Drug interactions
Everolimus + St john's wort
Severity: Major
Everolimus and St john's wort: major interaction.
Last updated Sources: UK SmPC
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 and can lower everolimus concentrations. This risks loss of efficacy such as graft rejection or reduced antitumour effect.
What this interaction means in plain words
Everolimus 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
St John's wort induces CYP3A4 and P-glycoprotein, increasing everolimus metabolism and efflux.
What to do
Avoid St John's wort in patients on everolimus. If it was already taken, stop it and monitor everolimus trough levels as induction wanes, since levels may rise.
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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References
Other interactions of Everolimus
- Bcg vaccine live + Everolimus Contraindicated
- Everolimus + Influenza virus vaccine quadrivalent intranasal Contraindicated
- Everolimus + Levoketoconazole Contraindicated
- Everolimus + Measles mumps and rubella vaccine live Contraindicated
- Everolimus + Measles mumps rubella and varicella vaccine live Contraindicated
- Everolimus + Measles vaccine Contraindicated
Frequently asked questions
Can I take Everolimus with St john's wort?
MediHelp rates the interaction as major. Everolimus 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 CYP3A4 and P-glycoprotein and can lower everolimus concentrations. This risks loss of efficacy such as graft rejection or reduced antitumour effect.
How serious is the interaction between Everolimus 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 St John's wort in patients on everolimus. If it was already taken, stop it and monitor everolimus trough levels as induction wanes, since levels may rise.
What other medicines interact with Everolimus?
MediHelp also lists interactions of Everolimus with, for example, Bcg vaccine live, Influenza virus vaccine quadrivalent intranasal, Levoketoconazole. The full list is on the Everolimus page.
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