Drug interactions
Ledipasvir-sofosbuvir + St john's wort
Severity: Contraindicated
Ledipasvir-sofosbuvir and St john's wort: contraindicated 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 is a potent inducer of intestinal P-glycoprotein and can markedly lower plasma concentrations of both ledipasvir and sofosbuvir. Reduced exposure may lead to loss of antiviral activity, failure to achieve sustained virologic response and possible resistance.
What this interaction means in plain words
Ledipasvir-sofosbuvir and St john's wort are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Why it happens
Induction of intestinal P-glycoprotein (and other inducible pathways) by St John's wort reduces absorption and plasma exposure of ledipasvir and sofosbuvir.
What to do
Do not combine; stop St John's wort before starting the hepatitis C regimen and choose an alternative if a herbal antidepressant is desired. Counsel patients to avoid herbal products during treatment.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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Other interactions of Ledipasvir-sofosbuvir
- Fosphenytoin + Ledipasvir-sofosbuvir Contraindicated
- Ledipasvir-sofosbuvir + Phenobarbital Contraindicated
- Ledipasvir-sofosbuvir + Phenytoin Contraindicated
- Ledipasvir-sofosbuvir + Rifampin Contraindicated
- Ledipasvir-sofosbuvir + Rifapentine Contraindicated
- Ledipasvir-sofosbuvir + Tipranavir Contraindicated
Frequently asked questions
Can I take Ledipasvir-sofosbuvir with St john's wort?
MediHelp rates the interaction as contraindicated. Ledipasvir-sofosbuvir and St john's wort are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. St John's wort is a potent inducer of intestinal P-glycoprotein and can markedly lower plasma concentrations of both ledipasvir and sofosbuvir. Reduced exposure may lead to loss of antiviral activity, failure to achieve sustained virologic response and possible resistance.
How serious is the interaction between Ledipasvir-sofosbuvir and St john's wort?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Do not combine; stop St John's wort before starting the hepatitis C regimen and choose an alternative if a herbal antidepressant is desired. Counsel patients to avoid herbal products during treatment.
What other medicines interact with Ledipasvir-sofosbuvir?
MediHelp also lists interactions of Ledipasvir-sofosbuvir with, for example, Fosphenytoin, Phenobarbital, Phenytoin. The full list is on the Ledipasvir-sofosbuvir page.
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