Drug interactions
St john's wort + Ticagrelor
Severity: Major
St john's wort and Ticagrelor: 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 P-glycoprotein, which can lower ticagrelor exposure and reduce its antiplatelet effect. This may raise the risk of stent thrombosis or recurrent ischemia.
What this interaction means in plain words
St john's wort and Ticagrelor 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-glycoprotein by hyperforin increases ticagrelor clearance.
What to do
Advise patients to stop St John's wort and avoid it during ticagrelor therapy. Consider alternative therapy 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 Ticagrelor
- Itraconazole + Ticagrelor Contraindicated
- Ketoconazole + Ticagrelor Contraindicated
- Levoketoconazole + Ticagrelor Contraindicated
- Abciximab + Ticagrelor Major
- Abrocitinib + Ticagrelor Major
- Acalabrutinib + Ticagrelor Major
Frequently asked questions
Can I take St john's wort with Ticagrelor?
MediHelp rates the interaction as major. St john's wort and Ticagrelor 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 P-glycoprotein, which can lower ticagrelor exposure and reduce its antiplatelet effect. This may raise the risk of stent thrombosis or recurrent ischemia.
How serious is the interaction between St john's wort and Ticagrelor?
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 stop St John's wort and avoid it during ticagrelor therapy. Consider alternative therapy for depression.
What other medicines interact with Ticagrelor?
MediHelp also lists interactions of Ticagrelor with, for example, Itraconazole, Ketoconazole, Levoketoconazole. The full list is on the Ticagrelor page.
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