Drug interactions
Brexpiprazole + St john's wort
Severity: Major
Brexpiprazole and St john's wort: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
St John's wort is a strong CYP3A4 inducer and can lower brexpiprazole exposure considerably. This may cause loss of therapeutic effect and symptom relapse.
What this interaction means in plain words
Brexpiprazole and St john's wort can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Induction of CYP3A4 (and P-glycoprotein) by hyperforin increases brexpiprazole clearance.
What to do
Avoid the combination where possible; if it is unavoidable, the brexpiprazole dose is roughly doubled over 1 to 2 weeks with response monitoring. Return to the usual dose over 1 to 2 weeks after stopping the herb.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Brexpiprazole
Frequently asked questions
Can I take Brexpiprazole with St john's wort?
MediHelp rates the interaction as major. Brexpiprazole and St john's wort can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. St John's wort is a strong CYP3A4 inducer and can lower brexpiprazole exposure considerably. This may cause loss of therapeutic effect and symptom relapse.
How serious is the interaction between Brexpiprazole and St john's wort?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible; if it is unavoidable, the brexpiprazole dose is roughly doubled over 1 to 2 weeks with response monitoring. Return to the usual dose over 1 to 2 weeks after stopping the herb.
What other medicines interact with Brexpiprazole?
MediHelp also lists interactions of Brexpiprazole with, for example, Alfentanil, Amisulpride, Apalutamide. The full list is on the Brexpiprazole page.
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