Drug interactions
Cyclosporin + St john's wort
Severity: Contraindicated
Cyclosporin and St john's wort: contraindicated 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 markedly reduces cyclosporine concentrations, and cases of acute organ rejection in transplant recipients have been reported. The effect can persist for some time after the herb is stopped, and levels may rise again.
What this interaction means in plain words
Cyclosporin and St john's wort are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Why it happens
Induction of CYP3A4 and P-glycoprotein by hyperforin increases cyclosporine clearance and reduces absorption.
What to do
Do not combine. If the patient has been taking St John's wort, stop it and monitor cyclosporine trough levels, as dose reduction may be needed afterward.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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Other interactions of Cyclosporin
- Adenovirus types 4 and 7 live + Cyclosporin Contraindicated
- Aliskiren + Cyclosporin Contraindicated
- Bcg vaccine live + Cyclosporin Contraindicated
- Bosentan + Cyclosporin Contraindicated
- Cidofovir + Cyclosporin Contraindicated
- Cyclosporin + Dengue vaccine Contraindicated
Frequently asked questions
Can I take Cyclosporin with St john's wort?
MediHelp rates the interaction as contraindicated. Cyclosporin and St john's wort are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. St John's wort markedly reduces cyclosporine concentrations, and cases of acute organ rejection in transplant recipients have been reported. The effect can persist for some time after the herb is stopped, and levels may rise again.
How serious is the interaction between Cyclosporin and St john's wort?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Do not combine. If the patient has been taking St John's wort, stop it and monitor cyclosporine trough levels, as dose reduction may be needed afterward.
What other medicines interact with Cyclosporin?
MediHelp also lists interactions of Cyclosporin with, for example, Adenovirus types 4 and 7 live, Aliskiren, Bcg vaccine live. The full list is on the Cyclosporin page.
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