Drug interactions
Netupitant-palonosetron + St john's wort
Severity: Major
Netupitant-palonosetron and St john's wort: major 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 can substantially lower netupitant exposure, risking reduced antiemetic effectiveness during chemotherapy.
What this interaction means in plain words
Netupitant-palonosetron 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, increasing netupitant clearance.
What to do
Avoid the combination and advise patients to stop St John's wort before chemotherapy, remembering induction wanes over about two weeks. Monitor for breakthrough emesis.
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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Other interactions of Netupitant-palonosetron
- Apomorphine + Netupitant-palonosetron Contraindicated
- Flibanserin + Netupitant-palonosetron Contraindicated
- Apalutamide + Netupitant-palonosetron Major
- Avapritinib + Netupitant-palonosetron Major
- Carbamazepine + Netupitant-palonosetron Major
- Cobimetinib + Netupitant-palonosetron Major
Frequently asked questions
Can I take Netupitant-palonosetron with St john's wort?
MediHelp rates the interaction as major. Netupitant-palonosetron 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 can substantially lower netupitant exposure, risking reduced antiemetic effectiveness during chemotherapy.
How serious is the interaction between Netupitant-palonosetron 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 the combination and advise patients to stop St John's wort before chemotherapy, remembering induction wanes over about two weeks. Monitor for breakthrough emesis.
What other medicines interact with Netupitant-palonosetron?
MediHelp also lists interactions of Netupitant-palonosetron with, for example, Apomorphine, Flibanserin, Apalutamide. The full list is on the Netupitant-palonosetron page.
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