenobarbital (with risk of seizures). St. John's Wort should be avoided

Phenprocoumon, St. John's wort

Weakening of phenprocoumon effect with the use concomitant or prior of John's Wort

Phenytoin, St. John's wort [2] ---> SmPC of [2] of eMC

Serum levels of phenytoin can be reduced by concomitant use of the herbal preparations containing St John's wort

Photosensitizing agents, St. John's wort

It is possible that concomitant use of St. John's Wort with other photosensitizing medicinal products could increase the potential for phototoxic reactions

Piperaquine/artenimol [1], St. John's wort ---> SmPC of [1] of EMA

Enzyme inducing medicinal products are likely to lead to reduced piperaquine plasma concentrations. The concentration of DHA may also be reduced. Concomitant treatment with such medicinal products is not recommended.

Pitolisant [1], St. John's wort ---> SmPC of [1] of EMA

With St John's Wort (Hypericum Perforatum), due to its strong CYP3A4 inducing effect, caution should be exercised when taken concurrently with pitolisant.

Polatuzumab vedotin [1], St. John's wort ---> SmPC of [1] of EMA

Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine, phenobarbital, phenytoin, St John's wort [Hypericum perforatum]) may decrease the exposure of unconjugated MMAE.

Ponatinib [1], St. John's wort ---> SmPC of [1] of EMA

Coadministration of ponatinib with strong CYP3A4 inducers (decreases in ponatinib exposure are possible) should be avoided, and alternatives to the CYP3A4 inducer should be sought, unless the benefit outweighs the possible risk of ponatinib underexposure

Pregnancy, St. John's wort

It should not be used during pregnancy

Pretomanid [1], St. John's wort ---> SmPC of [1] of EMA

Due to the possibility of a reduction of the therapeutic effect of pretomanid due to a decrease in systemic exposure, co-administration of pretomanid and moderate or strong CYP3A4 inducers used systemically should be avoided

Primidone, St. John's wort [2] ---> SmPC of [2] of eMC

St. John's Wort induces the CYP450 enzyme system and may result in a reduction of plasma levels of concomitantly administered primidone and of its major metabolite phenobarbitone.

Progesterone, St. John's wort

The strong CYP3A4 induction may decrease the levels of progesterone

Protease inhibitors, St. John's wort

St. John's wort, strong CYP3A4 inductor, may decrease the plasma concentrations of protease inhibitor. St. John's Wort should be avoided

Quinidine, St. John's wort

The strong CYP3A4 induction may decrease the levels of quinidine

Ranolazine [1], St. John's wort ---> SmPC of [1] of EMA

The CYP3A4 induction may decrease the plasma levels of ranolazine. During the treatment with CYP3A4 inductors should not be initiated a therapy with ranolazine

Rasagiline [1], St. John's wort ---> SmPC of [1] of EMA

Rasagiline should not be administered along with other MAO inhibitors as there may be a risk of non-selective MAO inhibition that may lead to hypertensive crises

Reboxetine [1], St. John's wort ---> SmPC of [1] of eMC

Low reboxetine serum levels have been reported with the concurrent administration of CYP3A4 inducers

Regorafenib [1], St. John's wort ---> SmPC of [1] of EMA

The strong CYP3A4 inductor may increase metabolism of regorafenib. The combination of regorafenib with strong CYP3A4 inductors should be avoided

Repaglinide [1], St. John's wort ---> SmPC of [1] of EMA

Rifampicin, a potent inducer of CYP3A4, but also CYP2C8, acts both as an inducer and inhibitor of the metabolism of repaglinide. It cannot be excluded that other inducers may have a similar effect.

