Drug interactions
Regorafenib + St john's wort
Severity: Major
Regorafenib 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 may reduce regorafenib concentrations, compromising efficacy. Exposure to M-5 may increase. Herbal use is often undisclosed, so it should be asked about.
What this interaction means in plain words
Regorafenib 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
Induction of CYP3A4 (and P-glycoprotein) accelerates regorafenib metabolism.
What to do
Avoid St John's wort during regorafenib therapy and counsel patients accordingly. Allow the inducing effect to wane after stopping before relying on regorafenib levels.
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 Regorafenib
Frequently asked questions
Can I take Regorafenib with St john's wort?
MediHelp rates the interaction as major. Regorafenib 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 may reduce regorafenib concentrations, compromising efficacy. Exposure to M-5 may increase. Herbal use is often undisclosed, so it should be asked about.
How serious is the interaction between Regorafenib 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 St John's wort during regorafenib therapy and counsel patients accordingly. Allow the inducing effect to wane after stopping before relying on regorafenib levels.
What other medicines interact with Regorafenib?
MediHelp also lists interactions of Regorafenib with, for example, Apalutamide, Atazanavir, Carbamazepine. The full list is on the Regorafenib page.
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