Drug interactions
St john's wort + Sunitinib
Severity: Major
St john's wort and Sunitinib: 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 reduces sunitinib and active metabolite exposure. This may compromise anticancer efficacy.
What this interaction means in plain words
St john's wort and Sunitinib 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) increases sunitinib clearance.
What to do
Avoid St John's wort during sunitinib therapy. Use a non-inducing alternative for depression.
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 Sunitinib
- Adagrasib + Sunitinib Major
- Amiodarone + Sunitinib Major
- Amisulpride + Sunitinib Major
- Anagrelide + Sunitinib Major
- Apalutamide + Sunitinib Major
- Arsenic trioxide + Sunitinib Major
Frequently asked questions
Can I take St john's wort with Sunitinib?
MediHelp rates the interaction as major. St john's wort and Sunitinib 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 reduces sunitinib and active metabolite exposure. This may compromise anticancer efficacy.
How serious is the interaction between St john's wort and Sunitinib?
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 sunitinib therapy. Use a non-inducing alternative for depression.
What other medicines interact with Sunitinib?
MediHelp also lists interactions of Sunitinib with, for example, Adagrasib, Amiodarone, Amisulpride. The full list is on the Sunitinib page.
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