Ribociclib [1], St. John's wort ---> SmPC of [1] of EMA

The concomitant use of strong CYP3A4 inducers may therefore lead to decreased exposure and consequently a risk for lack of efficacy. The concomitant use of strong CYP3A4 inducers should be avoided

Rilpivirine [1], St. John's wort ---> SmPC of [1] of EMA

Significant decreases in rilpivirine plasma concentrations are expected (induction of CYP3A enzymes). Concomitant use is contraindicated

Rimonabant [1], St. John's wort ---> SmPC of [1] of EMA

It is expected that concomitant administration of potent CYP3A4 inducers may reduce the plasma concentration of rimonabant and may result in loss of efficacy.

Riociguat [1], St. John's wort ---> SmPC of [1] of EMA

The concomitant use of riociguat with strong CYP3A4 inducers may lead to decreased riociguat plasma concentration.

Ritonavir [1], St. John's wort ---> SmPC of [1] of EMA

Serum levels of ritonavir can be reduced by concomitant use of herbal preparations containing St John's wort (Hypericum perforatum). This is due to the induction of medicinal product metabolising enzymes by St John's wort.

Rivaroxaban [1], St. John's wort ---> SmPC of [1] of EMA

The strong CYP3A4 induction may decrease the plasma concentrations of rivaroxaban. Concomitant administration of strong CYP3A4 inducers should be avoided unless the patient is closely observed for signs and symptoms of thrombosis.

Rizatriptan [1], St. John's wort ---> SmPC of [1] of eMC

Undesirable effects may be more common during concomitant use of triptans (5-HT1B/1D agonists) and herbal preparations containing St John's wort (Hypericum perforatum)

Rolapitant [1], St. John's wort ---> SmPC of [1] of EMA

Due to its strong inducing effect, St John's wort is contraindicated with rolapitant

Rosiglitazone [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of rosiglitazone with rifampicin (an inducer of CYP2C8) resulted in a 66 % decrease in rosiglitazone plasma concentrations. It cannot be excluded that other inducers may also affect rosiglitazone exposure.

Ruxolitinib [1], St. John's wort ---> SmPC of [1] of EMA

The strong CYP3A4 induction may reduce the AUC of ruxolitinib. It is possible that an increase of the ruxolitinib dose is needed with strong CYP3A4 inductors

Saquinavir [1], St. John's wort ---> SmPC of [1] of EMA

Plasma levels of saquinavir can be reduced by concomitant use of the herbal preparation St. John's wort (Hypericum perforatum). This is due to induction of drug metabolising enzymes and/or transport proteins by St. John's wort.

Serotonergic medicines, St. John's wort

The co-administration may increase the serotoninergic effects and the adverse reactions. St. John's Wort should be avoided

Serotonin agonists, St. John's wort

The co-administration may increase the serotoninergic effects and the adverse reactions. St. John's Wort should be avoided

Sertraline [1], St. John's wort ---> SmPC of [1] of EMA

Co-administration of sertraline with other drugs which enhance the effects of serotonergic neurotransmission should be undertaken with caution and avoided whenever possible due to the potential for a pharmacodynamic interaction

Sevoflurane [1], St. John's wort ---> SmPC of [1] of eMC

Severe hypotension and delayed emergence from anaesthesia with halogenated inhalational anaesthetics have been reported in patients treated long-term with St John's Wort.

Simeprevir [1], St. John's wort ---> SmPC of [1] of EMA

The CYP3A4 enzyme induction by St John's wort may decrease the plasma concentrations of simeprevir. It is not recommended to co-administer OLYSIO with products containing St John's wort

Simvastatine, St. John's wort

St. John's wort, strong CYP3A4 inductor, may decrease the plasma concentrations of statine. St. John's Wort should be avoided

Sirolimus [1], St. John's wort ---> SmPC of [1] of EMA

Inducers of CYP3A4 may increase the metabolism of sirolimus and decrease sirolimus blood levels

Sodium valproate, St. John's wort

St. John's wort, enzymatic inductor, may decrease the plasma concentrations of valproate (with risk of seizures). St. John's Wort should be avoided

