Drug interactions
Ranolazine + St john's wort
Severity: Contraindicated
Ranolazine 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 strongly induces CYP3A4 and P-gp, which can markedly lower ranolazine concentrations. This may cause loss of antianginal effect.
What this interaction means in plain words
Ranolazine 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 CYP3A4 and P-glycoprotein by hyperforin in St John's wort.
What to do
Avoid the combination, as ranolazine labeling contraindicates CYP3A inducers. Stop St John's wort and consider an alternative antidepressant if needed.
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 Ranolazine
- Adagrasib + Ranolazine Contraindicated
- Amobarbital + Ranolazine Contraindicated
- Apalutamide + Ranolazine Contraindicated
- Butabarbital + Ranolazine Contraindicated
- Carbamazepine + Ranolazine Contraindicated
- Clarithromycin + Ranolazine Contraindicated
Frequently asked questions
Can I take Ranolazine with St john's wort?
MediHelp rates the interaction as contraindicated. Ranolazine 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 strongly induces CYP3A4 and P-gp, which can markedly lower ranolazine concentrations. This may cause loss of antianginal effect.
How serious is the interaction between Ranolazine 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: Avoid the combination, as ranolazine labeling contraindicates CYP3A inducers. Stop St John's wort and consider an alternative antidepressant if needed.
What other medicines interact with Ranolazine?
MediHelp also lists interactions of Ranolazine with, for example, Adagrasib, Amobarbital, Apalutamide. The full list is on the Ranolazine page.
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