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Interactions between Ibrexafungerp and St. john's wort

1 drug interaction and 3 additional warnings found for the following 2 drugs:

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Drug interactions

Major drug interactions

Major:

St. John's wort ibrexafungerp

Applies to: st. john's wort and ibrexafungerp
Generally avoid

Coadministration with potent or moderate inducers of CYP450 3A4 may significantly decrease the plasma concentrations of ibrexafungerp, which is primarily metabolized by the isoenzyme in vitro. This interaction has not been studied, but decreased plasma concentrations of ibrexafungerp could theoretically result in treatment failure.

Management

Due to the potential for reduced pharmacologic effects, the concomitant use of ibrexafungerp with potent or moderate CYP450 3A4 inducers should generally be avoided.

References (1)
  1. (2021) "Product Information. Brexafemme (ibrexafungerp)." SCA Pharmaceuticals (503b)

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

St. John's wort Food/Lifestyle

Applies to: st. john's wort
Generally avoid

An isolated case report suggests that foods containing large amounts of tyramine may precipitate a hypertensive crisis in patients treated with St. John's wort. The mechanism of interaction is unknown, as St. John's wort is not thought to possess monoamine oxidase (MAO) inhibiting activity at concentrations achieved in vivo. The case patient was a 41-year-old man who had been taking St. John's wort for seven days prior to presentation at the emergency room with confusion and disorientation. The patient recalled last eating aged cheese and having a glass of red wine approximately 10 hours prior to admission. No other cause of delirium or hypertension could be identified. In addition, alcohol may potentiate some of the pharmacologic effects of St. John's wort. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

Management

Until further information is available, patients treated with St. John's wort should consider avoiding consumption of protein foods in which aging or breakdown of protein is used to increase flavor. These foods include cheese (particularly strong, aged or processed cheeses), sour cream, wine (particularly red wine), champagne, beer, pickled herring, anchovies, caviar, shrimp paste, liver (particularly chicken liver), dry sausage, figs, raisins, bananas, avocados, chocolate, soy sauce, bean curd, yogurt, papaya products, meat tenderizers, fava beans, protein extracts, and dietary supplements. Caffeine may also precipitate hypertensive crisis so its intake should be minimized as well. Patients should also be advised to avoid or limit consumption of alcohol.

References (1)
  1. Patel S, Robinson R, Burk M (2002) "Hypertensive crisis associated with St. John's Wort." Am J Med, 112, p. 507-8
Moderate:

ibrexafungerp Food/Lifestyle

Applies to: ibrexafungerp
Generally avoid

Coadministration with grapefruit juice may increase the plasma concentrations of ibrexafungerp. The mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict. In healthy subjects receiving the potent CYP450 3A4 inhibitor ketoconazole (400 mg once daily for 15 days), ibrexafungerp peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 2.5-fold and 5.8-fold, respectively. Increased plasma concentrations of ibrexafungerp may increase the risk for adverse effects such as diarrhea, nausea, abdominal pain, dizziness, and vomiting. When administered to healthy volunteers with a high-fat meal (800 to 1000 calories; 50% fat), ibrexafungerp Cmax and AUC increased 32% and 38%, respectively, compared to fasted conditions.

Management

Ibrexafungerp may be administered with or without food. However, avoiding consumption of grapefruit or grapefruit juice during treatment with ibrexafungerp may be advisable.

References (1)
  1. (2021) "Product Information. Brexafemme (ibrexafungerp)." SCA Pharmaceuticals (503b)

Disease interactions

1 potential interaction Applies to: 1 condition, including Liver Disease.

Liver Disease

Moderate:

ibrexafungerp

Ibrexafungerp has a moderate potential interaction with Liver Disease.

Administration of ibrexafungerp in patients with severe liver dysfunction (Child-Pugh C) has not been studied; caution is recommended. No dosage adjustment of ibrexafungerp is recommended in patients with mild or moderate liver dysfunction (Child-Pugh A or B).

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More resources

ibrexafungerp

A total of 88 drugs are known to interact with ibrexafungerp.

st. john's wort

A total of 674 drugs are known to interact with st. john's wort.

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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