Drug interactions
Eplerenone + St john's wort
Severity: Moderate
Eplerenone 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 may reduce eplerenone concentrations and weaken its blood pressure and cardiac benefit. The size of the effect varies with the herbal product used.
What this interaction means in plain words
Eplerenone 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
St John's wort induces CYP3A4 and P-glycoprotein, increasing the clearance of eplerenone.
What to do
Advise the patient to avoid St John's wort. If it is used, monitor blood pressure and potassium and adjust eplerenone, reassessing when the herb is 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 Eplerenone
- Amiloride + Eplerenone Contraindicated
- Atazanavir + Eplerenone Contraindicated
- Clarithromycin + Eplerenone Contraindicated
- Cobicistat + Eplerenone Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Eplerenone Contraindicated
- Ensitrelvir + Eplerenone Contraindicated
Frequently asked questions
Can I take Eplerenone with St john's wort?
MediHelp rates the interaction as moderate. Eplerenone 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 may reduce eplerenone concentrations and weaken its blood pressure and cardiac benefit. The size of the effect varies with the herbal product used.
How serious is the interaction between Eplerenone 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: Advise the patient to avoid St John's wort. If it is used, monitor blood pressure and potassium and adjust eplerenone, reassessing when the herb is stopped.
What other medicines interact with Eplerenone?
MediHelp also lists interactions of Eplerenone with, for example, Amiloride, Atazanavir, Clarithromycin. The full list is on the Eplerenone page.
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