Sofosbuvir [1], St. John's wort ---> SmPC of [1] of EMA

Medicinal products that are potent P-gp inducers in the intestine may significantly decrease sofosbuvir plasma concentration leading to reduced therapeutic effect of Sovaldi and thus are contraindicated with Sovaldi

Sofosbuvir/velpatasvir [1], St. John's wort ---> SmPC of [1] of EMA

Medicinal products that are potent P-glycoprotein or potent cytochrome P450 inducers are contraindicated with Epclusa. Co-administration will significantly decrease sofosbuvir or velpatasvir plasma levels and could result in loss of efficacy of Epclusa

Sofosbuvir/velpatasvir/voxilaprevir [1], St. John's wort ---> SmPC of [1] of EMA

Medicinal products that are strong inducers of P-gp or strong inducers of CYP2B6, CYP2C8, or CYP3A4 may decrease plasma levels of sofosbuvir, velpatasvir and/or voxilaprevir. The use of such medicinal products with Vosevi is contraindicated

Sonidegib [1], St. John's wort ---> SmPC of [1] of EMA

Sonidegib undergoes metabolism primarily by CYP3A4, and concomitant administration of strong inducers of CYP3A4 can decrease sonidegib concentrations significantly. Concomitant use of strong CYP3A inducers should be avoided

Sorafenib [1], St. John's wort ---> SmPC of [1] of EMA

Inducers of CYP3A4 activity and/or glucuronidation may increase metabolism of sorafenib and thus decrease sorafenib concentrations.

SSRI, St. John's wort

Dynamic interactions between SSRI and the herbal remedy St John's wort (Hypericum perforatum) can occur, resulting in an increase in undesirable effects

St. John's wort [1], sun ---> SmPC of [1] of eMC

While you are taking this product avoid excessive sunbathing or the use of sunbeds/solariums

St. John's wort [1], trazodone ---> SmPC of [1] of eMC

Undesirable effects may be more frequent when trazodone is administered together with preparations containing Hypericum perforatum (St John's wort).

St. John's wort [1], warfarin ---> SmPC of [1] of eMC

Herbal preparations containing St John's Wort (Hypericum perforatum) must not be used whilst taking warfarin due to a proven risk of decreased plasma concentrations and reduced clinical effects of warfarin.

St. John's wort, sumatriptan [2] ---> SmPC of [2] of eMC

Undesirable effects may be more common during concomitant use of triptans and herbal preparations containing St John's Wort (Hypericum perforatum)

St. John's wort, sunitinib [2] ---> SmPC of [2] of EMA

Administration of sunitinib with potent CYP3A4 inducers may decrease sunitinib concentrations. Combination with CYP3A4 inducers should therefore be avoided

St. John's wort, tacrolimus [2] ---> SmPC of [2] of EMA

Concomitant use of substances known to induce CYP3A4 may affect the metabolism of tacrolimus and thereby decrease tacrolimus blood levels.

St. John's wort, talazoparib [2] ---> SmPC of [2] of EMA

Other P-gp inducers (including but not limited to carbamazepine, phenytoin, and St. John's wort) may decrease talazoparib exposure.

St. John's wort, talinolol

Concomitant use of a P-gp inductor decreases the bioavailability of talinolol

St. John's wort, tapentadol [2] ---> SmPC of [2] of eMC

For patients on tapentadol treatment, caution should be exercised if concomitant drug administration of strong enzyme inducing drugs starts or stops, since this may lead to decreased efficacy or risk for adverse effects, respectively.

St. John's wort, telaprevir [2] ---> SmPC of [2] of EMA

Concomitant administration of telaprevir is contraindicated with active substances that strongly induce CYP3A and thus may lead to lower exposure and loss of efficacy of telaprevir

St. John's wort, telithromycin [2] ---> SmPC of [2] of EMA

Concomitant administration of CYP3A4 inducers is likely to result in subtherapeutic levels of telithromycin and loss of effect. Telithromycin should not be used during and 2 weeks after treatment with CYP3A4 inducers.

