Drug interactions
Esomeprazole + St john's wort
Severity: Moderate
Esomeprazole 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 CYP2C19 and CYP3A4, which can lower esomeprazole exposure and reduce acid suppression. Effects may persist for some time after the herb is stopped.
What this interaction means in plain words
Esomeprazole 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 CYP2C19 and CYP3A4 (via PXR activation) increases esomeprazole metabolism.
What to do
Monitor symptom control and increase the PPI dose if necessary, or advise stopping the herbal product.
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 Esomeprazole
- Esomeprazole + Mavacamten Contraindicated
- Esomeprazole + Rilpivirine Contraindicated
- Acalabrutinib + Esomeprazole Major
- Atazanavir + Esomeprazole Major
- Citalopram + Esomeprazole Major
- Clopidogrel + Esomeprazole Major
Frequently asked questions
Can I take Esomeprazole with St john's wort?
MediHelp rates the interaction as moderate. Esomeprazole 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 CYP2C19 and CYP3A4, which can lower esomeprazole exposure and reduce acid suppression. Effects may persist for some time after the herb is stopped.
How serious is the interaction between Esomeprazole 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: Monitor symptom control and increase the PPI dose if necessary, or advise stopping the herbal product.
What other medicines interact with Esomeprazole?
MediHelp also lists interactions of Esomeprazole with, for example, Mavacamten, Rilpivirine, Acalabrutinib. The full list is on the Esomeprazole page.
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