Drug interactions
Hydrocortisone + St john's wort
Severity: Moderate
Hydrocortisone 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 CYP3A4 and P-gp, which can lower hydrocortisone exposure. This may reduce glucocorticoid effect, a concern in adrenal insufficiency.
What this interaction means in plain words
Hydrocortisone 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 CYP3A4 and P-gp increases hydrocortisone clearance.
What to do
Avoid St John's wort in patients dependent on hydrocortisone replacement, or monitor response and increase the dose if needed.
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 Hydrocortisone
- Hydrocortisone + Mifepristone Contraindicated
- Hydrocortisone + Poliovirus vaccine live oral trivalent Contraindicated
- Hydrocortisone + Smallpox vaccine live Contraindicated
- Adenovirus types 4 and 7 live + Hydrocortisone Major
- Aldesleukin + Hydrocortisone Major
- Aspirin + Hydrocortisone Major
Frequently asked questions
Can I take Hydrocortisone with St john's wort?
MediHelp rates the interaction as moderate. Hydrocortisone 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 CYP3A4 and P-gp, which can lower hydrocortisone exposure. This may reduce glucocorticoid effect, a concern in adrenal insufficiency.
How serious is the interaction between Hydrocortisone 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: Avoid St John's wort in patients dependent on hydrocortisone replacement, or monitor response and increase the dose if needed.
What other medicines interact with Hydrocortisone?
MediHelp also lists interactions of Hydrocortisone with, for example, Mifepristone, Poliovirus vaccine live oral trivalent, Smallpox vaccine live. The full list is on the Hydrocortisone page.
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