St. John's wort, telmisartan/amlodipine [2] ---> SmPC of [2] of EMA

The concomitant use of CYP3A4 inducers may lead to a lower plasma concentration of amlodipine.

St. John's wort, temsirolimus [2] ---> SmPC of [2] of EMA

The strong CYP3A4 induction may decrease exposure of the active moieties, temsirolimus and its metabolite, sirolimus. Concomitant treatment of temsirolimus with agents that have CYP3A4/5 induction potential should be avoided

St. John's wort, tenofovir alafenamide [2] ---> SmPC of [2] of EMA

Co-administration of Vemlidy with inducers of P-glycoprotein (P-gp) may decrease tenofovir alafenamide plasma concentrations and is not recommended.

St. John's wort, teriflunomide [2] ---> SmPC of [2] of EMA

Rifampicin und andere bekannte starke CYP und Transporter-Induktoren, wie etwa Carbamazepin, Phenobarbital, Phenytoin und Johanniskraut, sollten während der Behandlung mit Teriflunomid mit Vorsicht angewendet werden.

St. John's wort, tezacaftor/ivacaftor [2] ---> SmPC of [2] of EMA

Tezacaftor exposures can be expected to decrease significantly during co-administration with strong CYP3A inducers; therefore, co-administration with strong CYP3A inducers is not recommended.

St. John's wort, theophylline [2] ---> SmPC of [2] of eMC

The St John's Wort increases clearance of theophylline and it may be necessary to increase dosage to ensure a therapeutic effect. St. John's Wort should be avoided

St. John's wort, tibolone [2] ---> SmPC of [2] of eMC

St. John's wort may induce the metabolism of oestrogens and progestogens via CYP3A4. Clinically, an increased metabolism of oestrogens and progestogens may lead to decreased effect and changes in the uterine bleeding profile.

St. John's wort, tipranavir [2] ---> SmPC of [2] of EMA

Plasma concentrations of tipranavir can be reduced by concomitant use of the herbal preparation St John's wort (Hypericum perforatum). This is due to induction of drug metabolising enzymes by St John's wort.

St. John's wort, tipranavir/ritonavir ---> SmPC of [tipranavir] of EMA

St. John's wort must not be combined with tipranavir/ritonavir. Combination is expected to substantially decrease tipranavir and ritonavir levels and may result in suboptimal levels of tipranavir (loss of virologic response and possible resistance)

St. John's wort, tivozanib [2] ---> SmPC of [2] of EMA

Herbal preparations containing St. John's wort (Hypericum perforatum) are contraindicated. The inducing effect of St John's wort may persist for at least 2 weeks after cessation of treatment with St John's wort

St. John's wort, tolbutamide [2] ---> SmPC of [2] of eMC

Increased hypoglycaemic effects have occurred or might be expected

St. John's wort, topiramate [2] ---> SmPC of [2] of eMC

A risk of decreased plasma concentrations resulting in a loss of efficacy could be observed with coadministration of topiramate and St John's Wort.

St. John's wort, trabectedin [2] ---> SmPC of [2] of EMA

Concomitant use of a strong CYP3A4 inductor with trabectedin may decrease the plasma exposure of trabectedin. Therefore, the concomitant use of trabectedin with strong CYP3A4 inducers should be avoided if possible

St. John's wort, tramadol

St. John's wort, enzymatic inductor, may decrease the plasma concentrations of tramadol. St. John's Wort should be avoided

St. John's wort, trandolapril/verapamil [2] ---> SmPC of [2] of eMC

Verapamil concentrations may be reduced by St. John's wort

St. John's wort, treprostinil [2] ---> SmPC of [2] of EMA

Other CYP2C8 inducers (e.g. phenytoin, carbamazepine, phenobarbital and St. John's Wort) may lead to reduced exposure to treprostinil.

