Drug interactions
Roflumilast + St john's wort
Severity: Major
Roflumilast 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 lower roflumilast exposure, reducing efficacy. Induction is dependent on product hyperforin content.
What this interaction means in plain words
Roflumilast 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
Hyperforin activates PXR, inducing CYP3A4 and other enzymes that metabolize roflumilast.
What to do
Advise patients to avoid St John's wort while taking roflumilast. If stopped, monitor symptoms as induction fades over about two weeks.
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 Roflumilast
Frequently asked questions
Can I take Roflumilast with St john's wort?
MediHelp rates the interaction as major. Roflumilast 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 lower roflumilast exposure, reducing efficacy. Induction is dependent on product hyperforin content.
How serious is the interaction between Roflumilast 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: Advise patients to avoid St John's wort while taking roflumilast. If stopped, monitor symptoms as induction fades over about two weeks.
What other medicines interact with Roflumilast?
MediHelp also lists interactions of Roflumilast with, for example, Apalutamide, Carbamazepine, Efavirenz. The full list is on the Roflumilast page.
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