Drug interactions
Ribociclib + St john's wort
Severity: Major
Ribociclib 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 lower ribociclib exposure, which may reduce its effectiveness. Ribociclib labeling advises avoiding strong CYP3A inducers.
What this interaction means in plain words
Ribociclib 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-gp) by St John's wort increases ribociclib clearance.
What to do
Avoid St John's wort during ribociclib therapy and advise patients to stop it before starting treatment. Use a different option for mood symptoms.
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 Ribociclib
- Amiodarone + Ribociclib Contraindicated
- Cisapride + Ribociclib Contraindicated
- Dofetilide + Ribociclib Contraindicated
- Dronedarone + Ribociclib Contraindicated
- Flibanserin + Ribociclib Contraindicated
- Ibutilide + Ribociclib Contraindicated
Frequently asked questions
Can I take Ribociclib with St john's wort?
MediHelp rates the interaction as major. Ribociclib 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 lower ribociclib exposure, which may reduce its effectiveness. Ribociclib labeling advises avoiding strong CYP3A inducers.
How serious is the interaction between Ribociclib 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 ribociclib therapy and advise patients to stop it before starting treatment. Use a different option for mood symptoms.
What other medicines interact with Ribociclib?
MediHelp also lists interactions of Ribociclib with, for example, Amiodarone, Cisapride, Dofetilide. The full list is on the Ribociclib page.
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