St. John's wort, triptans ---> SmPC of [zolmitriptan] of eMC

Undesirable effects may be more common during concomitant use of triptans and herbal preparations containing St John's wort (Hypericum perforatum).

St. John's wort, trofosfamide

It has to be taken into account a prior or actual treatment with drugs that are enzyme inducers

St. John's wort, ulipristal [2] ---> SmPC of [2] of EMA

Administration of the potent CYP3A4 inducers markedly decreased Cmax and AUC of ulipristal acetate and its active metabolite. Concomitant use of ulipristal acetate and potent CYP3A4 inducers is not recommended

St. John's wort, valproic acid

St. John's wort, enzymatic inductor, may decrease the plasma concentrations of valproic acid (with risk of seizures). St. John's Wort should be avoided

St. John's wort, vandetanib [2] ---> SmPC of [2] of EMA

The concomitant use of vandetanib with strong CYP3A4 inducers (such as rifampicin, St Johns' Wort, carbamazepine, phenobarbital) should be avoided

St. John's wort, vemurafenib [2] ---> SmPC of [2] of EMA

Concomitant administration of vemurafenib and potent inducers of CYP3A4 may lead to suboptimal exposure to vemurafenib and should be avoided.

St. John's wort, venetoclax [2] ---> SmPC of [2] of EMA

Preparations containing St. John's wort are contraindicated during treatment with venetoclax, as efficacy may be reduced

St. John's wort, venlafaxine [2] ---> SmPC of [2] of eMC

Serotonin syndrome may occur with venlafaxine treatment, particularly with concomitant use of other agents that may affect the serotonergic neurotransmitter system

St. John's wort, verapamil ---> SmPC of [trandolapril/verapamil] of eMC

Verapamil concentrations may be reduced by St. John's wort

St. John's wort, vinflunine [2] ---> SmPC of [2] of EMA

The concomitant use of vinflunine and potent CYP3A4 inducers should be avoided since they may decrease vinflunine and DVFL concentrations

St. John's wort, vinorelbine [2] ---> SmPC of [2] of eMC

CYP3A4 is the main enzyme involved in the metabolism of vinorelbine, and the combination with a drug that induces this iso-enzyme can affect the concentration of vinorelbine

St. John's wort, vismodegib [2] ---> SmPC of [2] of EMA

When vismodegib is administered with CYP inducers, exposure to vismodegib may be decreased. St. John's wort is contraindicated

St. John's wort, voriconazole [2] ---> SmPC of [2] of EMA

St. John's wort, strong CYP3A4 inductor, may decrease the plasma concentrations of voriconazole. St. John's Wort should be avoided

St. John's wort, vortioxetine [2] ---> SmPC of [2] of EMA

Concomitant use of antidepressants with serotonergic effect and herbal remedies containing St. John's wort (Hypericum perforatum) may result in a higher incidence of adverse reactions including serotonin syndrome

St. John's wort, ziprasidone

The co-administration of ziprasidone with P glycoprotein inductors may decrease the plasma concentrations of ziprasidone

St. John's wort, zolmitriptan [2] ---> SmPC of [2] of eMC

Undesirable effects may be more common during concomitant use of triptans and herbal preparations containing St John's wort (Hypericum perforatum).

St. John's wort, zopiclone [2] ---> SmPC of [2] of eMC

Plasma levels of zopiclone may be decreased when co-administered with CYP3A4 inducers

CONTRAINDICATIONS of St. John's wort

DO NOT TAKE this product if:

- you are under 18 years of age

- you are pregnant or breast-feeding

- you are allergic to any of the ingredients

- your skin is exceptionally sensitive to sunlight (photosensitive)

- you are having light treatment (phototherapy) for any condition

- you are suffering from depression

http://www.medicines.org.uk/emc/medicine/23809/XPIL/Boots+Mood+Lift+Coated+Tablets/. Stand of information: July 2008. Access date: 02/06/2014