Drug interactions
Liposomal doxorubicin + St john's wort
Severity: Moderate
Liposomal doxorubicin 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-glycoprotein and may reduce doxorubicin exposure, possibly weakening its anticancer effect. Evidence is mainly extrapolated from the mechanism.
What this interaction means in plain words
Liposomal doxorubicin 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 by hyperforin increases doxorubicin clearance.
What to do
Advise patients to stop St John's wort before and during chemotherapy. Monitor tumor response if use continues.
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 Liposomal doxorubicin
- Dengue vaccine + Liposomal doxorubicin Contraindicated
- Belatacept + Liposomal doxorubicin Major
- Cyclosporine + Liposomal doxorubicin Major
- Dronedarone + Liposomal doxorubicin Major
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Liposomal doxorubicin Major
- Fingolimod + Liposomal doxorubicin Major
Frequently asked questions
Can I take Liposomal doxorubicin with St john's wort?
MediHelp rates the interaction as moderate. Liposomal doxorubicin 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-glycoprotein and may reduce doxorubicin exposure, possibly weakening its anticancer effect. Evidence is mainly extrapolated from the mechanism.
How serious is the interaction between Liposomal doxorubicin 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 patients to stop St John's wort before and during chemotherapy. Monitor tumor response if use continues.
What other medicines interact with Liposomal doxorubicin?
MediHelp also lists interactions of Liposomal doxorubicin with, for example, Dengue vaccine, Belatacept, Cyclosporine. The full list is on the Liposomal doxorubicin page.
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