Drug Interactions between st. john's wort and Yosprala
This report displays the potential drug interactions for the following 2 drugs:
- st. john's wort
- Yosprala (aspirin/omeprazole)
Interactions between your drugs
omeprazole St. John's wort
Applies to: Yosprala (aspirin / omeprazole) and st. john's wort
GENERALLY AVOID: Coadministration with potent inducers of CYP450 2C19 and/or 3A4 may significantly decrease the plasma concentrations of omeprazole, which is primarily metabolized by these isoenzymes. In a study consisting of 12 healthy male subjects, administration of omeprazole in combination with St John's wort (300 mg three times daily for 14 days) decreased omeprazole peak plasma concentration (Cmax) and systemic exposure (AUC) in CYP450 2C19 poor metabolizers by 37.5% and 37.9%, respectively, and in extensive metabolizers by 49.6 % and 43.9%, respectively. The interaction is likely to also occur with esomeprazole, an enantiomer of omeprazole.
MANAGEMENT: The concomitant use of omeprazole or esomeprazole with St. John's wort or rifampin should generally be avoided.
References
- "Product Information. PriLOSEC (omeprazole)." Merck & Co., Inc (2022):
- "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals PROD (2001):
- Cerner Multum, Inc. "Australian Product Information." O 0
aspirin omeprazole
Applies to: Yosprala (aspirin / omeprazole) and Yosprala (aspirin / omeprazole)
Coadministration with proton pump inhibitors may decrease the oral bioavailability of aspirin and other salicylates. The interaction has been studied with omeprazole and aspirin, although data are conflicting. In one study, pretreatment with omeprazole (20 mg/day for 2 days) in 11 healthy volunteers led to a significant and progressively greater reduction in the mean serum salicylate level at 30, 60, and 90 minutes after administration of aspirin (650 mg single dose). The investigators suggest that acid suppression may reduce the lipophilic nature of aspirin, thereby adversely affecting its absorption from the gastrointestinal tract. Another study found no effect of omeprazole pretreatment (20 mg/day for 4 days) on plasma salicylate and aspirin levels, skin bleeding times, or antiplatelet effect of low-dose aspirin (125 mg single dose) in 14 healthy volunteers. However, these results do not exclude the possibility that omeprazole might interfere with the analgesic, antipyretic, or anti-inflammatory effects of aspirin, which has been demonstrated in rats.
Proton pump inhibitors may enhance the release rate of salicylates from enteric-coated formulations due to premature disruption of the coating and intragastric release of the drug secondary to an increase in gastric pH. In eight healthy volunteers, omeprazole pretreatment (20 mg/day for 4 days) did not affect the bioavailability of salicylate from uncoated aspirin tablets but significantly increased the absorption rate of salicylate from enteric-coated sodium salicylate tablets. The clinical significance of this interaction is unknown. Theoretically, it may increase the risk of gastric adverse effects associated with salicylates.
References
- Nefesoglu FZ, Ayanoglu-Dulger G, Ulusoy NB, Imeryuz N "Interaction of omeprazole with enteric-coated salicylate tablets." Int J Clin Pharmacol Ther 36 (1998): 549-53
- Anand BS, Sanduja SK, Lichetenberger LM "Effect of omeprazole on the bioavailability of aspirin: a randomized controlled study on healthy volunteers." Gastroenterology 116 (1999): A371
- Inarrea P, Esteva F, Cornudella R, Lanas A "Omeprazole does not interfere with the antiplatelet effect of low-dose aspirin in man." Scand J Gastroenterol 35 (2000): 242-6
Drug and food interactions
St. John's wort food
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
- Patel S, Robinson R, Burk M "Hypertensive crisis associated with St. John's Wort." Am J Med 112 (2002): 507-8
aspirin food
Applies to: Yosprala (aspirin / omeprazole)
GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.
MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.
References
- "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):
aspirin food
Applies to: Yosprala (aspirin / omeprazole)
One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.
References
- Yoovathaworn KC, Sriwatanakul K, Thithapandha A "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet 11 (1986): 71-6
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Report options
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
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