Drug interactions
Buprenorphine + St john's wort
Severity: Moderate
Buprenorphine and St john's wort: moderate interaction.
Last updated
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 induces CYP3A4 and P-glycoprotein, which can lower buprenorphine exposure. This may lead to reduced analgesia or withdrawal symptoms in patients on opioid maintenance.
What this interaction means in plain words
Buprenorphine and St john's wort can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Induction of CYP3A4-mediated buprenorphine metabolism by hyperforin.
What to do
Avoid the combination where possible. If used, monitor for withdrawal or loss of pain control, and reassess buprenorphine dose if the herb is started or stopped.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Buprenorphine
- Alvimopan + Buprenorphine Contraindicated
- Buprenorphine + Calcium / magnesium / potassium / sodium oxybates Contraindicated
- Buprenorphine + Olanzapine / samidorphan Contraindicated
- Buprenorphine + Phenelzine Contraindicated
- Buprenorphine + Pimozide Contraindicated
- Buprenorphine + Thioridazine Contraindicated
Frequently asked questions
Can I take Buprenorphine with St john's wort?
MediHelp rates the interaction as moderate. Buprenorphine and St john's wort can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. St John's wort induces CYP3A4 and P-glycoprotein, which can lower buprenorphine exposure. This may lead to reduced analgesia or withdrawal symptoms in patients on opioid maintenance.
How serious is the interaction between Buprenorphine and St john's wort?
MediHelp rates it moderate, 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 used, monitor for withdrawal or loss of pain control, and reassess buprenorphine dose if the herb is started or stopped.
What other medicines interact with Buprenorphine?
MediHelp also lists interactions of Buprenorphine with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Olanzapine / samidorphan. The full list is on the Buprenorphine page.
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