Drug interactions
Dabigatran etexilate + St john's wort
Severity: Major
Dabigatran etexilate and St john's wort: major 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 P-gp and may decrease dabigatran concentrations. This can lead to subtherapeutic anticoagulation and thromboembolic events.
What this interaction means in plain words
Dabigatran etexilate 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 intestinal P-glycoprotein by St John's wort increases dabigatran efflux, lowering absorption.
What to do
Avoid the combination and advise patients to stop St John's wort. Use an alternative anticoagulant if the herbal product must continue.
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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Other interactions of Dabigatran etexilate
- Dabigatran etexilate + Defibrotide Contraindicated
- Dabigatran etexilate + Ketorolac Contraindicated
- Dabigatran etexilate + Mifepristone Contraindicated
- Abciximab + Dabigatran etexilate Major
- Alteplase + Dabigatran etexilate Major
- Amiodarone + Dabigatran etexilate Major
Frequently asked questions
Can I take Dabigatran etexilate with St john's wort?
MediHelp rates the interaction as major. Dabigatran etexilate 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 induces P-gp and may decrease dabigatran concentrations. This can lead to subtherapeutic anticoagulation and thromboembolic events.
How serious is the interaction between Dabigatran etexilate 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 and advise patients to stop St John's wort. Use an alternative anticoagulant if the herbal product must continue.
What other medicines interact with Dabigatran etexilate?
MediHelp also lists interactions of Dabigatran etexilate with, for example, Defibrotide, Ketorolac, Mifepristone. The full list is on the Dabigatran etexilate page.
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