Drug interactions
Rolapitant + St john's wort
Severity: Major
Rolapitant 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 rolapitant exposure. This could undermine control of delayed nausea and vomiting.
What this interaction means in plain words
Rolapitant 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 in St John's wort activates PXR, inducing CYP3A4 and increasing rolapitant clearance.
What to do
Advise patients to avoid St John's wort during rolapitant-based antiemetic therapy. Use another antiemetic option if the herb cannot be stopped.
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 Rolapitant
- Pimozide + Rolapitant Contraindicated
- Rolapitant + Thioridazine Contraindicated
- Atomoxetine + Rolapitant Major
- Deutetrabenazine + Rolapitant Major
- Eliglustat + Rolapitant Major
- Flecainide + Rolapitant Major
Frequently asked questions
Can I take Rolapitant with St john's wort?
MediHelp rates the interaction as major. Rolapitant 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 rolapitant exposure. This could undermine control of delayed nausea and vomiting.
How serious is the interaction between Rolapitant 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 during rolapitant-based antiemetic therapy. Use another antiemetic option if the herb cannot be stopped.
What other medicines interact with Rolapitant?
MediHelp also lists interactions of Rolapitant with, for example, Pimozide, Thioridazine, Atomoxetine. The full list is on the Rolapitant page.
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