etopophos and st-john-s-wort Interactions

You searched for interactions between:

• etopophos
• st-john-s-wort (St. John's wort)

Interaction(s) found:

St. John's wort and etoposide phosphate (Moderate Drug-Drug)

GENERALLY AVOID: Coadministration with St. John's wort may alter the pharmacokinetics of antineoplastic agents that are substrates of the CYP450 3A4 isoenzyme (e.g., abiraterone, bexarotene, bortezomib, busulfan, cyclophosphamide, dasatinib, docetaxel, doxorubicin, etoposide, exemestane, ifosfamide, imatinib, irinotecan, letrozole, paclitaxel, sorafenib, sunitinib, tamoxifen, temsirolimus, teniposide, thiotepa, toremifene, tretinoin, vandetanib, vinca alkaloids). The mechanism is induction of CYP450 3A4 metabolism by constituents of St. John's wort, which is expected to reduce the systemic levels and pharmacologic effects of many of these agents. In contrast, some agents such as cyclophosphamide and ifosfamide are prodrugs that are converted to active metabolites by CYP450 3A4, thus pharmacologic effects may be enhanced by St. John's wort. However, clinical data are currently limited.

MANAGEMENT: Until more information is available, the use of St. John's wort should probably be avoided before and during the entire course of chemotherapy. It is not known how much time should elapse between the discontinuation of St. John's wort and initiation of chemotherapy. Patients should be advised to consult with their caregivers before using any herbal or alternative medicines.