Drug interactions
Sofosbuvir-velpatasvir + St john's wort
Severity: Contraindicated
Sofosbuvir-velpatasvir 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 induces P-gp and CYP3A4 and can substantially lower sofosbuvir and velpatasvir concentrations. This may cause HCV treatment failure and resistance.
What this interaction means in plain words
Sofosbuvir-velpatasvir 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
Hyperforin-mediated induction of P-gp and CYP2B6/2C8/3A4 increases antiviral clearance.
What to do
Do not coadminister; stop St John's wort before starting HCV therapy.
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 Sofosbuvir-velpatasvir
- Rifampin + Sofosbuvir-velpatasvir Contraindicated
- Rifapentine + Sofosbuvir-velpatasvir Contraindicated
- Amiodarone + Sofosbuvir-velpatasvir Major
- Apalutamide + Sofosbuvir-velpatasvir Major
- Carbamazepine + Sofosbuvir-velpatasvir Major
- Dabrafenib + Sofosbuvir-velpatasvir Major
Frequently asked questions
Can I take Sofosbuvir-velpatasvir with St john's wort?
MediHelp rates the interaction as contraindicated. Sofosbuvir-velpatasvir 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 induces P-gp and CYP3A4 and can substantially lower sofosbuvir and velpatasvir concentrations. This may cause HCV treatment failure and resistance.
How serious is the interaction between Sofosbuvir-velpatasvir 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: Do not coadminister; stop St John's wort before starting HCV therapy.
What other medicines interact with Sofosbuvir-velpatasvir?
MediHelp also lists interactions of Sofosbuvir-velpatasvir with, for example, Rifampin, Rifapentine, Amiodarone. The full list is on the Sofosbuvir-velpatasvir page.
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